Predicting the Short Form-6D Preference-Based Index Using the Eight Mean Short Form-36 Health Dimension Scores: Estimating Preference-Based Health-Related Utilities When Patient Level Data Are not Available

Objective:  The objective is to derive an algorithm to predict a cohort preference-based short form-6D (short form-6D) score using the eight mean health dimension scores from the short form-36 (SF-36) when patient level data are not available.
Methods:  Health-related quality of life data (N = 6890) covering a wide range of health conditions was used to explore the relationship between the SF-6D and the eight health dimension scores. Models obtained using ordinary least square regressions were compared for goodness of fit and predictive abilities on both within-sample subgroups and out-of-sample published data sets.
Results:  The models explained more than 83% of the variance in the individual SF-6D scores with a mean absolute error of 0.040. When using mean health dimension scores from within-sample subgroups and out-of-sample published data sets, the majority of predicted scores were well within the minimal important difference (0.041) for the SF-6D.
Conclusions:  This article presents a mechanism to estimate a mean cohort preference-based SF-6D score using the eight mean health dimension scores of the SF-36. Using published summary statistics, the out-of-sample validation demonstrates that the algorithms can be used to inform both clinical and economic research. Further research is required in different health conditions.     

Use of the Perceive, Recall, Plan and Perform System of Task Analysis for persons with schizophrenia: A preliminary study

Background/aim:  Task analysis that targets information processing skills is an essential tool to understanding difficulties encountered by people with schizophrenia in their daily activities. The purpose of this preliminary study was to explore the use of the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis for this clientele. The specific objectives were to describe information processing difficulties as measured by the PRPP and to examine preliminary evidence of construct validity and interrater reliability.
Methods:  In the first part of this study, 10 participants with schizophrenia living in the community were assessed using the PRPP during both a simple and a complex meal preparation task. Community functioning was measured using the Independent Living Skills Survey. In the second part, interrater reliability was appraised using three trained raters, who scored 15 participants preparing the complex meal preparation task.
Results:  Analysis of performance demonstrates that people with schizophrenia have difficulties especially in the Perceive and Plan quadrants of the PRPP and are more challenged in the complex task. The PRPP total score for the complex task is strongly related to the community functioning score. Results indicate good interrater reliability for the PRPP total score and moderate interrater reliability for the quadrant scores.
Conclusion:  Despite the small sample size, results from this preliminary study support the use of the PRPP System of Task Analysis to further explore the impact cognitive deficits have on daily task performance and thus on community functioning in people with schizophrenia.     

Confirmatory Factor Analysis and Sample Invariance of the Chinese Patient Satisfaction Questionnaire (ChPSQ-9) among Patients with Breast and Lung Cancer

Objectives:  Previous exploratory factor analysis of the 9-item Chinese Patient Satisfaction Questionnaire (ChPSQ-9) identified two dominant factors: doctor and nurse. The present study employed confirmatory factor analysis (CFA) to examine the factorial invariance of the ChPSQ-9 between and within samples of Chinese patients with breast or lung cancer.
Methods:  Longitudinal data were analyzed from Chinese breast and lung cancer patients who had completed the ChPSQ-9 during their first outpatient visit, at 3 months, and at 6 months after baseline. CFAs tested the fit of a one-factor model, a hierarchical model that comprised a general latent factor and two first-order factors, and a correlated model that comprised two correlated first-order factors to the data. The factorial invariance of the ChPSQ-9 between six independent samples across time was investigated using multigroup CFAs.
Results:  The CFA's results demonstrated a better fit of the correlated model over the one-factor model and the hierarchical model in the breast and lung cancer samples. The correlated model showed evidence of cross-sample and longitudinal factorial invariance. Patients were generally satisfied with services provided by doctors and nurses. Internal consistency of the scale was also good for both cancer samples across time.
Conclusions:  The ChPSQ-9 is a valid and reliable instrument to be employed among breast and lung cancer patients, in clinical settings or intervention research, to evaluate group differences in patient satisfaction and its association with intervention effectiveness.     

The Collaborative Model of Fieldwork Education: Implementation of the model in a regional hospital rehabilitation setting

Aim:   This paper describes the implementation of a Collaborative Model of Fieldwork Education in a regional hospital occupational therapy department.
Methods:  The literature on models of fieldwork education for occupational therapy students is reviewed, and an approach to the implementation of the collaborative model with three students to one clinical educator is described after piloting of this model's recommendations, arising from the pilot placement, are proposed.
Conclusions:  The implementation of a Collaborative Model of Fieldwork Education requires careful planning, close links with the university fieldwork team and a willingness on the behalf of occupational therapist clinical educators to explore alternative approaches to the provision of fieldwork education.     

Satisfaction with Daily Occupations: Construct validity and test–retest reliability of a screening tool for people with mental health disorders

Background/Aim:  In occupational therapy research and in clinical practice there is a need for valid, reliable and easily administered measures. For research and screening purposes, the Satisfaction with Daily Occupations (SDO) instrument was developed. It addresses work, leisure, domestic tasks and self-care and generates a satisfaction and an activity level score. This study investigated its construct validity, internal consistency and test–retest reliability in 55 clients visiting occupational therapists in outpatient mental health care.
Methods:  The SDO was administered on two occasions with a 1-week interval, and data on the Canadian Occupational Performance Measure (COPM), psychosocial functioning and self-rated health were collected on the first of these occasions.
Results:  In contrast to what was expected, the relationships between the SDO scores and the COPM scores were low. The strongest relationship between the SDO satisfaction score and any other variable was to psychosocial functioning. These variables shared 23% of the variance. Internal consistency for the satisfaction score was acceptable, alpha = 0.75 on the second occasion, and the test–retest reliability was good; r _s   = 0.84 for the satisfaction score and r _s   = 0.92 for the activity level.
Conclusions:  The results indicated that the SDO has satisfactory reliability. The instrument targets a specific construct, as compared to the COPM and the measurements of self-rated health and psychosocial functioning. Thus, the SDO and the COPM satisfaction scale seem to assess different phenomena, probably because the SDO has predefined items, not specifically targeting a certain client's problematic occupations, whereas the COPM is based on self-defined problems. The instruments may therefore supplement each other.     

Estimating Clinically Meaningful Changes for the Functional Assessment of Cancer Therapy—Prostate: Results from a Clinical Trial of Patients with Metastatic Hormone-Refractory Prostate Cancer

Objective:  To determine clinically meaningful changes (CMCs) for the Functional Assessment of Cancer Therapy–Prostate (FACT–P).
Methods:  We obtained data from a Phase III trial of atrasentan in metastatic hormone-refractory prostate cancer patients (n = 809). We determined anchor-based differences using Karnofsky Performance Status (KPS), bone alkaline phosphatase (BAP), hemoglobin, time to disease progression (TTP), adverse events (AE), and survival. One-third and one-half standard deviation and standard error of measurement (SEM) were used as distribution-based criteria for CMCs. Comparison across baseline FACT–P domains and derived scales [FACT–P total score, Trial Outcome Index (TOI) score, prostate cancer subscale (PCS) score, pain-related score, and FACT Advanced Prostate Symptom Index (FAPSI)] were conducted for KPS, BAP, and hemoglobin using Student's t tests. Twelve-week change scores were compared for TTP, AE, and survival using ANCOVA.
Results:  CMCs were estimated as 6 to 10 for FACT–P total score, 5 to 9 for FACT–P TOI score, 2 to 3 for FACT–P PCS, 1 to 2 for the 4 PCS pain-related questions, and 2 to 3 for FAPSI. CMCs were also estimated using distribution-based criteria. Kappa statistics were computed to determine the degree of correspondence between the recommended guideline of 1.0 SEM and empirically derived standards. Most of the kappas for health-related quality of life domains and SEM standards had "substantial" to "almost perfect" concordance.
Conclusions:  The significant relationship between clinical and quality of life data provides support for the use of CMCs to increase interpretability of FACT–P scores.     

Dietary Approaches to Stop Hypertension (DASH) diet: applicability and acceptability to a UK population

Background:  The Dietary Approaches to Stop Hypertension (DASH) diet is widely promoted in the USA for the prevention and treatment of high blood pressure. It is high in fruit and vegetables, low-fat dairy and wholegrain foods and low in saturated fat and refined sugar. To our knowledge, the use of this dietary pattern has not been assessed in a free-living UK population.
Methods:  The DASH diet was adapted to fit UK food preferences and portion sizes. Fourteen healthy subjects followed the adapted DASH diet for 30 days in which they self-selected all food and beverages. Dietary intake was assessed by 5-day food diaries completed before and towards the end of the study. Blood pressure was measured at the beginning and end of the study to assess compliance to the DASH style diet.
Results:  The DASH diet was easily adapted to fit with UK food preferences. Furthermore, it was well tolerated and accepted by subjects. When on the DASH style diet, subjects reported consuming significantly ( P  <   0.01) more carbohydrate and protein and less total fat (5%, 6% and 9% total energy, respectively). Sodium intakes decreased by 860 mg day⁻¹ ( P  <   0.001). Systolic and diastolic blood pressure decreased significantly ( P  <   0.05) by 4.6 and 3.9 mmHg, respectively when on the DASH style diet.
Conclusions:  The DASH style diet was well accepted and was associated with a decrease in blood pressure in normotensive individuals and should be considered when giving dietary advice to people with elevated blood pressure in the UK.     

Current dietetic practices of obesity management in Saudi Arabia and comparison with Australian practices and best practice criteria

Aim:  To describe the dietetic practices of the treatment of obesity in Saudi Arabia and compare this with best practice criteria and the practice in Australia.
Methods:  Anonymous questionnaires were completed by dietitians in Saudi Arabia. The topics included barriers to obesity management, demand and level of service and strategies and approaches used for weight management. Best practice scores were based on those used to assess Australian dietitians.
Results:  A total of 253 dietitians participated in the survey. Of these, 175 (69%) were involved in the management of obesity. The best practice score for Australian dietitians was slightly greater than the scores of Saudi dietitians (median 43 vs 39). There was also a significant correlation between the best practice score and years of experience (r = 0.26, P < 0.001). The most common assessment approaches were assessment of body mass index (87%) and exercise habits (81%), while the most common strategies for obesity management were: dietary total fat reduction (92%) and increase incidental daily activity (92%). The major barrier for establishment of a weight management clinic reported by 49% of participants was inadequate resources.
Conclusion:  Saudi Arabian dietetic practice for the management of obesity does incorporate most best practice recommendations, but some specific elements are rarely used.     

How and why do occupational therapists use the OTseeker evidence database?

Background:  OTseeker is a free online bibliographic database containing systematic reviews and methodological ratings of randomised controlled trials relevant to occupational therapy. The database aims to help therapists efficiently identify high quality pre-appraised research.
Aim:  This study explored the search practices of therapists who regularly used OTseeker, what they did with the information retrieved and their perceptions of the database.
Sample:  A purposive sample of 11 occupational therapists was recruited in 2004. All had visited OTseeker at least five times in the previous 12 months.
Study design:  Qualitative.
Methods:  A semistructured interview was conducted with each participant. Grounded theory methods were used for analysis.
Findings:  Five distinct categories were identified: reasons for visiting OTseeker, learning about OTseeker, search times and locations, using information from OTseeker, and improving OTseeker. Therapists used the database to teach or model evidence-based practice, answer clinical questions and keep up-to-date. Suggestions for improvement focussed on search functionality, access to abstracts and the location of the PEDro rating scale. Only two participants synthesised information from OTseeker into a summary, and/or used it to inform client reports.
Conclusion:  This study suggests that OTseeker is helping to increase research utilisation by occupational therapists. Further research is needed to help therapists apply research evidence to change practice and policy.     

Psychometric Development and Validation of the Chronic Constipation Treatment Satisfaction Questionnaire (CTSAT-Q)

Objectives:  To develop and validate the constipation treatment satisfaction questionnaire (CTSAT-Q) for use in patients with chronic constipation and irritable bowel syndrome with constipation (IBS-c).
Methods:  Questionnaire development included item representation from the reviewed literature, focus groups, and pretesting. Dimensions related to treatment satisfaction were identified with exploratory factor analysis, verified with confirmatory factor analysis (CFA), and tested with structural equation modeling.
Results:  A total of 31,988 email invitations were disseminated to obtain 311 qualified respondents with diagnoses for chronic constipation and IBS-c using ROME II criteria, which required that two of the following symptoms: fewer than 3 bowel movements per week, hard or lumpy stools, straining with defecation, and a sensation of incomplete evacuation, a sensation of anorectal obstruction, and the use of manual maneuvers to assist defecation be present 25% of the time during the last year. Approximately 84% of the sample was female. Item-to-total correlations were 0.66 for activities , ranged from 0.60 to 0.67 for expectations , from 0.59 to 0.69 for value , from 0.56 to 0.60 for effectiveness , and 0.68 to 0.79 for treatment satisfaction . All standardized parameter estimates from CFA were significant ( P  < 0.01). The chi-square was 46.98, df  = 41, P  = 0.241, comparative fit index = 0.996, Tucker-Lewis Index = 0.994, root mean square error of approximation = 0.022, indicating an excellent fit between the sample data and proposed model. Treatment satisfaction was a strong and significant predictor of effectiveness, activities, and value ( P  < 0.001).
Conclusions:  The CTSAT-Q was demonstrated to be reliable and valid, and appears to assess treatment satisfaction for patients with chronic constipation and patients with IBS-c.     

Diet quality of persons living with HIV/AIDS on highly active antiretroviral therapy

Background  This study sought to assess the diet quality of individuals living with HIV/AIDS who were receiving antiretroviral therapy in São Paulo, Brazil.
Methods  This cross-sectional study involved 56 HIV-infected adults. Demographic and anthropometric data were collected, and diet quality was measured using the Healthy Eating Index (HEI), modified for Brazilians, which included ten components: adequacy of intake of six different food groups, total fat, cholesterol, dietary fibre and dietary variety.
Results  Among the individuals assessed, 64.3% of the participants had a diet needing improvement, while 8.7% had a poor diet. The overall HEI score was 68.3 points (SD = 14.9). Mean scores were low for fruits, vegetables, dairy products and dietary fibre; and high for meats and eggs, total fat and cholesterol. The overall HEI score was higher among individuals who were not overweight ( P  = 0.003), who were also more likely to achieve dietary goals for dairy products ( P  = 0.039) and grains ( P  = 0.005).
Conclusion  Most of these adults living with HIV/AIDS had diets that required improvement, and being overweight was associated with poorer diet quality. Nutritional interventions aimed at maintaining healthy body weight and diet should be taken into account in caring for HIV-infected people.     

Using the Rasch Model to Validate and Enhance the Interpretation of the Functional Assessment of Cancer Therapy–Kidney Symptom Index—Disease-Related Symptoms Scale

Objectives:  The Functional Assessment of Cancer Therapy–Kidney Symptom Index—Disease-Related Symptoms (FKSI-DRS) was developed to assess patients' kidney-cancer-related symptoms. The Rasch rating scale, a one-parameter logistic item response model, may enhance FKSI-DRS interpretation and validate its measurement properties.
Methods:  We applied the Rasch model to FKSI-DRS data from a randomized phase 3 trial in which first-line sunitinib therapy showed superiority to interferon-alfa in patients with metastatic renal cell carcinoma. Of 750 enrolled patients, 668 patients completed the questionnaire on cycle 1, day 28 and were evaluated in the current study. The nine FKSI-DRS items were analyzed to enhance interpretation of the summary score by using an item characteristic curve that related score to probability of reporting specific symptoms.
Results:  The Rasch model fitted the FKSI-DRS well: 8 of 9 items had acceptable infit and outfit statistics (<1.5, >0.5); item difficulty spanned a wide range (−3.23 to 1.64 logits); and the five response categories performed adequately. The item characteristic curve offered enhanced interpretation of FKSI-DRS: For example, an FKSI-DRS score of 27 (mean baseline score for total sample) indicated a 47% chance of reporting "no" to "lack of energy," although a two-point difference between sunitinib and interferon-alfa, averaged across all assessments (29 vs. 27), corresponded to sunitinib achieving a 28% increase (13% absolute difference) in the probability of reporting "no" to "lack of energy" (60% vs. 47%).
Conclusions:  Data suggest that the FKSI-DRS is an adequate measure of symptom status in patients with metastatic renal cell carcinoma. The Rasch model supports its validation and enhances its interpretation.     

Validation of Gastrointestinal Quality of Life Index in Swedish for Assessing the Impact of Gallstones on Health-Related Quality of Life

Objective:  The aim of the present study was to validate a Swedish translation of the Gastrointestinal Quality of Life Index (GIQLI) questionnaire in patients with gallstone disease.
Methods:  Sensitivity to change, internal consistency, and test–retest stability were tested in 187 consecutive patients who underwent planned cholecystectomy. Construct validity was assessed by comparing the GIQLI score with the bodily pain scale of SF-36 and four single-item questions in a separate group of 104 patients.
Results:  A significant increase in all five domains as well as in the overall GIQLI score 6 months after surgery (all P  < 0.05) was seen. All five domains correlated significantly with other measures of gallstone-related symptoms except one single-item question. Intraclass correlations ranged from 0.62 to 0.87. Cronbach's alpha ranged from 0.77 to 0.89.
Conclusion:  The Swedish translation of GIQLI has a high validity and reliability for assessing the impact of gallstones on quality of life.     

Valuation of the Economic Benefits of Human Papillomavirus Vaccine in Taiwan

Objectives:  The study aims to apply the contingent valuation method to elicit the willingness-to-pay (WTP), and measure the value of a statistic life (VSL), for human papillomavirus (HPV) vaccine in Taiwan.
Methods:  A total of 512 questionnaires were completed on women aged 20 to 55 years with at least one daughter, during March through May 2007. The respondents' WTP for the vaccines was elicited by double-bounded binary-choice questions under two scenarios: one was to protect themselves from cervical cancer (CC) and the other was for their daughter(s). The WTP was modeled as a function of the respondents' knowledge score, attitudes toward CC and HPV vaccine, the vaccination outcome scenarios, and individual characteristics. A log-normal survival model was constructed and the maximum-likelihood method was used for estimation.
Results:  The median regression-adjusted WTP was estimated at US$1098 to US$1233 (US$913–1004) for vaccinating the daughter (mother); and the VSL was estimated at approximately US$0.65 to US$4.09 (US$0.56–3.16) million for vaccinating the daughter (mother).
Conclusions:  The study results provided important evidences on the monetary value women placed on a HPV vaccine, and the differential benefits between vaccinating the women and their daughters.     

Deterioration of Quality of Life of High-Risk Breast Cancer Patients Treated with High-Dose Chemotherapy: The PEGASE 01 Quality of Life Study

Objective:  The aim of this study was to compare the quality of life (QOL) of high-risk breast cancer patients included in a randomized clinical trial (PEGASE 01) comparing conventional chemotherapy versus adding an additional high-dose chemotherapy (HDC) cycle with blood stem cell support.
Methods:  A total of 314 patients were included in the clinical trial. QOL evaluations were available for 199 patients. QOL was assessed over a 1-year follow-up period, using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30. The results were analyzed using a linear mixed-effects model.
Results:  Toxicity of HDC has a strong negative impact on patients' QOL during the treatment phase. This negative impact tended to last longer in the HDC group, as for most of the QLQ-C30 scales, the QOL scores of HDC patients tend to improve at a slower rate than that of patients receiving standard chemotherapy. In particular, physical functioning remains deteriorated 1 year after inclusion for HDC patients comparatively to conventional chemotherapy patients (85.99 vs. 76.65, P  = 0.021), and the pain score was still higher in the HDC group at that time (28.32 vs. 15.97, P  = 0.004).
Conclusion:  HDC has a negative impact on QOL even after treatment phase. In the absence of an overall survival benefit of using HDC for high-risk breast cancer patients, QOL studies with a longer follow-up play an important role in informing the complex trade-off implied by HDC between higher toxicity, reduced risk of relapse, and QOL decrease after the active phase of treatment.     

Mapping Utility Scores from a Disease-Specific Quality-of-Life Measure in Bariatric Surgery Patients

Objectives:  To develop algorithms for a conversion of disease-specific quality-of-life into health state values for morbidly obese patients before or after bariatric surgery.
Methods:  A total of 893 patients were enrolled in a prospective cross-sectional multicenter study. In addition to demographic and clinical data, health-related quality-of-life (HRQoL) data were collected using the disease-specific Moorehead-Ardelt II questionnaire (MA-II) and two generic questionnaires, the EuroQoL-5D (EQ-5D) and the Short Form-6D (SF-6D). Multiple regression models were constructed to predict EQ-5D- and SF-6D-based utility values from MA-II scores and additional demographic variables.
Results:  The mean body mass index was 39.4, and 591 patients (66%) had already undergone surgery. The average EQ-5D and SF-6D scores were 0.830 and 0.699. The MA-IIwas correlated to both utility measures (Spearman's r  = 0.677 and 0.741). Goodness-of-fit was highest ( R ² = 0.55 in the validation sample) for the following item-based transformation algorithm: utility (MA-II-based) = 0.4293 + (0.0336 × MA1) + (0.0071 × MA2) + (0.0053 × MA3) + (0.0107 × MA4) + (0.0001 × MA5). This EQ-5D-based mapping algorithm outperformed a similar SF-6D-based algorithm in terms of mean absolute percentage error ( P  = 0.045).
Conclusions:  Because the mapping algorithm estimated utilities with only minor errors, it appears to be a valid method for calculating health state values in cost-utility analyses. The algorithm will help to define the role of bariatric surgery in morbid obesity.     

Patient Characteristics Impacting Health State Index Scores, Measured by the EQ-5D of Females with Stress Urinary Incontinence Symptoms

Objective:  To describe the characteristics of women seeking treatment for symptoms of stress urinary incontinence (SUI) and to investigate the association of SUI symptoms with generic health-related quality of life (HRQoL) as measured by the EuroQol (EQ-5D) instrument.
Methods:  The Stress Urinary Incontinence Treatment (SUIT) study was a 12-month observational study in four European countries that evaluated the cost-effectiveness of duloxetine compared with other forms of nonsurgical intervention in the treatment of the symptoms of SUI. Four hundred thirty-one physicians observed women seeking treatment for their SUI, and recorded the care provided and the outcomes of that care at enrollment and at 3, 6 and 12 months afterward The impact of SUI on baseline HRQoL as expressed by the EQ-5D index score was assessed by linear and logistic regression.
Results:  Three thousand seven hundred sixty-two women were enrolled into SUIT, with the largest patient group from Germany. Overall, the majority of women were postmenopausal, had a mean age of 58.0 years, were not current smokers, and tended to be overweight (mean body mass index [BMI] = 27.7 kg/m²), with at least one comorbidity. The health state index scores were significantly and independently influenced by the presence of comorbidity(ies) affecting quality of life, total number of stress and urge incontinence episodes, urinary incontinence subtype, comorbidity(ies) affecting incontinence, BMI, socioeconomic status, educational status, age, and country.
Conclusion:  This article describes the characteristics of patients at the SUIT enrollment visit, and demonstrates that the number of incontinence episodes has a significant impact on the EQ-5D index score.     

The Effect of Waiting Time on Health-Related Quality of Life, Pain, and Physical Function in Patients Awaiting Primary Total Hip Replacement: A Randomized Controlled Trial

Objective:  This prospective randomized study assessed the effect of waiting time (WT) on health outcomes in Finnish patients admitted to hospital for primary total hip replacement (THR).
Methods:  A total of 395 consecutive patients with a need for a primary THR because of osteoarthritis and who were placed on the waiting list between August 2002 and November 2003. After placement on the waiting list, the patients were randomly assigned to a short WT (≤3 months) group (n = 174) or a nonfixed WT group (n = 221). The patients completed self-administered questionnaires at the time of placing on the waiting list and at hospital admission. Health-related quality of life was measured by the generic 15D instrument. Hip pain and function were measured by the patient self-report Harris hip score (HHS).
Results:  Of the 395 patients, 312 (79%) completed the follow-up (140 patients with short and 172 with nonfixed WT). At admission, the mean 15D scores for patients with short and nonfixed WT were 0.784 and 0.783, respectively. In the intention-to-treatment analysis, the difference between the groups (Δ0.001, 95% confidence interval [CI]: –0.019 to 0.021) was not statistically significant or clinically important. The mean self-report HHS in patients with short WT was 43.5, and among those with nonfixed WT was 41.9. The difference (Δ1.6, 95% CI: –1.77 to 4.87) was not statistically significant.
Conclusions:  Both generic and disease-specific measures revealed that longer WTs did not result in poorer health status at admission.