Importance of sensitivity to change as a criterion for selecting health status measures.
(1/1113)
OBJECTIVE: To assess the sensitivity to change over time of four health status instruments in relation to patients with rheumatoid arthritis. DESIGN: Observational three month study of four self assessed instruments (arthritis impact measurement scales (AIMS), health assessment questionnaire (HAQ), Nottingham health profile (NHP), functional limitations profile (FLP)). SETTING: One rheumatology unit. PATIENTS: 101 patients with definite or classic rheumatoid arthritis. MAIN MEASURES: Change scores for dimensions of instruments, as determined by effect size (mean change in score/baseline standard deviation of variable) and conventional rheumatological measures, at baseline and after three months. RESULTS: Change scores for comparable dimensions (mobility, activities of daily living, household, pain, mood or emotion, and social scales) of the instruments were compared among 30 patients who considered their health status to have improved over three months. For all dimensions of health status the magnitude of change varied considerably according to the instrument. Maximum range in effect size was for social scales (AIMS 0.06, NHP 0.24, FLP 0.60). No single instrument seemed consistently to show the most change over all dimensions. CONCLUSION: Selection of health status instruments for audit or evaluation may have a considerable impact on the pattern of results obtained, and the "responsiveness" of such scales should be as carefully examined as their reliability and acceptability when selecting outcome measures. (+info)
Measuring handicap: the London Handicap Scale, a new outcome measure for chronic disease.
(2/1113)
OBJECTIVE: To develop a handicap measurement scale in a self completion questionnaire format, with scale weights allowing quantification of handicap at an interval level of measurement. DESIGN: Adaptation of the International Classification of Impairments, Disabilities and handicaps into a practical questionnaire incorporating the dimensions of handicap mobility, occupation, physical independence, social integration, orientation, and economic self sufficiency and scale weights derived from interviews with a general population sample, with the technique of conjoint analysis. SETTING: Two general practices in different areas of London. SUBJECTS: 240 adults aged 55-74 years randomly selected from the practices, 101 (42%) of whom agreed to be interviewed, and 79 (78%) of whom completed the exercise. MAIN MEASURES: Rating of severity of handicap associated with 30 hypothetical health scenarios on a visual analogue scale, from which was derived a matrix of scale weights ("part utilities") relating to different levels of disadvantage on each dimension, with a formula for combining them into an overall handicap score. Severity scores measured directly for five scenarios not used to derive the scale weights were compared with those calculated from the formula to validate the model. RESULTS: The part utilities obtained conformed with the expected hierarchy for each dimension, confirming the validity of the method. The measured severities and those calculated from the formula for the five scenarios used to validate the model agreed closely (Pearson's r = 0.98, p = 0.0009; Kendall's tau = 1.00, p = 0.007). CONCLUSIONS: This interval level handicap measurement scale will be useful in assessing both specific therapies and health services, in clinical trials, in analyses of cost effectiveness, and in assessments of quality assurance. (+info)
Healthcare utilization among women with eating disordered behavior.
(3/1113)
This study was designed to explore relationship between self-reported eating disordered behavior (without formally established eating disorder diagnoses) and healthcare utilization among women in a primary care setting. Through a self-report questionnaire, 150 participants between the ages of 17 and 49 were asked if they had ever vomited, starved themselves, or abused laxatives in a manner that was intentional and self-harming (i.e., eating disordered behavior identified as pathologic by the participant). Participants who reported a history of disordered eating (n = 17) exhibited higher scores on two of five measures of healthcare utilization (mean number of telephone contacts and mean number of specialist referrals) compared with participants without eating disorders (n = 133). These data suggest that eating disordered behavior may be a predictor of increased healthcare utilization among women in primary care settings. (+info)
Heart failure and disease management.
(4/1113)
Disease management is a comprehensive program that identifies a population of patients at risk, provides a coherent framework of coordinated care for these patients, and demonstrates improved outcomes. In applying disease management strategies to heart failure, there is clearly the technology to improve outcomes. The two main issues involved are influencing physician practice patterns and improving patient compliance. A successful disease management program in heart failure should include patient identification patient assessment, patient education and training, patient monitoring, and triage and acute intervention. With the advances in treatment of heart failure, we have the means to keep patients out of the hospital, maintain their functionality, and decrease mortality. The real issue, which is where disease management can help, is how to apply technology in an effective way to turn potential gains into real gains. The key is not to develop more technology, but to implement effectively the technology that exists. (+info)
Health status: patient and physician judgments.
(5/1113)
Patients at a rehabilitation center in Derbyshire, England, were asked to assess their own functional abilities at admission and again at discharge, using an 82-item questionnaire concerning 12 areas of daily living. Questionnaire responses were correlated with results of physical examinations, assessments by center personnel, and assessments of capacity for specific body movements. The highest correlations were observed in areas that related most directly to physical movements and to dressing and toileting. The results suggest that self-assessment of health status using this questionnaire may provide a viable alternative to judgments made by trained assessors. (+info)
Validation of an interval scaling: the sickness impact profile.
(6/1113)
The Sickness Impact Profile (SIP) is a measure of sickness-related behavioral dysfunction consisting of 189 items in 14 topic categories. To increase its discrimination, precision, and sensitivity in accounting for variance, the decision was made to scale the instrument. A two-step direct scaling procedure was used in order to avoid the monumental scaling tasks required by indirect procedures that guarantee equal-interval results; but because an equal-interval scale was needed, it was necessary to validate the scale values obtained and investigated the equal-intervval properties of the obtained scale. A three-stage validation process is described, consisting of an initial scaling by a group of 25 health professionals and students in 1973, a second scaling by 108 members of a prepaid group health plan in 1975, and an investigation of the metric properties of the resulting scale values. In addition, the concept of dysfunction underlying the SIP was validated. SIP scores from a field trial were compared with mean ratings of severity of dysfunction represented by the combinations of checked items from which the scores were derived. (+info)
Predicting self-assessed health status: a multivariate approach.
(7/1113)
Two-stage multivariate analysis was used to examine factors affecting personal perception of health status. In the first stage, sociodemographic variables were used as independent variables in Automatic Interaction Detector (AID) analysis in order to partition the study sample (11,153 civilian noninstitutionalized adults aged 58-63) into subgroups. In the second stage, binary multiple regression analysis was performed on each AID subgroup and on the total sample. Predictors used were indicators of psychological, socioeconomic, and sociomedical well-being. Finally the applicability of these indicators in classifying persons in one of the two categories of perceived health status was examined by discriminant function analysis. Sociomedical health indicators were better explanatory variables of self-assessed health status than socioeconomic or psychological indicators of well-being. (+info)
Tay-Sachs screening: social and psychological impact.
(8/1113)
Participants in two Tay-Sachs screening programs were generally satisifed with the organization of the tests and the results. There was no evidence of adverse impact on reproductive plans or interpersonal relations, and the respondents professed to believe in the value of screening. While the carriers discussed their condition freely with others and were no less favorable to the idea of screening than the noncarriers, about one-half of their number expressed discomfort in being told they were heterozygotes. These feelings were allayed by counseling, but there was evidence of some residual unease. It is suggested that this anxiety would be less prominent and more easily reduced if screening were done under conditions of ordinary primary medical care rather than outside the conventional system. (+info)