Biomedical subjects

K W Wyrwich

Publications and source records attributed to K W Wyrwich.

9 recordsLinked to original sources

PubMed2003

Retest reliability of surveillance questions on health related quality of life.

STUDY OBJECTIVES: Health related quality of life (HRQoL) is an important surveillance measure for monitoring the health of populations, as proposed in the American public health plan, Healthy People 2010. The authors investigated the retest reliability of four HRQoL questions from the US Behavioral Risk Factor Surveillance System (BRFSS). DESIGN: Randomly sampled BRFSS respondents from the state of Missouri were re-contacted for a retest of the HRQoL questions. Reliability was estimated by kappa statistics for categorical questions and intraclass correlation coefficients for continuous questions. SETTING: Missouri, United States. PARTICIPANTS: 868 respondents were re-interviewed by telephone about two weeks after the initial interview (mean 13.5 days). Participants represented the adult, non-institutionalised population of Missouri: 59.1% women; mean age 49.5 years; 93.2% white race. MAIN RESULTS: Retest reliability was excellent (0.75 or higher) for Self-Reported Health and Healthy Days measures, and moderate (0.58 to 0.71) for other measures. Reliability was lower for older adults. Other demographic subgroups (for example, gender) showed no regular pattern of differing reliability and there was very little change in reliability by the time interval between the first and second interview. CONCLUSIONS: Retest reliability of the HRQoL Core is moderate to excellent. Scaling options will require future attention, as will research into appropriate metrics for what constitutes important population group differences and change in HRQoL.

Adolescent↗

PubMed2000

Identifying meaningful intra-individual change standards for health-related quality of life measures.

Although numerous measures have been developed for the evaluation of health-related quality of life (HRQoL), strategies for identifying meaningful intra-individual change in these measures have not kept pace with instrument development. As a result, clinical trial researchers, quality assurance assessment teams and practising clinicians are without established standards to evaluate individual patient change in HRQoL measures as improved, stable or declined. This article reviews and critiques the methods that have been applied to establish intra-individual HRQoL change standards. These methods include within-person and between-persons anchor-based studies, as well as distribution-based techniques using the effect size, the standard error of measurement, the mean squared error or individual slope coefficients derived from hierarchical linear modelling. Practical approaches to improving and advancing HRQoL change evaluations that enhance the interpretation of intra-individual change are provided. Two future methodological challenges in this area of HRQoL research are examined: (1) the development of individual change standards for generic HRQoL measures; and (2) the incorporation of individual clinical assessments into the process for establishing significant intra-individual change standards.

Humans↗

PubMed2000

Physical activity, disability, and the risk of hospitalization for breast cancer among older women.

BACKGROUND: A recent investigation of physical activity, disability, and the risk of breast cancer among older women in the Iowa 65 + Rural Health Study reported a decreased risk of breast cancer among women with any disability compared with physically capable but inactive women (relative risk [RR] = 0.4. 95% confidence interval [CI] 0.2-0.9). Because of the intriguing nature of that association, those investigators urged replication before drawing any conclusions. METHODS: We replicated the Iowa approach using the Longitudinal Study on Aging (LSOA). a nationally representative, prospective cohort study. The 3131 community-dwelling women for whom we had complete data for these analyses ranged in age from 70 to 98 years old at baseline in 1984. Using ICD9-CM 174 codes, linked Medicare hospital claims identified 77 women with hospitalizations for breast cancer between 1984 and 1991. Multivariable proportional hazards regression was used to model the risk for this event among disabled, inactive, moderately active, and highly active women. RESULTS: No significant association between disability in older women and the risk of hospitalization for breast cancer relative to inactive older women was detected (adjusted hazard ratio [AHR]-0.78, 95% CI 0.41-1.5). Highly active older women had a significantly reduced risk of hospitalization for breast cancer (AHR-0.42, 95% CI 0.194).95). CONCLUSION: The intriguing finding from the Iowa 65+ Rural Health Study that disabled older women's risk for breast cancer was reduced could not be replicated in the LSOA, although power was limited. Highly active older women, however, had a significantly lower risk for breast cancer in both studies.

Activities of Daily Living↗

PubMed2000

Rethinking functional limitation pathways.

Functional limitation has received considerable attention in gerontology and geriatrics. Much of this work has focused on single-wave transitions devoid of context rather than on the pattern of transitions over time that constitute trajectories. This Forum article suggests that it is time for a different way of looking at functional limitation pathways. It focuses on trajectories. Responses to three Rosow and Breslau (1966) and two Nagi (1976) items, asked of 12,998 older adults who participated in up to seven waves of data collection as part of the Established Populations for the Epidemiologic Study of the Elderly, are used to illustrate this approach, emphasizing both its conceptual and pragmatic advantages. The results provide greater clarity in terms of those who become functionally limited, take on more functional limitations, or recover as well as those who are likely to be lost to follow-up and in terms of the outcomes associated with those individuals over time.

Activities of Daily Living↗

PubMed1999

Further evidence supporting an SEM-based criterion for identifying meaningful intra-individual changes in health-related quality of life.

This study used the standard error of measurement (SEM) to evaluate intra-individual change on both the Chronic Respiratory Disease Questionnaire (CRQ) and the SF-36. After analyzing the reliability and validity of both instruments at baseline among 471 COPD outpatients, the SEM was compared to established minimal clinically important difference (MCID) standards for three CRQ dimensions. A value of one SEM closely approximated the MCID standards for all CRQ dimensions. This SEM-based criterion was then validated by cross-classifying the change status (improved, stable, or declined) of 393 follow-up outpatients using the one-SEM criterion and the MCID standard. Excellent agreement was achieved for all three CRQ dimensions. Although MCID standards have not been established for the SF-36, the one-SEM criterion was explored in these change scores. Among SF-36 scales demonstrating acceptable reliability and reasonable variance, the percent of individuals within each change category was consistent with those seen in the CRQ dimensions. These results replicate previous findings where a value of one SEM also closely approximated MCIDs for all dimensions of the Chronic Heart Disease Questionnaire among cardiovascular outpatients. The one-SEM criterion should be explored in other health-related quality of life instruments with established MCIDs.

Adult↗

PubMed1999

The risk of hospitalization for acute myocardial infarction among older adults.

BACKGROUND: The purpose of this study was to prospectively examine the risk of hospitalization for acute myocardial infarction (AMI) in a large, nationally representative sample of very old men and women. METHODS: We utilized secondary analysis of the Longitudinal Study of Aging. Baseline (1984) in-person interview data were linked to Medicare hospitalization records for 1984-1991. Subjects were 6,071 noninstitutionalized adults 70 years old or older at baseline. Hospitalization for AMI was defined as having primary discharge diagnoses containing ICD9-CM 410 codes. Multivariable proportional hazards regression was used to evaluate the epidemiologic risks for all persons, and separately for women, men, self-respondents, those with no previous AMIs, and those with no history of coronary heart disease. RESULTS: Of the sample, 357 persons (5.9%; 172 women and 185 men) had at least one primary discharge diagnosis of AMI. Significant (p<.05) risk factors for being hospitalized with an AMI (adjusted hazards ratios in parentheses) from the pooled analysis were male gender (1.86), having no more than a grade school education (1.35), atherosclerosis (1.43), hypertension (1.29), coronary heart disease (1.63), angina (1.60), previous AMI (1.52), diabetes (1.89), and four or more lower body limitations (1.43). The gender-specific analyses, however, revealed that hypertension, angina, diabetes, and lower body limitations were risk factors only for women, and that having no more than a grade school education was a risk factor only for men. CONCLUSION: Men, especially those with low education, women with diabetes, angina, hypertension, or lower body limitations, and either men or women with previous AMIs, coronary heart disease, or atherosclerosis have elevated risks for AMI resulting in hospitalization, and they should be considered for evaluation and monitoring. Current protocols for therapeutic management should be adopted, and compliance should be encouraged.

Activities of Daily Living↗

PubMed1999

Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life.

OBJECTIVE: To compare the standard error of measurement (SEM) with established standards for clinically relevant intra-individual change in an evaluation of health-related quality of life. DESIGN: Secondary analysis of data from a randomized controlled trial. SUBJECTS: Six hundred and five outpatients with a history of cardiac problems attending the general medicine clinics of a major academic medical center. MEASURES: Baseline and follow-up interviews included a modified version of the Chronic Heart Failure Questionnaire (CHQ) and the SF-36. The SEM values corresponding to established standards for minimal clinically important differences (MCIDs) on the CHQ were determined. Individual change on the SF-36 was explored using the same SEM criterion. RESULTS: One-SEM changes in this population corresponded well to the patient-driven MCID standards on all CHQ dimensions (weighted kappas (0.87; P < 0.001). The distributions of outpatients who improved, remained stable, or declined (defined by the one-SEM criterion) were generally consistent between CHQ dimensions and SF-36 subscales. CONCLUSIONS: The use of the SEM to evaluate individual patient change should be explored among other health-related quality of life instruments with established standards for clinically relevant differences. Only then can it be determined whether the one-SEM criterion can be consistently applied as a proxy for clinically meaningful change.

Adult↗

PubMed1999

Gender differences in the sequelae of hospitalization for acute myocardial infarction among older adults.

OBJECTIVE: To examine the effect of gender differences among older adults hospitalized for an acute myocardial infarction (AMI) on subsequent health outcomes. DESIGN: Secondary analysis of the Longitudinal Study on Aging. Data from baseline interviews (1984) and three biennial (1986, 1988, and 1990) re-interviews were linked to Medicare hospitalization and National Death Index records for 1984-1991. PARTICIPANTS: A total of 6071 community-dwelling adults aged 70 years or older at baseline. METHODS: Pooled and stratified multivariable models were used to examine gender differences in the independent effects of being hospitalized for an AMI on all-cause mortality, the risk and volume of subsequent hospitalization, and increases in the number of functional limitations. Two comparison groups were used. RESULTS: Three hundred fifty-seven AMI cases (6%; 172 women and 185 men) were compared with 3976 hospitalized controls and 1738 nonhospitalized controls. The risk of all-cause mortality for AMI cases was greater than that for either hospitalized controls or nonhospitalized controls (referent), and this increased risk was significantly (P < .001) stronger for women (adjusted hazards ratio (AHR) = 14.24, 95%CI = 10.99, 18.46) than for men (AHR = 9.91, 95%CI = 7.75, 12.67). Overall, AMI cases were also more likely to be hospitalized subsequently than the hospitalized controls (referent; adjusted odds ratio (AOR) = 1.47, 95%CI = 1.17, 1.85), although in the stratified analysis this association held for men (AOR = 1.73, 95%CI = 1.25, 2.41) but not for women (AOR = 1.25, 95%CI = .90, 1.73). Among those subsequently hospitalized, both women and men AMI cases consumed more hospital resources than the hospitalized controls, and there were gender differences suggesting that the effects on total charges and length of stay were greater for women than for men with AMI. Finally, although the AMI cases had greater adjusted mean increases in the number of instrumental activities of daily living limitations and lower body limitations than the nonhospitalized controls, they were no worse off than the hospitalized controls, and there were no gender differences in those effects. CONCLUSION: Relative to the appropriate comparison groups, hospitalization for an AMI increases the risk of death and the total costs and lengths of stay of subsequent hospitalizations for women more than for men. Therefore, increased primary prevention, diagnosis, and treatment efforts should be directed toward women.

Aged↗

PubMed1998

Generic versus disease-specific health status measures. An example using coronary artery disease and congestive heart failure patients.

The objectives of this study were to evaluate and compare the psychometric properties of a generic health status measure, the Medical Outcomes Study SF-36, and a disease-specific health status measure, a modified version of the Chronic Heart Failure Questionnaire (CHQ), among outpatients known to have coronary artery disease (CAD) and/or congestive heart failure (CHF). A cross-sectional analysis of baseline data obtained from 670 outpatients participating in a randomized controlled clinical trial in the general medicine clinics of a major academic medical center was performed. The SF-36 was more comprehensive in its coverage of different health status domains. In contrast, the CHQ had fewer problems with floor and ceiling effects, was more internally consistent, had better dimensional reproducibility, and exhibited less factorial complexity. Although both instruments are appropriate for use among outpatients known to have CAD and/or CHF, the CHQ has significantly better psychometric properties than does the SF-36.

Activities of Daily Living↗