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PubMed1996

Quality of life and driving in recipients of the implantable cardioverter-defibrillator.

UNLABELLED: The efficacy of a treatment is primarily based on objective criteria, such as mortality and morbidity. Besides these criteria, the interest in measuring quality of life (QOL) in relation to health care has increased in recent years. Although the concept of patients' QOL is inherently subjective, and definitions vary, it can be assessed on a basis of 3 major components: physical condition, psychological well-being, and social activities. The basic requirements of QOL assessments are: multidimensional construct, reliability, validity, sensitivity, responsiveness, appropriateness to question or use, and practical utility. The instruments to assess QOL can be disease specific or generic, depending on the context. In 1991 a prospective and systematic evaluation of QOL in implantable cardioverter-defibrillator (ICD) recipients was started at the University of Bonn: psychological profile and patient acceptance were assessed in 57 consecutive patients using a specifically designed questionnaire. The results of this pilot study demonstrated that the acceptance of the ICD was remarkably high. Restrictions on driving a vehicle may have a substantial impact on QOL in patients with ICDs. A specifically designed questionnaire was addressed to 47 European national delegates in order to determine their present practices and criteria utilized when advising driving restrictions to patients after ICD implantation. Of the 39 (83%) respondents, 22 (56%) cardiologists advised all patients to abstain from driving--13 (33%) advising permanent abstinence, while 26 (67%) recommended temporary driving abstinence for periods of 3-18 months (mean 9 +/- 4 months). Despite medical advice not to drive, one third of the patients resume driving; half of the patients resumed driving after 6 months, with the vast majority driving within 12 months after ICD surgery. Two patients experienced ICD discharges while driving, but no motor vehicle accident occurred. Another patient had a motor vehicle collision with a fatal outcome, which was not caused by loss of consciousness or ICD discharge. CONCLUSIONS: (1) Fatal accidents or ICD discharges while driving are a rare finding in ICD patients. (2) About half of the physicians always advise their patients to cease driving for a period of 9 +/- 4 months. Despite this medical advice, the majority of the patients resume driving within 6 months of ICD implantation. (3) Criteria used in advising driving abstinence are not uniform among physicians.

Attitude↗
PubMed1998

Beneficial effects of long-term GH replacement therapy on quality of life in adults with GH deficiency.

OBJECTIVE: Quality of life tends to be adversely affected in adults with GH deficiency. The aim of this study was to examine changes in quality of life in a large group of GH-deficient adults receiving long-term GH replacement therapy. DESIGN: The study was conducted in two stages. The first stage was a prospective, open trial of GH replacement therapy in 71 GH-deficient adults, during which GH was administered for 20-50 months. For the second stage, a further 90 patients were recruited to create a population of 161 GH-deficient adults, all of whom had received GH replacement therapy for more than 12 months. This population was investigated retrospectively, using a questionnaire designed specifically for this study. PATIENTS: All patients were GH deficient and showed a peak GH response of less than 3.0 micrograms/l during an insulin tolerance test in which blood glucose levels dropped to 2.2 mmol/l or below. MEASUREMENTS: The quality of life of patients in the prospective stage was assessed using the Nottingham Health Profile (NHP) parts I and II, and the Psychological General Well-Being (PGWB) index. In the retrospective study patients completed a specially developed questionnaire, designed to determine whether changes in quality of life were sudden or gradual, and whether quality of life continued to change after GH had been administered for more than 12 months. RESULTS: In the prospective stage, mean overall score on the NHP I improved significantly during the first 6 months of GH therapy, and remained at its new level thereafter. Scores in all areas of the NHP II improved significantly between baseline and 20-50 months, as did the total score and five of six area scores on the PGWB index. The total PGWB score and three area scores improved significantly between 6 or 12 months and 20-50 months. In the retrospective stage, 92.7% of the patients reported that they had experienced positive effects of GH therapy. In 30.3% of patients, however, such effects did not become apparent until GH had been administered for more than 6 months. Almost 60% of patients felt that their condition was still improving. CONCLUSIONS: These results indicate that the previously reported beneficial effects of GH therapy on quality of life in GH-deficient adults are sustained during long-term therapy. In addition, they suggest that, once started, GH therapy should be continued for at least 6 months before judgements are made regarding its efficacy in improving quality of life.

Adult↗
PubMed1999

Patients' perceptions of the Odstock Dropped Foot Stimulator (ODFS).

OBJECTIVE: To determine the perceived benefit, pattern and problems of use of the Odstock Dropped Foot Stimulator (ODFS) and the users' opinion of the service provided. DESIGN: Questionnaire sent in a single mailshot to current and past users of the ODFS. Returns were sent anonymously. SETTING: Outpatient-based clinical service. SUBJECTS: One hundred and sixty-eight current and 123 past users with diagnoses of stroke (CVA), multiple sclerosis (MS), incomplete spinal cord injury (SCI), traumatic brain injury (TBI) and cerebral palsy (CP). INTERVENTION: Functional electrical stimulation (FES) to correct dropped foot in subjects with an upper motor neuron lesion, using the ODFS. MAIN OUTCOME MEASURES: Purpose-designed questionnaire. RESULTS: Return rate 64% current users (mean duration of use 19.5 months) and 43% past users (mean duration of use 10.7 months). Principal reason cited for using equipment was a reduction in the effort of walking. Principal reasons identified for discontinuing were an improvement in mobility, electrode positioning difficulties and deteriorating mobility. There were some problems with reliability of equipment. Level of service provided was thought to be good. CONCLUSION: The ODFS was perceived by the users to be of considerable benefit. A comprehensive clinical follow-up service is essential to achieve the maximum continuing benefit from FES-based orthoses.

Adult↗
PubMed1998

Introductory notes regarding a European Medical Risk Related History questionnaire (EMMRH) designed for use in dental practice.

The Medical Risk Related History (MRRH) has been in use for several years in the Netherlands. Since 1994 the MRRH system has been subject to research in nine European countries. Legal and ethical demands in all participating countries have been listed, and a national epidemiological analysis of pathology interfering with dental treatment has been undertaken for every participant.

Dental Care for Chronically Ill↗
PubMed2003

Reproducibility and validity of the secondary level School-Based Nutrition Monitoring student questionnaire.

OBJECTIVE: To evaluate the reproducibility and validity of the School-Based Nutrition Monitoring (SBNM) secondary level student questionnaire. DESIGN: Reproducibility was evaluated using a test-retest study design by administering the questionnaire on the same day (morning and afternoon, n=254) and, when appropriate, 9 to 14 days apart (n=259). Validity was assessed by comparing foods selected on the questionnaire with foods reported from a single 24-hour recall covering the same referent period (yesterday) in 209 students. SUBJECTS/SETTING: Eighth grade students in middle schools from central Texas were used: male and female, approximately 75% white, for the reproducibility study, with 15% Hispanic, 6% African American; for the validation study, approximately 38% white, 41% Hispanic, and 17% African American. STATISTICAL ANALYSIS: Spearman rank order correlation, kappa statistic, and percentage agreement were used for both reproducibility and the validation. RESULTS: For the reproducibility study, agreement for questions about food intake "yesterday" were 70% to 98%, with kappa statistics ranging from 0.54 to 0.93 and correlations between 0.66 and 0.97. Questions on recent physical activity had high agreement (66% to 89%) as did "usual" physical activity items, weight loss, and food selection behaviors. Nutrition knowledge items showed relatively weaker reliability: agreements ranged from 47% to 92%, with kappa statistics between 0.30 and 0.56. Attitude questions had weaker agreement (50% to 87%), kappa statistics (0.27 to 0.52), and correlations (0.33 to 0.63). For the validation study, correlation coefficients ranged from 0.32 for breads to 0.68 for milk and beans. Percentage agreement ranged from 38% for breads to 89% for gravy. APPLICATIONS/CONCLUSIONS: Most questions on the SBNM secondary questionnaire were found to have acceptable reproducibility, whereas validation of food choice behaviors showed results similar to or better than other dietary assessment instruments for this age group. This questionnaire is a useful epidemiologic tool for surveillance, assessing broad intervention effects among groups or providing needs assessment data on selected nutrition and physical activity-related constructs.

Adolescent↗
PubMed1995

Feasibility of monitoring patient based health outcomes in a routine hospital setting.

OBJECTIVE: To assess the feasibility of monitoring health outcomes in a routine hospital setting and the value of feedback of outcomes data to clinicians by using the SF 36 health survey questionnaire. DESIGN: Administration of the questionnaire at baseline and three months, with analysis and interpretation of health status data after adjustments for sociodemographic variables and in conjunction with clinical data. Exploration of usefulness of outcomes data to clinicians through feedback discussion sessions and by an evaluation questionnaire. SETTING: One gastroenterology outpatient department in Aberdeen Royal Hospitals Trust, Scotland. PATIENTS: All (573) patients attending the department during one month (April 1993). MAIN MEASURES: Ability to obtain patient based outcomes data and requisite clinical information and feed it back to the clinicians in a useful and accessible form. RESULTS: Questionnaires were completed by 542 (95%) patients at baseline and 450 (87%) patients at follow up. Baseline health status data and health outcomes data for the eight different aspects of health were analysed for individual patients, key groups of patients, and the total recruited patient population. Significant differences were shown between patients and the general population and between different groups of patients, and in health status over time. After adjustment for differences in sociodemography and main diagnosis patients with particularly poor scores were identified and discussed. Clinicians judged that this type of assessment could be useful for individual patients if the results were available at the time of consultation or for a well defined group of patients if used as part of a clinical trial. CONCLUSIONS: Monitoring routine outcomes is feasible and instruments to achieve this, such as the SF 36 questionnaire, have potential value in an outpatient setting. IMPLICATIONS: If data on outcomes are to provide a basis for clinical and managerial decision making, information systems will be required to collect, analyse, interpret, and feed it back regularly and in good time.

Adolescent↗
PubMed1996

Effect of past gymnastics participation on adult bone mass.

The purposes of this study were to determine bone mineral density (BMD) of former female college gymnasts (FG; n = 18) and controls (FC; n = 15) by using dual-energy X-ray absorptiometry (Hologic QDR 1000W) and to examine the relationships between current and former activity levels, diet, menstrual history and BMD. Current physical activity, dietary intake, and menstrual irregularity were assessed with the use of standardized questionnaires. A study-designed questionnaire was used to assess past physical activity. The BMDs of the FG were significantly higher (P < 0.001) than the BMDs of FC for the lumbar spine, femoral neck, Ward's triangle, and whole body, even when the influences of current and past physical activity levels were statistically controlled via analysis of covariance. FG and FC did not differ in nutrient intakes, and there were no BMD differences between FG who always had regular menstrual cycles vs. those who had an interruption (> or = 3 mo) of their menstrual cycle in the past. The higher BMD in FG compared with FC suggests that past participation in college gymnastics may provide a residual effect on adult BMD.

Adult↗
PubMed1995

Day-of-the-week effect on doctors' response to a postal questionnaire.

OBJECTIVE: To test a possible day-of-the-week effect on doctors' response rate to a postal questionnaire. DESIGN: Dispatch of postal questionnaire randomized to Thursday or Saturday. SETTING: A nationwide survey on doctors' attitudes. SUBJECTS: 200 general practitioners and 260 practising specialists/consultants. MAIN OUTCOME MEASURES: Response rate and Kaplan-Meier survival curve for no-response. RESULTS: The probability of response was not influenced by receiving the questionnaire just before or just after a week-end. CONCLUSION: Response rates in postal surveys sent to doctors cannot be improved by their receiving the questionnaire just before a week-end.

Attitude of Health Personnel↗
PubMed2002

[Pain in failed back surgery syndrome].

The problems of diagnosis and treatment of Failed Back Surgery Syndrome are briefly analyzed in this article. Literature overview and analysis is supplemented by the data collected at the Spinal Neurosurgery Department in Kaunas University of Medicine Hospital during the study in which clinical findings and data were analyzed and compared to the answers of patients in the special questionnaires about pain specially designed for the patients with low back pain and the Failed Back Surgery Syndrome. During this study specially designed questionnaire was introduced for the detailed pain evaluation, McGill pain questionnaire and visual analogical scales were included in this diagnostic tool. The most important clinical aspects of diagnosis and treatment of Failed Back Surgery Syndrome are discussed in this article and compared to the clinical trial in order to point out the real their value, effectiveness and long term results. In addition, the clinical value and use of special pain questionnaires is discussed and their auxiliary role is established.

Chronic Disease↗
PubMed1997

On the assessment of dental health care attitudes in 1986 and 1995, using the dental attitude questionnaire.

OBJECTIVE: To re-establish and update the empirical data obtained in 1986 with the Dental Attitude Questionnaire. DESIGN: In 1995 this questionnaire, presented earlier by Hoogstraten and Broers (1986), was completed in a similar setting using similar subjects as in 1985, to make a comparison between 1986 and 1995 possible. SUBJECTS: 375 persons, all first grade psychology students who participated for additional course credit. Mean age was 21.7 years, 65 per cent were female. RESULTS: Data show a change in oral health care attitudes and a change in the internal consistency of the DAQ subscales, making the present version of the questionnaire inadequate for measuring present oral health care attitudes. CONCLUSION: This study has shown once more the importance of conducting replication studies after relatively long periods of time in order to update the psychometric characteristics of questionnaires.

Adult↗
PubMed2000

Psychosocial morbidity in prostate cancer: I. Design of a new questionnaire.

OBJECTIVE: To design a questionnaire capable of measuring psychosocial morbidity in patients with prostate cancer and in their partners. METHODS: Issues to be covered in the questionnaire were determined by discussion among professionals, a literature review and semi-structured interviews with a group of seven patients and their partners. The potential issues were analysed and condensed, then re-presented to a further group of professionals, and to 10 patients and partners for comment and amendment. This process aimed to confirm the completeness and relevance of the list of issues. Questions were then constructed around the final list of issues and the questionnaire adjusted continually while testing on patients, until it was completed easily. RESULTS: The questionnaire consisted of 10 items; three items related to the general threat of cancer (concern about the diagnosis itself, fear of the future and difficulty dealing with the emotional response to the disease). Two items covered social and role functioning and there were five items to determine the severity of psychological morbidity caused by pain, urinary symptoms, treatment, physical limitation and sexual dysfunction. The questionnaire appeared to cover those areas of morbidity most consistently raised by patients and partners; it was also rapidly and easily completed by most respondents. CONCLUSION: The questionnaire constructed may be easily applied as part of routine clinical practice; it addresses aspects of psychosocial morbidity related to prostate cancer in patients and their partners. Although it appears to have content validity, further psychometric testing is required.

Aged↗
PubMed2001

Ways of coping with cystic fibrosis: implications for treatment adherence.

PURPOSE: How individuals cope with aspects of cystic fibrosis (CF) has the potential to influence their self management and the course of their disease. To evaluate how individuals cope with CF, a disease specific coping scale was developed and validated. A second objective of the work was to examine the relationship between coping styles and treatment adherence. METHODS: The development of the coping scale constituted a longitudinal design. A cross-sectional questionnaire design was used to examine the coping-adherence relationship. The development and validation of the coping scale comprised three phases: (1) Initially, 60 patients were interviewed to identify CF concerns. From this information a list of 23 concerns were recorded; (2) Eighty-three patients were interviewed to identify CF coping responses. For each concern, they were asked what they did or thought to ease the worry. A list of 24 coping strategies were recorded that formed a comprehensive set of items as to how people with CF act, feel and think about aspects of their disease; and (3) Further development and testing of the questionnaire involved 174 patients completing the measure. Four distinct ways of coping with CF were identified by factor analysis. These were termed optimistic acceptance, hopefulness, distraction and avoidance. The cronbach alpha coefficients were 0.74 (optimistic acceptance), 0.69 (hopefulness). 0.71 (distraction) and 0.76 (avoidance). To evaluate the relationship between coping and treatment adherence 60 patients completed the CF Coping Questionnaire and the Manchester Adult Cystic Fibrosis Compliance Questionnaire. RESULTS: Compared with patients who were non-adherent, those who were adherent scored higher on the optimistic acceptance scale (physiotherapy p < 0.05, enzymes p < 0.003, vitamins p < 0.05) and hopefulness scale (physiotherapy p < 0.002, enzymes p < 0.001). Those who were partially adherent reported using distraction as a way of coping to a greater extent than adherent or non-adherent patients (all p's < 0.05). Non-adherent patients used avoidance strategies to a greater extent than those who were adherent (physiotherapy p < 0.05, enzymes p < 0.04), although interestingly, adherence with exercise was associated with avoidant coping (p < 0.004). CONCLUSIONS: The degree of adherence to treatments was influenced by a person's style of coping. The identification of effective coping strategies to aid both long-term psychological and clinical well-being should improve the management of non-adherence.

Adaptation, Psychological↗
PubMed1994

Test-retest reliability of a questionnaire that identifies elders at risk for hospital admission.

OBJECTIVE: To determine the test-retest reliability of a questionnaire designed to measure elderly persons' probability of repeated admission (P(ra)) to a hospital within 4 years. DESIGN: Participants received the test questionnaire by mail; respondents to the test questionnaire received the retest questionnaire 3 weeks later. PARTICIPANTS: Elderly (65+) community-dwelling enrollees in the Medical Assistance (Medicaid) program of Ramsey County, MN (n = 192). MAIN OUTCOME MEASURE: The correlation (r) between the P(ra) values computed from the test-retest correlations (k) of the questionnaire's individual items were also measured. RESULTS: The response rate was 63% (121/192) for the test questionnaire and 69% (84/121) for the retest questionnaire. The test and retest values of P(ra) computed from responses to the questionnaires were highly correlated (r = 0.78, P < 0.0001). For the individual questionnaire items, the range of k values was 0.50-1.00 (P < 0.0001 for all items). Slightly higher values of r and k were obtained when the respondents were women and when the same person (either proxy or self) completed both questionnaires. Age was not consistently related to reliability. CONCLUSION: the test-retest reliability of individual items and of the computed P(ra) was high, suggesting that responses by elderly persons to mailed questionnaires pertaining to health status are stable over brief periods of time. The resulting P(ra) values may be useful in identifying elders at high risk for hospital admission.

Age Factors↗
PubMed1990

Pilot study of records of shared care for people with mental illnesses.

OBJECTIVE: To develop and evaluate a record of shared care to be held by the patient designed to increase the effectiveness of long term care of patients with severe mental illness. DESIGN: Questionnaires completed by medical staff, community psychiatric nurse, and patients to evaluate the shared care record. SETTING: General practices, a psychiatric outpatient clinic, and a mental health resource centre in south east London. PATIENTS: 84 Patients held shared care records over an 18 month period. They were selected by general practitioners, a psychiatrist, or a community psychiatric nurse, the criterion being that their care was shared between the general practitioner and the psychiatrist or community psychiatric nurse. Patients who had been admitted to hospital several times with short remissions were excluded. MAIN OUTCOME MEASURES: Patients were asked to complete a questionnaire to assess their views on the acceptability, usefulness, and problems of the shared care record. A questionnaire for health staff was designed to identify patients for whom the shared care record was most and least appropriate. It also assessed the patients' compliance and the way the record affected communication between all concerned. RESULTS: Patients found the shared care records very acceptable and were enthusiastic about their use. They valued being consulted about what was recorded and found the record of their treatment and progress useful. Patients also thought that they were in a better position to challenge their doctor. Those least likely to comply were people with severe paranoia. The acceptability of the record to patients greatly exceeded that to the psychiatrists and nurse managers, none of whom were interested in using the record. Communication among health staff was greatly improved by the shared care record, and it facilitated the identification of potentially dangerous drug interactions. CONCLUSIONS: Shared care records were acceptable to patients with severe mental illnesses, increased the patients' autonomy, and improved communication and the effectiveness of shared care. Obstacles to further development of this approach relate to the attitudes, perceptions, and anxieties of the doctors, nurses, and managers and can be overcome.

Attitude to Health↗
PubMed1995

Trivial or terrible? The psychosocial impact of psoriasis.

BACKGROUND: Psoriasis remains a chronic disease with lesions that are often extensive and disfiguring. While the potential for psychosocial morbidity and impairment are recognized, the literature remains equivocal with regard to the prevalence and degree of this impairment. METHODS: The present study utilized a new questionnaire designed to assess the type and degree of psychosocial impairment present among psoriasis patients. The questionnaire was designed to assess major areas of psychosocial functioning and was completed by 64 patients undergoing outpatient treatment. RESULTS: Approximately half the patients were found to have moderate to extreme levels of anxiety, depression, and anger. Patients reported experiencing these negative emotional sequelae both during their disease flares and during periods of remission. Patients were also found to have moderate to extreme levels of pruritus associated with their flares. Psychologic morbidity was positively associated with length of disease flare. Significant levels of social embarrassment, life disruption, and social withdrawal were found as well. CONCLUSIONS: Psoriasis does appear to cause significant psychosocial morbidity. Greater awareness by physicians and more comprehensive treatment addressing these psychosocial components may avert, or at least minimize, some of these negative sequelae.

Anger↗