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Biomedical subjects

Charlotte Paterson

Publications and source records attributed to Charlotte Paterson.

12 recordsLinked to original sources
PubMed2006

Measuring changes in self-concept: a qualitative evaluation of outcome questionnaires in people having acupuncture for their chronic health problems.

BACKGROUND: Changes in self-concept are an important potential outcome for many interventions for people with long-term conditions. This study sought to identify and evaluate outcome questionnaires suitable for quantifying changes in self-concept in people with long-term conditions, in the context of treatment with acupuncture and Chinese medicine. METHODS: A literature search was followed by an evaluation of three questionnaires: The Wellbeing Questionnaire W-BQ12, the Patient Enablement Instrument (PEI), and the Arizona Integrative Outcome Scale (AIOS). A convenience sample of 23 people completed the questionnaires on two occasions and were interviewed about their experience and their questionnaire responses. All acupuncturists were interviewed. RESULTS: Changes in self-concept were common and emerged over time. The three questionnaires had different strengths and weaknesses in relation to measuring changes in self-concept. The generic AIOS had face validity and was sensitive to changes in self-concept over time, but it lacked specificity. The PEI was sensitive and specific in measuring these changes but had lower acceptability. The sensitivity of the W-BQ12 was affected by initial high scores (ceiling effect) and a shorter timescale but was acceptable and is suitable for repeated administration. The PEI and W-BQ12 questionnaires worked well in combination. CONCLUSION: Changes in self-concept are important outcomes of complex interventions for people with long-term illness and their measurement requires carefully evaluated tools and long-term follow-up. The literature review and the analysis of the strengths and weaknesses of the questionnaires is a resource for other researchers. The W-BQ12 and the PEI both proved useful for this population and a larger quantitative study is planned.

Acupuncture Therapy↗
PubMed2005

A pilot study of therapeutic massage for people with Parkinson's disease: the added value of user involvement.

OBJECTIVE: To carry out a pilot study, with particular attention to adequacy of outcome measures. DESIGN: Observational study and user participation. SETTING AND PARTICIPANTS: A local user group selected seven participants with a wide range of illness severity. INTERVENTION: A course of eight 1hr sessions of deep whole body (therapeutic) massage over 8 weeks. OUTCOME MEASURES: The Parkinson's Disease Questionnaire (PDQ-39), the Measure Yourself Medical Outcome Profile (MYMOP), and the Medication Change Questionnaire (MCQ). Semi-structured interviews, before and after the intervention. RESULTS: In addition to enjoying the massage, individuals showed improvement in self-confidence, well-being, walking and activities of daily living. There was good agreement between data from the outcome questionnaires, interviews and clinical notes. User involvement highlighted issues that would otherwise have been ignored. CONCLUSIONS: The study confirms the benefits of involving users in the research process and makes recommendations concerning the design of any future randomised trial.

Aged↗
PubMed2005

A narrative review shows the unvalidated use of self-report questionnaires for individual medication as outcome measures.

OBJECTIVE: Accurate individualized data on drug consumption is required for a number of purposes. While electronic medication event monitoring is the best objective measure available, self-report tools would be a useful alternative in certain situations. We searched for validated self-completion questionnaires suitable for measuring change in medication. METHODS: A systematic search of the English language literature since 1980, and a narrative literature review. RESULTS: Few articles described the development or use of self-report methods to measure change in medication over time. We found no questionnaire that was commonly used for this purpose, nor one that had been evaluated and published. Considerable work has been undertaken to develop questionnaires or diaries for individual projects, but because these tools and their validation are rarely published, they are not available for other researchers to use, and comparison across studies is difficult. Some work has been done developing diary formats and the Medication Quantification Scale converts complex medication change data to a single numerical score. CONCLUSION: Medication change is rarely considered as an outcome, and when it is measured, nonstandardized methods are used. More attention needs to be given to developing self-report tools and validating them across a range of criteria.

Drug Monitoring↗
PubMed2004

'Take small steps to go a long way' consumer involvement in research into complementary and alternative therapies.

This investigation set out to learn about consumer involvement in complementary medicine research from those who have experience of practice in this area. A literature search was combined with written and oral responses from key people and organisations in the UK. Letter or e-mail contact was made with 59 key people and organisations and 43 people responded. Eighteen respondents were interviewed. The overall level of consumer involvement was low but participants provided examples of experiences of consumer involvement in commissioning, designing, carrying out, and disseminating research. Clear roles and tasks and a consumer-friendly research environment, enabled consumers to contribute, gain confidence, and gradually widen their areas of involvement. There appears to be no single 'right way' for researchers and consumers to work together, but with experience and mutual respect researchers became increasingly enthusiastic about the value of the consumer perspective. As one consumer said: 'You have to take small steps to go a long way'.

Community Participation↗
PubMed2004

Seeking the patient's perspective: a qualitative assessment of EuroQol, COOP-WONCA charts and MYMOP.

An outcome questionnaire that is patient-centred should encompass the aims, values and treatment effects that are prioritised by individuals, and should enable each individual to provide an unambiguous assessment of change over time. There is little evidence about how well outcome questionnaires perform in this regard. This paper describes how interviews that combined in-depth enquiry and cognitive techniques were used to explore patients' experiences of completing three outcome questionnaires over a 6 month period. The 23 interviewees all had chronic disease and were receiving acupuncture treatment for the first time. Many of the problems uncovered by this study can be ameliorated by attention to questionnaire design. For example, by the provision of at least five response options, by being explicit about including co-morbidity, and by measuring medication change as a separate outcome. The study also highlighted more fundamental conceptual difficulties, such as response shift and the respondent's conflict between scoring external function and internal distress (what they did, vs. what they felt). These issues relate to the co-existence of different perspectives and the impossibility of reducing health status to one 'single truth'. The study concludes that qualitative evaluations have an important role to play in questionnaire design and development and are likely to lead to more modest and realistic appraisals of outcome questionnaire performance.

Acupuncture↗
PubMed2004

Acupuncture as a complex intervention: a holistic model.

OBJECTIVES: Our understanding of acupuncture and Chinese medicine is limited by a lack of inquiry into the dynamics of the process. We used a longitudinal research design to investigate how the experience, and the effects, of a course of acupuncture evolved over time. DESIGN AND OUTCOME MEASURES: This was a longitudinal qualitative study, using a constant comparative method, informed by grounded theory. Each person was interviewed three times over 6 months. Semistructured interviews explored people's experiences of illness and treatment. Across-case and within-case analysis resulted in themes and individual vignettes. SUBJECTS AND SETTINGS: Eight (8) professional acupuncturists in seven different settings informed their patients about the study. We interviewed a consecutive sample of 23 people with chronic illness, who were having acupuncture for the first time. RESULTS: People described their experience of acupuncture in terms of the acupuncturist's diagnostic and needling skills; the therapeutic relationship; and a new understanding of the body and self as a whole being. All three of these components were imbued with holistic ideology. Treatment effects were perceived as changes in symptoms, changes in energy, and changes in personal and social identity. The vignettes showed the complexity and the individuality of the experience of acupuncture treatment. The process and outcome components were distinct but not divisible, because they were linked by complex connections. The paper depicts these results as a diagrammatic model that illustrates the components and their interconnections and the cyclical reinforcement, both positive and negative, that can occur over time. CONCLUSIONS: The holistic model of acupuncture treatment, in which "the whole being greater than the sum of the parts," has implications for service provision and for research trial design. Research trials that evaluate the needling technique, isolated from other aspects of process, will interfere with treatment outcomes. The model requires testing in different service and research settings.

Acupuncture Therapy↗
PubMed2003

Acupuncture for people with chronic illness: combining qualitative and quantitative outcome assessment.

OBJECTIVES: Many people with chronic disease seek acupuncture treatment, despite it being largely excluded from Western state-funded health care systems. What benefits and problems do such people perceive and experience as important? To what extent do three subjective health questionnaires encompass and measure these treatment effects? DESIGN AND OUTCOME MEASURES: A longitudinal qualitative study, using a constant comparative method, informed by grounded theory. Each person was interviewed three times over 6 months and before each interview participants completed three health status questionnaires, EuroQol, COOP-WONCA charts, and MYMOP2. Semistructured interviews used open-ended questions to explore peoples' experiences of illness and treatment, and then used the cognitive interview technique to discuss their questionnaire responses. SUBJECTS AND SETTINGS: Eight professional acupuncturists in seven different settings publicized the study to their patients. We interviewed a maximum variation sample of 23 people with chronic illness, who were having acupuncture for the first time. RESULTS: In addition to changes in their presenting symptoms people experienced whole-person effects that were characterized by changes in strength and energy, and changes in personal and social identity. These effects were distinct but not divisible because of their interdependence and their complex and individual development over time. The health status questionnaires varied in their ability to reflect and measure these changes, and the whole person effects were often missed. After 6 months some people had changed their treatment goals and some individuals were still seeing health improvement. One person found that acupuncture exacerbated her symptoms. CONCLUSIONS: Knowledge of the range, individuality, and varied temporal patterns of treatment outcomes can guide potential patients, clinicians, health care providers, and researchers. Qualitative methods have highlighted the strengths and weaknesses of different outcome questionnaires, and the importance of long-term follow-up. We plan to do further work on appropriate outcome questionnaire selection and development.

Acupuncture Therapy↗