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Biomedical subjects

Gerold Stucki

Publications and source records attributed to Gerold Stucki.

9 recordsLinked to original sources
PubMed2003

The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research.

OBJECTIVE: To develop the Self-Administered Comorbidity Questionnaire (SCQ) and assess its psychometric properties, including the predictive validity of the instrument, as reflected by its association with health status and health care utilization after 1 year. METHODS: A cross-sectional comparison of the SCQ with a standard, chart abstraction-based measure (Charlson Index) was conducted on 170 inpatients from medical and surgical care units. The association of the SCQ with the chart-based comorbidity instrument and health status (short form 36) was evaluated cross sectionally. The association between these measures and health status and resource utilization was assessed after 1 year. RESULTS: The Spearman correlation coefficient for the association between the SCQ and the Charlson Index was 0.32. After restricting each measure to include only comparable items, the correlation between measures was stronger (Spearman r = 0.55). The SCQ had modest associations with measures of resource utilization during the index admission, and with health status and resource utilization after 1 year. CONCLUSION: The SCQ has modest correlations with a widely used medical record-based comorbidity instrument, and with subsequent health status and utilization. This new measure represents an efficient method to assess comorbid conditions in clinical and health services research. It will be particularly useful in settings where medical records are unavailable.

Aged↗
PubMed2003

Assessment of the impact of disease on the individual.

From the medical or disease perspective, patients' functioning, disability and health are seen primarily as the consequences or the impact of a disease or condition. In this perspective, self-administered health status instruments are used primarily to evaluate the effects of drug treatments or surgical interventions. The interpretation of these measures is generally based on scales and scores and not on individual items. Currently used instruments are reviewed and an algorithm for the selection of instruments is provided. In the rehabilitation or disability perspective, patients' functioning and health is associated with and not merely a consequence of, a condition or disease. The basis for the understanding of functioning, disability and health--in association with the condition but also the personal and contextual factors--is WHO's International Classification of Functioning, Disability and Health or ICF. This chapter illustrates the use of the ICF framework for structuring patients' problems, and the use of condition-specific ICF-Core-Sets to check for problems typically encountered in patients with a given condition.

Disability Evaluation↗
PubMed2002

Use of a numerical rating scale as an answer modality in ankylosing spondylitis-specific questionnaires.

OBJECTIVES: To determine the agreement of scores on the original visual analog scale (VAS) or Likert scale of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Dougados Functional Index (DFI) with scores on a numerical rating scale (NRS). To assess the reproducibility and responsiveness of the instruments with the original scale and NRS. METHODS: Five hundred thirty-six patients with ankylosing spondylitis from the Netherlands, Mexico, and Switzerland completed a questionnaire in which all questions from the BASDAI, BASFI, and DFI were presented twice in random order with an 11-point NRS and either a 10-cm VAS (BASDAI and BASFI) or a 5-point Likert scale (DFI). Agreement of scores using Bland-Altman plots and intraclass correlation coefficients (ICCs), reproducibility using ICCs, and responsiveness were assessed. RESULTS: Large variability between the scores on the original scales and the NRS was found in individual questions of all 3 questionnaires, although total scores showed ICCs of at least 0.88. Reproducibility of all answer modalities showed low ICCs in individual questions, but moderate to good ICCs in total scores (Dutch group 0.62-0.89; Mexican group 0.53-0.72). Moderate to large effects (0.48-1.04) were found in responsiveness scores in the 3 questionnaires. No major differences in reproducibility and responsiveness between the answer modalities were found. CONCLUSION: Although large variability between the scores on the original answer scales and the NRS was observed, the BASDAI, BASFI, and DFI can be administered with an NRS, which does not show important differences compared with the original scales.

Adult↗
PubMed2002

Linking health-status measurements to the international classification of functioning, disability and health.

With the approval of the International Classification of Functioning, Disability and Health by the World Health Assembly in May 2001, the concurrent use of both health-status measures and the International Classification of Functioning, Disability and Health is expected. It is therefore important to understand the relationship between these two concepts. The objective of this paper is to provide a systematic and standardized approach when linking health-status measures to the International Classification of Functioning, Disability and Health. The specific aims are to develop rules, to test their reliability and to illustrate these rules with examples. Ten linking rules and an example of their use are presented in this paper. The percentage agreement between two health professionals for 8 health-status instruments tested is also presented. A high level of agreement between the health professionals reflects that the linking rules established in this study allow the sound linking of items from health-status measures to the International Classification of Functioning, Disability and Health.

Activities of Daily Living↗
PubMed2002

Measuring clinically important changes with patient-oriented questionnaires.

BACKGROUND: The measurement of the patient's experience with a condition or an illness is an important and quantifiable outcome and an example of action research. By making these concerns paramount, the goals and processes of health care can be redirected from anatomical and physiologic restoration to patient-oriented outcomes. At the same time, research can illuminate the complex mechanisms responsible. METHODS: Critical, analytic synthesis and review of the research evaluating the ability of self-administered questionnaires to capture clinically meaningful changes. RESULTS: Responsiveness is differentiated from sensitivity, and statistical methods for evaluating sensitivity of instruments are referenced. Techniques for evaluating whether differences in instrument sensitivity could have occurred by chance are presented, and methods for assessing a clinically meaningful change are discussed. CONCLUSION: Responsiveness is the key psychometric property of an instrument if it is to be incorporated into daily practice. Improving responsiveness is a major research priority.

California↗
PubMed2002

Minimal clinically important rehabilitation effects in patients with osteoarthritis of the lower extremities.

OBJECTIVE: To estimate minimal clinically important differences (MCID) of effects measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in patients with osteoarthritis (OA) of the lower extremities undergoing a comprehensive inpatient rehabilitation intervention. METHODS: A prospective cohort study assessed patients' health by the WOMAC at baseline (entry into the clinic) and at the 3 month followup, and by a transition questionnaire asking about the change of "health in general related to the OA joint" during that time period. The WOMAC section score differences between the "equal" group and the "slightly better" and "slightly worse" groups resulted in the MCID for improvement and for worsening. RESULTS: In total 192 patients were followed up. The MCID for improvement ranged from 0.80 to 1.01 points on the continuous WOMAC numerical rating scale from 0 to 10, reflecting changes of 17 to 22% of baseline scores. The MCID for worsening conditions ranged from 0.29 (6%) to 1.03 points (22%). In the transition reply subjectively unchanged patients reported a "pessimistic bias" of 0.35 to 0.51 points, except for the stiffness section. Both MCID and pessimistic bias showed regression to the mean and baseline dependency. CONCLUSION: The assessment of MCID using the transition method is a heuristic and valid strategy to detect particular rehabilitation effects in patients with OA of the lower extremities with the use of the WOMAC, and it is worth implementing. The size of the MCID and of the systematic bias is comparable to that assessed by other methods and in other therapeutic settings.

Adult↗
PubMed2002

Use of the ICF model as a clinical problem-solving tool in physical therapy and rehabilitation medicine.

The authors developed an instrument called the "Rehabilitation Problem-Solving Form" (RPS-Form), which allows health care professionals analyze patient problems, to focus on specific targets, and to relate the salient disabilities to relevant and modifiable variables. In particular, the RPS-Form was designed to address the patients' perspectives and enhance their participation in the decision-making process. Because the RPS-Form is based on the International Classification of Functioning, Disability, and Health (ICF) Model of Functioning and Disability, it could provide a common language for the description of human functioning and therefore facilitates multidisciplinary responsibility and coordination of interventions. The use of the RPS-Form in clinical practice is demonstrated by presenting an application case of a patient with a chronic pain syndrome.

Arthritis↗
PubMedDate not supplied

Value and application of the ICF in rehabilitation medicine.

Rehabilitation medicine may be defined as the multi- and interdisciplinary management of a person's functioning and health. Rehabilitation medicine defines itself with respect to concepts of functioning, disability and health. Assessment and intervention management rely on this concept. The current framework of disability--the WHO International Classification of Functioning, Disability and Health (ICF)--providing a coherent view of health from a biological, individual and social perspective. However, ICF success will depend on its compatibility with measures used in rehabilitation and on the improvement of its practicability. Thus, it is expected to see the development of the ICF based on versions of currently used instruments and on the development of ICF Core Sets. The new language ICF is an exciting landmark event for rehabilitation. It may lead to a stronger position of rehabilitation within the medical community, change multi-professional communication and improve communication between patients and rehabilitation professionals.

Activities of Daily Living↗