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Biomedical subjects

N B Oldridge

Publications and source records attributed to N B Oldridge.

At least 19 recordsLinked to original sources
PubMed2003

Health-related quality of life in patients with coronary artery disease treated for angina: validity and reliability of German translations of two specific questionnaires.

The German versions of two patient-perceived heart disease specific health-related quality of life (HRQL) questionnaires, the Seattle Angina Questionnaire (SAQ) and the MacNew Heart Disease questionnaire, were examined for their psychometric properties in patients with angiographically documented coronary artery disease and angina who were treated either medically or invasively and followed up for 1 year. Both HRQL questionnaires and the modified Canadian Cardiovascular Society (CCS) angina-associated disability scale were completed by 158 patients at baseline and 12 months later when they also completed a generic health status questionnaire, the SF-36. Both specific HRQL questionnaires were acceptable to patients. Three of the four MacNew scales, but none of the SAQ scales, discriminated between patients by baseline CCS disability levels I and IV. Internal consistency ranged from 0.75 to 0.94 for the SAQ and from 0.86 to 0.97 for the MacNew scales. Test-retest reliability over a 4-week period of time ranged from 0.45 to 0.81 for the SAQ scales and 0.61 to 0.68 for the MacNew scales. Over 12 months, HRQL improved (p < 0.001) on three of the five SAQ and on all four of the MacNew scales with the responsiveness statistic ranging from 0.59 to 1.55 for the SAQ and 0.86 to 1.12 for the MacNew. The 12 month scores on all SAQ and MacNew scales were significantly higher in patients who improved than those who deteriorated on the SF-36 reported health transition question. We conclude that the SAQ and the MacNew are both valid, reliable, and responsive in German, that the MacNew discriminates better between angina grades at baseline, that HRQL improves over 12 months with both measures, that the SAQ angina frequency and disease perception scales have the largest effect sizes, and that the 12-month change in HRQL with both instruments was associated with change in SF-36 reported health transition status.

Aged↗
PubMed2001

Prevalence and outcomes of comorbid metabolic and cardiovascular conditions in middle- and older-age adults.

UNLABELLED: To estimate age group differences in the prevalence and outcomes of three common and often comorbid metabolic conditions (i.e., obesity, hypertension, and diabetes) and heart disease. DESIGN: Nationally representative prospective cohort study. SETTING: PARTICIPANTS' homes. PARTICIPANTS: 9825 adults aged 51 to 61 years (middle-age) in 1992, and 7370 adults aged 70 years and over (older-age) in 1993. MEASUREMENTS: Two-year dichotomous outcomes included: doctor visits, hospitalization, mobility difficulty, activity of daily living limitation, poor perceived health, and mortality. Odds ratios (OR) were adjusted for sociodemographic characteristics and history of cancer or lung disease. RESULTS: Those with one condition represented 80% and 70% of the middle- and older-age groups, respectively, while just 1-2% of each age group reported all three metabolic conditions. Thirteen percent and 32%, respectively, reported heart disease with or without metabolic conditions. Diabetes comorbid with other metabolic conditions, and particularly with heart disease, substantially elevated the risk of adverse outcomes such as health-related quality of life deficits, health services use, and mortality in both middle- and older-age adults. In the middle-age group, the OR was 6.81 for mortality in patients with a combination of obesity and diabetes and 6.10 in those with a combination of heart disease and diabetes. There also were significant ORs for mortality in middle-aged patients with heart disease (OR = 2.40), diabetes (OR = 2.63) and for those with a combination of obesity, hypertension, and diabetes (OR = 3.26). CONCLUSION: The impact of these often comorbid conditions underscores the importance of targeted and aggressive prevention, particularly among middle-age adults.

Age Distribution↗
PubMed2000

[Adaptation of the MacNew QLMI quality of life questionnaire after myocardial infarction to be used in the Spanish population].

BACKGROUND: The advantage of specific quality of life instruments is its ability to evaluate specific issues related to the illness of interest. The aim of the present study is to develope a Spanish version of the self-administered questionnaire MacNew QLMI, specific for patients after myocardial infarction (MI). MATERIAL AND METHOD: Forward and back-translation method by bilinguals was performed; once the test for feasibility and comprehension was carried out. 143 patients with a first MI completed the Spanish version of the MacNew QLMI and principal components factor analysis was performed. Reliability was assessed in 50 patients with stable MI that completed twice the questionnaire (with an interval of two weeks), measuring reproducibility and internal consistency with Student t test, intraclass correlation and Cronbach's alpha. RESULTS: Factor analysis showed a similar three dimensional structure as the original version. Intraclass correlation coeficient were 0.83, 0.87 and 0.83, and Cronbach's alpha coeficients were 0.85, 0.88 and 0.83 for the emotional, physical and social dimensions respectively. CONCLUSIONS: The Spanish version of the MacNew QLMI questionnaire has a good equivalence with the original version, a good internal consistency and a good reproducibility; it can be used in the Spanish population to study its validity.

Adult↗
PubMed2000

Determinants of exercise tolerance after acute myocardial infarction in older persons.

OBJECTIVES: Exercise tolerance is reduced with advancing age. Identification of potentially reversible determinants of the age-related decrement in exercise tolerance, which remain largely unexplored in older subjects and in patients recovering from a recent myocardial infarction (MI), may have useful therapeutic implications. The objective of this study was to identify the independent determinants of exercise tolerance in older patients with a recent MI. DESIGN, SETTING, AND PARTICIPANTS: Data is from baseline assessment of 265 post-MI patients (age range 45-85 years) enrolled in the Cardiac Rehabilitation in Advanced Age randomized, controlled trial. Patients with major comorbidities or severe MI complications were excluded from the trial. Exercise tolerance was determined from symptom-limited exercise testing and expressed as total work capacity (TWC, kg.m) or peak oxygen consumption (VO2peak, mL/kg/min). The associations between both TWC and VO2peak and baseline demographic, social, clinical, and neuropsychological variables and an index of health-related quality of life were determined with univariate and multivariate analysis. RESULTS: With univariate analysis, TWC decreased by 1285 kg.m per decade of increasing age between 45 and 85 years of age. With multivariate analysis, TWC decreased by 922 kg.m per decade. Increasing age (P < .001), female gender (P < .001), a small body surface area (P < .001), a low level of usual physical exercise before MI (P < .002), and the presence of post-MI depressive symptoms (P < .024) were independently associated with a lower TWC. The same factors, in addition to a small arm muscle area (P < .002), were also independently associated with a lower VO2peak. CONCLUSIONS: Age per se accounts for approximately 70% of the age-related decay in TWC or VO2peak. However, the inclusion of modifiable factors such as physical exercise and depression in the prediction model reinforces the importance of a multidimensional approach to the evaluation and treatment of older patients with a recent MI.

Age Factors↗
PubMed1998

Comprehensive cardiac rehabilitation: is it cost-effective?

A major challenge for all health care systems is to identify the most efficient use of limited and finite resources available for health care. Economic evaluation provides a balance sheet of the benefits, harms and costs for making choices between alternative health care services and is one strategy to assist decision-makers to make rational choices about effective and efficient health care. Cost and outcomes data collected on two or more alternatives form the basis for economic evaluations and calculating a cost-effectiveness ratio. While comprehensive cardiac rehabilitation has been shown to be an effective intervention for patients with documented heart disease, the economic evaluation data from which to determine the efficiency of cardiac rehabilitation are limited. Available economic evaluations of comprehensive cardiac rehabilitation suggest that it is a cost-effective intervention following an acute coronary event that can be economically justified. Although the majority of data from studies with less rigorous designs suggest either savings or a decrease in health care utilization, there were increased costs per quality-adjusted life year gained in the only randomized controlled trial with a cost-effectiveness analysis of cardiac rehabilitation. As the traditional delivery of cardiac rehabilitation services is undergoing re-examination, there is a need for considerably more research on the cost-effectiveness of cardiac rehabilitation before any definitive statement about reimbursement is made.

Coronary Disease↗
PubMed1997

Cardiac rehabilitation and risk factor management after myocardial infarction. Clinical and economic evaluation.

The increasing scarcity of available, and finite, health care resources, and the increased demands for health care, have made consideration of effectiveness and cost-effectiveness of health care services, such as the secondary prevention of heart disease, an imperative. There is considerable evidence that modification of cigarette smoking, hyperlipidemia, hypertension, and lack of physical activity, either singly or in combination, are effective in reducing the number of clinical events in the secondary prevention of heart disease. Economic evaluation is the comparative analysis of alternative courses of action in terms of both costs and consequences. Data generated in economic evaluations of health care services, such as risk factor modification in the secondary prevention of heart disease, are useful in developing clinical practice guidelines and health policies. Smoking cessation is the most cost-effective intervention for patients with documented heart disease while treatment of hyperlipidemia and referral to cardiac rehabilitation are highly cost-effective per quality-adjusted life year and relatively cost-effective per year of life saved. Risk factor management, provided by a team including cardiovascular specialists and other physicians together with appropriately trained allied health professionals, is the cornerstone of optimal care in both the primary and secondary prevention of heart disease.

Adult↗
PubMed1996

Outcomes measurement: health-related quality of life.

Outcomes research is rapidly expanding and evolving in the assessment of medical treatment and has significant potential contributions to the assistive technology field. Over the past two decades, numerous instruments have been developed and are widely used to collect data for evaluating the efficacy and effectiveness of traditional medical interventions. Although this methodology may not transfer seamlessly to assistive technology, the basis of its instrumentation and many of its concepts are highly relevant. Many current and emerging medical and assistive technology interventions are vigorously advocated but have inadequately demonstrated their positive impact on outcome. A key concept used in medical technology outcomes measurement is health-related quality of life, which represents the functional effect of an illness and its consequent therapy as perceived by the individual receiving treatment. People tend to make decisions about alternative health care services by estimating the effects of an intervention on outcomes important to themselves, by comparing intervention benefits and harms and by deciding whether the outcomes are worth the costs. Numerous valid, reliable, and responsive health-related quality of life instruments are available and are designed to discriminate between individuals, to evaluate change over time, or to predict outcome. Many are worth examining for potential use or adaptation in assistive technology outcomes measurement. Some of these instruments are generic, some specific, and others deal with health state preference. Generic health-related quality of life instruments are broadly applicable across various diseases, conditions, or populations. Specific instruments focus on a given disease, condition, or population. Health state preference instruments assess an individual's desirability for a given health state or outcome. Assistive technology practitioners claim that they improve the quality of life for the individuals they serve. Health-related quality of life must then be considered an integral component of the evaluation of service effectiveness. This paper reviews the concepts and instrumentation used in medical technology assessment for consideration and potential application in assistive technology measurement.

Health Services Research↗
PubMed1996

Outcomes measurement: health state preferences and economic evaluation.

A major health care policy issue in this era of accountability is controlling the introduction and utilization of increasingly sophisticated and expensive health care technologies. Data are needed about both the effectiveness and the costs of assistive technologies before making decisions without relying on "that's what we did last time," "gut feelings," or even "educated guesses." Services, such as assistive technology, fall in the category where rigorous scientific evidence about cost-effectiveness is virtually nonexistent. The field of medical technology assessment has been studying cost-effectiveness for decades and offers many methodological ideas to related fields such as assistive technology. Based on the experiences of medical technology assessment, the measurement of health state preferences and its use to estimate quality-adjusted life years is discussed in this paper. Economic evaluation can be defined as the comparative analysis of alternative courses of action in terms of both costs and consequences. Information from economic evaluation studies, including the use of quality-adjusted life years as an outcome measure, helps us to determine which health care services we can afford to incorporate into routine clinical practice. The major forms of economic evaluation for health care described in this paper are cost-benefit, cost-effectiveness, and a special form of cost-effectiveness, cost-utility. Important national and state health care policies are being considered and implemented on the basis of economic evaluation data and these are bound to have major implications for assistive technology. The assistive technology field needs to be aware of these methods both to understand how large scale health-related policy decisions are impacted by economic evaluations and to become participants in and contributors to this process.

Cost-Benefit Analysis↗
PubMed1994

Lumbar spine surgery and mortality among Medicare beneficiaries, 1986.

OBJECTIVES: The purpose of this study was to compare lumbar spine surgical procedures by age, gender, and number of comorbidities with respect to mortality in patients 65 years of age and older in the United States. METHODS: A 100% sample of the 1986 Medicare inpatient Health Care Financing Administration claims files databases involving lumbar spine surgical procedures was analyzed. RESULTS: Lumbar spine surgery in 34,418 patients (median age = 71 years) was associated with a significant increase in in-hospital and 1-year cumulative mortality only beyond 80 years of age. When adjusted for age, in-hospital and 1-year cumulative mortality with both decompression and excision procedures were significantly higher in men than in women. When adjusted for both age and gender, mortality increased significantly as the number of comorbidities increased. CONCLUSIONS: With lumbar spine surgery in elderly patients, mortality did not significantly increase until 80 years of age and was consistently associated with decompression and excision, with male gender, and with an increase in number of comorbidities.

Age Factors↗
PubMed1991

Cardiac rehabilitation services: what are they and are they worth it?

The objectives of cardiac rehabilitation include lowering mortality but, more importantly, increasing functional capacity so reducing disability and potentially improving quality of life. The data suggest that cardiac rehabilitation services are worth the patient's costs and efforts and as such, they should be considered an integral component of comprehensive cardiovascular care by cardiologists and primary care physicians. While there is considerable agreement on the roles of exercise testing and training in the three position stands, there are also substantiated, and important, differences in their recommendations on other cardiac rehabilitation services, such as counseling and risk factor management. The challenge for the 1990's is not only to continue to better define the effectiveness of cardiac rehabilitation services, but more urgently, how to deliver effective services most efficiently. This will help physicians provide optimum care for their patients, will improve the patient's likelihood of regaining for themselves an active and productive life, and should generate a more equitable and accountable reimbursement system for quality health care.

Cardiac Rehabilitation↗
PubMed1990

Self-efficacy and in-patient cardiac rehabilitation.

Self-efficacy reflects an individual's perceptions or beliefs about how capable he or she is of performing a specific activity or task and measures self-confidence to perform that specific activity or task. This study investigated the effect of in-patient cardiac rehabilitation on self-efficacy scores for 3 categories of activities: routine physical activities, daily living tasks and levels of concentration and ability to cope. On discharge from the intensive or coronary care unit, patients without contraindications to early ambulation were randomized to either a ward ambulation program (n = 26) or a dedicated exercise center program (n = 25) with all patients receiving the same standardized education/counseling. There were no differences between the groups in self-efficacy at baseline, at hospital discharge or 7 days later. Significant improvements in self-efficacy scores were observed by day 28 in both groups for routine physical activities and daily living tasks with no change in self-efficacy scores for concentration or ability to cope. At that time the exercise center patients had higher self-efficacy scores for walking time (p = 0.041) and overall exertion (p = 0.024) than the ward ambulation patients. For the majority of the self-efficacy variables considered, both in-patient exercise rehabilitation programs were equally effective in improving self-efficacy scores for physical activities and daily living tasks over the first 28 days after return to home. The lower cost associated with ward ambulation programs suggests that they are more cost-effective than developing a program in a dedicated in-patient exercise center.

Activities of Daily Living↗
PubMed1990

Measuring quality of life in cardiac spouses.

The purpose of this study was to develop an objective instrument to measure changes in quality of life of spouses of post-myocardial infarction (MI) patients, and to determine its responsiveness and validity. A 70-item list of potential areas of concern was compiled; the 25 most frequent and important concerns comprised the framework of the final questionnaire. The questions on the Quality of Life Questionnaire for Cardiac Spouses (QL-SP) were categorized into the Emotional Function Dimension (EFD), and the Physical and Social Function Dimension (PSFD). Subjects (n = 39) completed the QL-SP and a battery of established questionnaires at home, 1-2 weeks post-hospital discharge for the patient, and 8 weeks later. Scores on the QL-SP between visits were improved for both the EFD (t = 5.56, p less than 0.001), and the PSFD (t = 6.11, p less than 0.001). The agreement between predicted and observed relationships between the dimension changes and other index changes, as measured statistically by a kappa with Cicchetti weights, was significant (kappa w = 0.43, p = 0.0012). The QL-SP appears to be responsive and valid, and may be useful in evaluating clinical and research intervention strategies.

Activities of Daily Living↗
PubMed1990

The health belief model: predicting compliance and dropout in cardiac rehabilitation.

We investigated the health belief model and the health locus of control constructs as predictors of group membership (compliers or dropouts) with cardiac rehabilitation and whether they added predictive utility to routinely assessed patient demographics and health behaviors. Questionnaires were completed on entry into the study by 120 patients with coronary artery disease, and by the end of the 6 month program there were 58 compliers and 62 dropouts. Discriminant function analyses were carried out to determine prediction of group membership. The health belief model predicted group membership 64.6% of the time, explaining 5.2% of the variance. Demographics, health behaviors, and health belief model factors accounted for 21.1% of the variance between compliers and total dropouts with group membership correctly predicted 74.4% of the time; avoidable and unavoidable dropout was correctly predicted 84.2% of the time with 56.9% of the variance explained. Health locus of control did not distinguish between compliers and dropouts. The addition of the health belief model provided additional information about compliance with cardiac rehabilitation beyond that explained by demographic and health behavior variables alone, particularly when predicting avoidable/unavoidable dropout.

Attitude to Health↗
PubMed1989

Maximal isokinetic cycle ergometry in patients with coronary artery disease.

We assessed the utility of short-term (30 s) maximal isokinetic cycle ergometry as an additional method of investigating the limitations to exercise in 33 carefully selected patients with documented coronary artery disease. The technique proved safe and reproducible in these patients. In relation to normal standards, performance was better in the maximal isokinetic cycle ergometer test (peak power = 819 +/- 116 W; average power = 532 +/- 72 W; total work = 13.1 +/- 2.1 kJ; 95-101% of predicted) than in the progressive incremental exercise test (VO2 = 1.80 +/- 0.37 l.min-1; power output = 919 +/- 165 kpm.min-1; 70-80% of predicted). Beta blockade did not affect maximal performance during either isokinetic or progressive incremental cycling, although maximal heart rate was significantly lower during both tests in patients on beta blockade. Power output in the progressive exercise was not as strongly related to the indices measured during the 30 s isokinetic test (r = 0.59-0.63) as it was in previous studies of healthy individuals (r = 0.89). The ability to detect individual variations in short-term exercise capacity measured with maximal isokinetic cycle ergometry may have significant potential value 1) as an additional method of determining the limitations to exercise and 2) when executing an exercise prescription in patients with coronary artery disease.

Adrenergic beta-Antagonists↗
PubMed1989

Improvement in maximal isokinetic cycle ergometry with cardiac rehabilitation.

It is unclear whether improvements in short-term (30 s) exercise capacity are associated with the increased aerobic exercise tolerance frequently observed in cardiac patients following training. Carefully selected patients with documented coronary artery disease were randomly allocated either to a control group (N = 10) or to 12 wk of endurance exercise training (N = 12); both progressive incremental cycle ergometer testing (maximal power output and peak VO2) and 30 s maximal isokinetic cycle ergometry (peak power, total work, and fatigue index) were measured on entry into the study and 12 wk later. Initial maximum performance measures in progressive incremental exercise and in maximal short-term isokinetic cycling were similar in both groups. Following the training program, maximum power output measured during progressive incremental exercise increased by 21% (P less than 0.005) and peak VO2 increased by 18% (P less than 0.005) in the exercise group, but they were unchanged in the control group. Isokinetic peak power and total work improved by 14% (P less than 0.001) and 11%, respectively, in the exercise group, whereas there were corresponding reductions of 6 and 8% in the control subjects, with little change in fatigue index in either group. The similar relative increases in isokinetic peak power and peak VO2 suggest that improvement in short-term exercise capacity may be an important contributor to the improvement in aerobic exercise tolerance frequently observed in cardiac patients undergoing an endurance exercise program.

Coronary Disease↗