Biomedical subjects

Ray Fitzpatrick

Publications and source records attributed to Ray Fitzpatrick.

At least 19 recordsLinked to original sources

PubMed2007

Evidence-based guidelines for using the Short Form 36 in cervical dystonia.

We aimed to provide evidence-based guidelines for using the Short Form 36 (SF-36) as an outcome measure in cervical dystonia (CD). To do this, we tested the hypothesized relationships between items, scales, and summary measures of the SF-36 using psychometric analyses in data from a postal survey of 235 people with CD. Although the majority of subscales performed adequately, the Role Physical and Role Emotional subscales had substantial floor and/or ceiling effects. Evidence did not support computing SF-36 Physical and Mental Component Summary scores. We propose guidelines that include the recommendation that these subscale and summary scores should be reported with caution.

Aged↗

PubMed2006

Cross-cultural evaluation of the short form 8-item Parkinson's Disease Questionnaire (PDQ-8): results from America, Canada, Japan, Italy and Spain.

OBJECTIVE: The purpose of this study was to evaluate the psychometric properties of a short form health survey, the Parkinson's Disease Questionnaire (PDQ-8), cross-culturally, by comparing results gained from this instrument to the original longer form instrument-the PDQ-39. DESIGN: Data are from the Global Parkinson's Disease Survey. OUTCOMES: The 8-item Parkinson's Disease Questionnaire Single Index Score (PDQ-8-SI). In this study, we evaluate response rate, scaling assumptions, and data quality, in terms of comparability of results with the parent form from which the PDQ-8 was derived, of the instrument in the USA, Canada, Spain, Italy and Japan. RESULTS: The PDQ-8 was found to produce results that were very similar to the parent form across all five countries. However, it should be borne in mind that the PDQ-8 was nested within the PDQ-39, and results may be influenced by this. CONCLUSIONS: Results suggest that the PDQ-8 is a valid and reliable measure that can be appropriately and meaningfully used in cross-cultural studies.

Aged↗

PubMed2006

Pain and overall health status in older people with hip and knee replacement: a population perspective.

OBJECTIVE: To investigate the health-related quality of life and presence of hip or knee pain according to whether or not people had had previous hip or knee arthroplasty. STUDY DESIGN AND SETTING: Cross-sectional survey representing randomly selected sample of 5500 elderly (65+) people. Pain prevalence rates obtained from standard screening questions. Standard pain severity ratings obtained for each hip and knee. RESULTS: People with a past arthroplasty had worse health status compared to other people (p < 0.001 for all but two SF-36 dimensions). Hip or knee pain was more prevalent amongst people with past hip or knee replacement than amongst those without (62.5% versus 36.5% respectively; following adjustment for age and sex: Mantel-Haenszel combined odds ratio = 2.90, 95% CI 2.30-3.68, p < 0.001). More replaced knee joints were symptomatic than replaced hip joints (OR = 1.62, p = 0.022). CONCLUSIONS: Elderly people with a past hip or knee arthroplasty have significantly greater health and social care needs than other people--especially those related to pain and mobility. This may reflect the generalised nature of the underlying disease process.

Aged↗

PubMed2006

The Parkinson's Disease Questionnaire (PDQ-39): evidence for a method of imputing missing data.

BACKGROUND: The Parkinson's Disease Questionnaire (PDQ-39) is the most widely used Parkinson's specific measure of health status. It is increasingly used in treatment trials, sometimes as a primary end-point, where any missing data can potentially cause difficulties in analyses. OBJECTIVES: The purpose of this article is to evaluate the Expectation Maximisation (EM) algorithm for the imputation of missing dimension scores on the 39-item PDQ-39. METHODS: A postal survey of patients diagnosed with Parkinson's disease (PD). A total of 1,372 patients were surveyed and 839 (61.15%) questionnaires returned completed or partially completed. Of these, complete PDQ data were available in 715 (85.22%) cases. Data were deleted from this complete dataset and a sub-set of 200 respondents from this dataset and then imputed using the EM algorithm; results were then compared to the dataset before data deletion. RESULTS: Results gained from imputation of data closely mirrored that of the complete dataset in each case. Descriptive statistics, mean scores and spread of scores were almost identical between original and imputed datasets. Furthermore, original and imputed datasets were highly correlated [intra-class correlation coefficient (ICC) = 0.93 or greater], and mean differences were small (+/-1.00). CONCLUSIONS: The results suggest that the use of EM for the PDQ-39 provides data that closely mirrors the original when this has been deliberately removed. Consequently, EM is likely to be appropriate for trials using the PDQ that contains missing data points.

Adult↗

PubMed2006

Patient participation in the consultation process: a structured review of intervention strategies.

OBJECTIVE: To describe the range and effectiveness of intervention strategies designed to enhance patient participation in the consultation process. METHODS: A systematic review of published literature (1976-2004) was undertaken. Controlled trials in English were included. Data regarding study design, intervention characteristics, patient populations and study results were extracted. RESULTS: One hundred and forty-six articles describing 137 trials were reviewed. A pragmatic categorisation of intervention strategies and study outcomes supported data synthesis. Patient-targeted coaching and educational materials, and provider-targeted communication skills training have a substantial impact on communication. Information feedback to providers from patient-reported outcome measures (PROMs) benefits provider diagnosis and management of patient conditions. Communication and provider diagnosis and management benefit most from the reviewed interventions. Although patient satisfaction and health status were two of the most frequently measured outcomes, overall, the interventions appeared to have less impact on patient self-efficacy, attitudes and behaviours, patient satisfaction, health status and resource use. CONCLUSION: Evidence is insufficient to strongly advocate one approach to enhancing patient participation in the consultation process. More rigorous research design with clearly specified intervention strategies and appropriately defined outcomes assessed over both the short and long term is required. PRACTICE IMPLICATIONS: Although limited and inconclusive, the most extensive and most encouraging evidence to enhance patient participation in the consultation process is available for three patient-targeted intervention strategies (coaching, educational materials and PROMs feedback to providers) and one provider-targeted intervention strategy (communication skills training).

Clinical Competence↗

PubMed2006

Impact of patient-reported outcome measures on routine practice: a structured review.

RATIONALE, AIMS AND OBJECTIVES: Regular use of patient-reported outcome measures (PROMs) by health care providers in their routine practice may help to improve the quality of care, but more evidence is needed before routine use of PROMs can be recommended. A structured review was undertaken to examine whether and how regular use of PROMs might improve routine practice. METHODS: A systematic search of Medline accessed through Webspirs Silverplatter was undertaken for the years 1976-2004. Controlled trials in English evaluating the impact of clinical use of PROMs on routine practice were included. Data regarding study design, characteristics of PROMs feedback, patient populations and study results were extracted by three reviewers. RESULTS: Feedback of PROMs results to health care providers appears to have a substantial impact on some processes of care, particularly on diagnosis of mental health conditions. However, the impact on patient health status is less consistent. Most of the published studies evaluated PROMs as a one-off screening technology and measured only provider behaviours and patient health outcomes. CONCLUSIONS: The pattern of results suggests a general lack of clarity in the field, especially regarding appropriate goals for PROMs and the mechanisms by which they might achieve them. To fully evaluate their role in routine practice, studies need to use PROMs that capture issues of importance to patients and to measure impacts relating to the patient-provider relationship and patient contributions to their well-being. Until studies evaluate PROMs as a means facilitate patient-centred care, their full potential in clinical practice will remain unknown.

Humans↗

PubMed2006

Parental views on the introduction of an infant pneumococcal vaccine.

Streptococcus pneumoniae is a major cause of early childhood morbidity and mortality. A heptavalent pneumococcal conjugate vaccine (PnC7) is licensed for use and could prevent the majority of infant invasive pneumococcal infections. A recent announcement confirmed its inclusion into the U.K. childhood immunisation programme. In anticipation of PnC7 being recommended for use, this study explored parental understanding of pneumococcal disease and their views on the possible introduction of this vaccine. Twenty three interviews and two focus groups were held with parents of children under two years of age. Four main themes emerged from the data analysis: 'Confidence and belief in immunisation'; 'Anxiety about immunisation'; 'Trust and understanding of immunisation information' and 'Response to a new immunisation'. Overall parental confidence in immunisation has been affected by the MMR controversy. With little knowledge of pneumococcal disease, parents want information about the safety and effectiveness of PnC7. Information needs to be conveyed in a way that restores parents' trust in immunisation.

Adult↗

PubMed2005

A response to issues raised in a recent paper concerning the Oxford knee score.

In a recently published paper, authors were critical of the Oxford Knee Score (OKS) patient based measure. We discuss a number of the interesting issues that this paper raised and point out some obvious misunderstandings. The OKS, whilst not perfect, has been shown in independent comparative studies to perform more satisfactorily than other measures. It remains one of a small number of measures with satisfactory measurement properties. It would be a great pity if clinicians were deterred from using the OKS on the basis of comments made in the recent publication.

Aged↗

PubMed2005

Impact of persistent hip or knee pain on overall health status in elderly people: a longitudinal population study.

OBJECTIVE: To investigate hip or knee symptoms in older persons from a longitudinal, population perspective, and to determine the impact of persistent hip or knee pain on general health status over time. METHODS: A postal questionnaire was sent to a random sample of 5,500 individuals ages > or = 65 years containing the Short Form 36 (SF-36) general health survey, Lequesne hip and knee indices, and a hip/knee pain severity item. Respondents reporting hip or knee symptoms at baseline received an identical questionnaire 12 months later. Respondents were classified into a persistent pain group with either hip or knee pain at both baseline and followup, and a non-persistent pain group who reported hip or knee pain at baseline but no pain at followup. RESULTS: At baseline, 1,305 (40.7%) of 3,210 eligible respondents reported hip or knee pain. At 1 year, 1,072 (82.1%) of 1,305 individuals responded, of whom 820 (76.5%) remained symptomatic (the persistent group). In multivariate analysis, baseline factors identified as strongly related to having persistent pain were maximum Lequesne score (odds ratio [OR] 1.09, P < 0.001), maximum hip/knee pain score (OR 1.61, P < 0.001), and number of painful hip and knee joints at baseline (OR 1.48, P = 0.004). Following adjustment for age, sex, and baseline score, differences in mean SF-36 change scores of the 2 groups were significant for all dimensions except for mental health. CONCLUSION: In older persons, a symptomatic hip or knee frequently progresses in terms of worsening symptoms and accrual of other symptomatic hip or knee joints. The impact of persistent symptoms on general health is substantial.

Aged↗

PubMed2005

Assessing the health of women in prison: a study from the United Kingdom.

The number of women imprisoned in the United Kingdom is rising rapidly, but there is little research on their health and well-being. We could find no studies in which the researchers had used measures of subjective health status to gain a picture of the health of imprisoned women. This self-completed questionnaire study aimed to explore the usefulness of the Short Form 36 (SF-36) in a general female prison population. The scores of imprisoned women for all but 3 of the 8 dimensions were significantly lower than those for women in the social class with the worst health in the United Kingdom, confirming the very poor mental and physical health of this population.

Adult↗

PubMed2005

Population survey comparing older adults with hip versus knee pain in primary care.

BACKGROUND: Knee pain is nearly twice as prevalent as hip pain in elderly people, yet knee replacement is far less common than hip replacement. AIM: To investigate whether systematic differences in the primary care management of hip versus knee problems might explain the disparate rates of joint replacement. DESIGN OF STUDY: Cross-sectional, population-based postal survey. SETTING: Random sample of 5500 Oxfordshire residents aged 65 years and above. METHOD: Screening questions were used to identify symptomatic individuals: "During the past 12 months, have you had pain in or around either of your hips/knees on most days for 1 month or longer?". Standard (Lequesne) severity ratings were obtained for each hip and knee. Logistic regression was used to estimate odds ratios (ORs) for "knee cases" versus "hip cases" for selected healthcare services and attitudes toward replacement. RESULTS: Among 3341 responders, 212 hip cases and 612 knee cases were identified. Knee pain led to a GP consultation more often than hip pain (OR = 1.76, P = 0.04), but specialist referral was no more likely (OR = 0.85, P = 0.57). Similar percentages of hip and knee cases would agree to hip/knee replacement surgery if it was offered, but hip and knee cases differed in their views on the general success of joint replacement. CONCLUSIONS: Some variations in primary care management for hip versus knee pain were apparent. People with hip pain were mostly positive about replacement outcomes, whereas people with knee pain were more uncertain about replacement. Attitudes appeared to be influenced by knowing someone who had undergone such surgery.

Aged↗

PubMed2004

Prospective study of elderly people comparing treatments following first primary care consultation for a symptomatic hip or knee.

BACKGROUND: Symptomatic knee problems in elderly people are considerably more common than hip problems, yet far more hips are replaced. OBJECTIVE: The purpose of this study was to investigate whether systematic differences occur in early primary care management of elderly patients who first consult with hip versus knee symptoms. METHODS: A prospective analysis was carried out of anonymized records in the MediPlus general practice database. This was a 3 year (1996-1998) prospective study of 310,843 patients aged 65+ regarding consultations about a new hip or knee problem. Survival analysis techniques were used to analyse time to and frequency of various interventions. RESULTS: A total of 1410 new hip and 3152 new knee consulters were identified. Baseline characteristics of the two groups were very similar. By 3 years following the first consultation, more of the hip cases had referral to a specialist (38.2% hips versus 31.5% knees, P <0.001) and joint replacement (9.6% hips versus 1.8% knees, P <0.001) recorded. Non-steroidal anti-inflammatory drug (NSAID) prescribing was high for both groups, with approximately 51% prescribed one of the safer forms and approximately 15% prescribed one with a lower safety record within 3 years. CONCLUSION: Rates of specialist referral and joint replacement in older people are much lower, or slower, for those with symptomatic knees relative to hips. In the absence of surgery, prescriptions for pain killers are similar for both groups. Elderly people with symptomatic knees are therefore at increased risk of drug side effects relative to those with symptomatic hips. This may represent another facet of unmet need for surgery in people with knee disease.

Aged↗

PubMed2004

Patient-based outcomes of cervical dystonia: a review of rating scales.

Decisions on treatment choice for patients are based on trials and outcome studies that are wholly dependent upon the scientific quality of the rating scales used. This study reviewed rating scales used in cervical dystonia outcome research to determine the extent that they satisfy recommended criteria for rigorous measurement.

Humans↗

PubMed2004

Distribution-based criteria for change in health-related quality of life in Parkinson's disease.

BACKGROUND AND OBJECTIVE: To be useful, results from health-related quality of life (HRQoL) measures must be interpretable. The objective of this article is to examine statistical (distributional) approaches to interpretability. The standard error of measurement (SEM) and the standard error of the difference (S(diff)) are used in data on individuals with Parkinson's disease to calculate the minimum change scores required to be statistically meaningful for each dimension of an instrument to assess HRQoL in Parkinson's disease, the PDQ-39. METHODS: Data was collected from both a community and a clinic study; in both studies the PDQ-39 was administered at baseline and follow-up. RESULTS: The patterns of SEMs and S(diff)s were similar both across time periods and between samples, for all dimensions except Social Support. CONCLUSIONS: The results suggest that, for example, six points change on a 0-100 transformed scoring of the Mobility dimension may be considered on distributional grounds a minimum meaningful change. The demonstrated consistency across occasions and types of sample of SEMs and S(diff) for the majority of the dimensions of the PDQ-39, is evidence of the theoretically claimed advantage of this measure of sample independence, and supports use of this distributional approach to minimum meaningful change.

Adult↗

PubMed2004

Health-related quality of life in amyotrophic lateral sclerosis: determining a meaningful deterioration.

This paper uses the standard error of measurement (SEM) and the standard error of the difference (S(diff)) in relation to data on individuals with amyotrophic lateral sclerosis (ALS) to calculate the minimum change scores required by statistical criteria for each dimension of the Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-40). Data collected from a longitudinal study was used to evaluate the usefulness of SEM and S(diff) criteria and to compare these criteria with an anchor-based approach in determining meaningful change. Questionnaires were completed on two occasions, 3 months apart. 764 questionnaires were returned. Questionnaires included the ALSAQ-40 and dimension specific transition items. The ALSAQ-40 is a disease specific health-related quality of life instrument for use in studies of patients with ALS or other motor neuron diseases. For all dimensions of the ALSAQ-40 the patterns of SEMs were similar over time. The results suggest that, for example, six points change on a 0-100 transformed scoring of the physical mobility dimension may be considered on distributional grounds a minimum meaningful change. The demonstrated consistency of SEMs for the dimensions of the ALSAQ-40 is empirical evidence of the theoretically claimed advantage of this measure of sample independence, and supports use of this distributional approach to calculate meaningful change.

Amyotrophic Lateral Sclerosis↗

PubMed2004

Comparing alternative Rasch-based methods vs raw scores in measuring change in health.

OBJECTIVES: To compare alternative Rasch-based approaches to the assessment of change over time through the example of an outcome measure used in total hip replacement surgery. SUBJECTS: Preoperative data were collected on 1424 patients receiving total hip replacement surgery; 1221 (86%) were sent follow-up questionnaires 1 year after surgery. MEASURES: The 12-item Oxford Hip Score (OHS) questionnaire administered preoperatively and 1-year postoperatively. METHODS: Subscales of the OHS for pain and functional impairment were examined for unidimensionality and item invariance. Two criteria were used to examine Rasch-based measurement of the 2 subscales. Advantages of Rasch measurement were examined in terms of whether it produced improved discrimination of outcomes of patients (1) undergoing different levels of complexity of surgery; and (2) reporting different retrospective judgments of the success of their surgery. Using the method of relative precision in relation to groups of patients distinguished in these 2 ways, change scores using Likert scoring methods were compared with 2 Rasch scoring methods: (1) separate analyses of the 2 time points; and (2) a common scale analysis obtained by stacking patients from the 2 time points. RESULTS: Less evidence for item invariance over time was found for the pain subscale. Other evidence supported treating subscales as unidimensional. Whichever Rasch scoring method was used, some gains in precision over standard Likert scoring were obtained in discriminating between groups of patients. CONCLUSIONS: The evidence from the current study suggests that there may be some gains in sensitivity to change of outcome measures from different Rasch-based scoring approaches.

Aged↗

PubMed2004

Equity and need when waiting for total hip replacement surgery.

OBJECTIVES: To explore sociodemographic and health status factors associated with waiting times both for first outpatient appointment and for total hip replacement surgery (THR). METHODS: A survey of THR in five former English regions was conducted between September 1996 and October 1997. Every patient listed for THR was asked to fill out a questionnaire preoperatively. This questionnaire included the 12-item Oxford Hip Score (OHS) questionnaire and two questions on the length of time patients waited for an outpatient appointment and subsequently for their operation. RESULTS: From multiple logistic regression analyses, region, private vs. public sector, housing tenure and preoperative OHS were all independently associated with a waiting time for an outpatient appointment for > 3 months. Region, housing tenure and gender were also independently associated with a wait of >or= 6 months on the surgical waiting list. CONCLUSIONS: A large proportion of patients had long waiting times both for an outpatient appointment and while on a surgical waiting list. There were significant differences in waiting time according to social, geographical and health care system factors. Patients with a worse pain and disability at surgery waited longer for an outpatient appointment. The longer patient waited, the worse was their pain and disability, suggesting that patients were not prioritized by these criteria. Benefits of prioritizing should be tested.

Aged↗

PubMed2004

The use of probabilistic decision models in technology assessment : the case of total hip replacement.

There is increasing recognition that decision modelling is central to health technology assessment and, in particular, to analyses to support formal decision making regarding the funding of the use of new technologies. In part, the key role of decision analysis stems from the need to handle multiple sources of uncertainty in the available evidence. The use of probabilistic decision analysis is a means of reflecting the parameter uncertainty in models and presenting this in a comprehensible manner to decision makers. In this article, we demonstrate the potential role of probabilistic models using the case study of total hip replacement surgery.A cost-effectiveness model was constructed to compare the Charnley and Spectron hip prostheses in terms of lifetime costs and quality-adjusted life-years (QALYs). Revision rates were estimated from the Swedish National Total Hip Arthroplasty Register (1992-2000); the risk of revision with the Spectron prosthesis relative to the Charnley prosthesis was 0.67 (95% confidence interval [CI] 0.32, 1.02) for early revisions and 0.26 (95% CI 0.07, 0.46) for late revisions. This lower revision risk resulted in the Spectron generating more QALYs than the Charnley prosthesis. Based on mean costs and QALYs, the Spectron results in cost savings in younger patients, and generates incremental cost-effectiveness ratios of between pound1000 and pound16 000 in older patient groups. The probabilistic results from the model indicated that, if it is assumed that decision makers are willing to pay up to pound20 000 per additional QALY, the probability of the Spectron being the more cost-effective prosthesis ranged between 70% and 100%, depending on the age and sex of the patient.This article looks at the application of probabilistic decision modelling using total hip replacement as a case study to emphasis the need for decision models to quantify all sources of parameter uncertainty and to clearly distinguish parameter uncertainty from subgroup heterogeneity.

Adult↗