ABSTRACT
BACKGROUND: The majority of studies support modern assertive health service models. However, the evidence is limited for parts of continental Europe, as well as for the pharmacological adherence outcome parameter. METHOD: We conducted a quasi-experimental controlled trial including adult patients with a schizophreniform disorder and a maximum of 60 points on the Global Assessment of Functioning Scale (GAF). Interventions (n=176) and controls (TAU, n=142) were assessed every six-month within one year in 17 study practices in rural areas. Mental and functional state were rated using the Brief Psychiatric Rating Scale (BPRS) and the GAF. Functional limitations and pharmacological adherence were patient-rated using the WHO-Disability Assessment Schedule II (WHODAS-II) and the Medication Adherence Report Scale (MARS). We computed multilevel mixed models. RESULTS: The GAF and BPRS of both groups improved significantly, yet the increase in the intervention group was significantly higher. In contrast, patient-rated variables - WHODAS-II and MARS - neither showed a stable temporal improvement nor a difference between groups. CONCLUSION: Our findings only partly support the investigated AO intervention, because of conflicting results between clinician- and patient-ratings. Accordingly, the benefits of AO need to be further evaluated.
Subject(s)
Disability Evaluation , Psychotic Disorders , Psychotropic Drugs/therapeutic use , Adult , Brief Psychiatric Rating Scale , Europe , Female , Humans , Male , Medication Adherence , Middle Aged , Models, Organizational , Outcome Assessment, Health Care , Psychotic Disorders/diagnosis , Psychotic Disorders/therapy , Rural Health Services/organization & administrationABSTRACT
Diverse methods are available for evaluation of (medical) interventions. In each case one has to decide on a specific method. Our aim was to analyze typical problems involved in the measurement of change. Different methods are delineated, and their specific pros and cons are set out. Subsequently, empirically derived recommendations are outlined on which method should be employed for which problem and under which circumstances. A characteristic of rehab treatment is that as a rule a multitude of problems are addressed, and accordingly, treatment goals are heterogenic. Straightforward recommendations for one or the other method cannot be given.
Subject(s)
Algorithms , Diagnostic Self Evaluation , Disabled Persons/rehabilitation , Outcome Assessment, Health Care/methods , Patient Satisfaction , Germany , Humans , Treatment OutcomeABSTRACT
BACKGROUND: Although randomized clinical trials have reported significant improvement in mortality and functional outcome as measured with modified Rankin Scale (mRS) or Barthel index (BI) in stroke patients with space-occupying anterior circulation infarctions treated with hemicraniectomy, many clinicians are still concerned about the long-term health-related quality of life (HRQoL). AIM: Assessment of HRQoL after hemicraniectomy to holistically reevaluate clinical outcome. METHODS: Eleven patients (6 men, 5 women; mean age 48 (SD 5.8) years) were examined at 9-51 months after hemicraniectomy. Test batteries comprised NIH stroke scale, BI, mRS, neuropsychological tests (Visual Object and Space Perception Battery and clock test), and HRQoL-scales (Short Form 36 Health Survey (SF-36), Nottingham Health Profile (NHP), Questions on Life Satisfaction, Hospital Anxiety and Depression Scale and EQ-5D). RESULTS: Median values for NIHSS, BI and mRS were 11.5, 55 and 3.5. In HRQoL-scales, subscales related to physical mobility and functioning were consistently severely impaired, while subscales related to psychological well-being were impaired to a lesser extent. Mean scores for physical functioning and physical role were 10.5 and 12.5 in the SF-36, and 61.3 and 43.3 for physical mobility and energy in the NHP; emotional role and mental health scored 63.3 and 66.4 (SF-36), scores for emotional reaction and social isolation were 18.9 and 16.0 (NHP), respectively. CONCLUSION: Although, physical components of HRQoL are highly impaired, these stroke patients achieved a satisfying level of psychological well-being which was endorsed by a nearly unanimous retrospective appraisal of life-saving hemicraniectomy.
Subject(s)
Brain Edema/psychology , Brain Edema/surgery , Decompression, Surgical/psychology , Neurosurgical Procedures/psychology , Quality of Life/psychology , Stroke/psychology , Stroke/surgery , Adult , Aged , Anxiety/etiology , Anxiety/psychology , Cerebral Infarction/surgery , Craniotomy , Depression/etiology , Depression/psychology , Female , Humans , Male , Middle Aged , Mobility Limitation , Neuropsychological Tests , Personal Satisfaction , Retrospective Studies , Social Isolation , Stroke Rehabilitation , Treatment OutcomeABSTRACT
AIM OF THE STUDY: The aim of the study was to examine the direct and the indirect change measurement; previous studies comparing the 2 methods demonstrated that they agree only to a limited extent. Analyses of the factorial structure have shown that indicators of direct change measurement were assigned regardless of the content of a dimension common to them. This paper examined whether previous results obtained on scale level were also valid on item level. METHODS: Empirical data were obtained from 3 rehabilitation patient samples (n=466, n=194, n=610). The factorial structures of the direct and indirect measurements of change were assessed and compared using principal components analysis with oblique rotation. Additionally, analyses were performed stratified across clinical indications and only for items of the direct change measurement. RESULTS: The factorial structure of 3 data sets showed that the previously published scale-level results were also valid on item level. Analyses demonstrated only low to medium agreement between the 2 methods of change measurement. The indicators of direct change measurement loaded regardless of their content on one or a few common dimensions, which did not agree with those of the indirect change measurement. CONCLUSION: In considering the 2 methods of measuring change, it is apparent that the standard method of change measurement (indirect change measurement) is suitable to reflect a comprehensive and multi-dimensional representation of changes within the field of medical rehabilitation evaluation.
Subject(s)
Activities of Daily Living , Disabled Persons/classification , Disabled Persons/rehabilitation , Outcome Assessment, Health Care/methods , Recovery of Function , Adolescent , Adult , Female , Germany , Humans , Male , Middle Aged , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Little empirical evidence is available on differential associations between social status indicators and back pain in Germany. This study therefore systematically evaluated associations between different indicators of social status and back pain. METHODS: In total 4,412 employed adults, aged 18 to 65 years participated in a postal survey in 5 regions of Germany. The point prevalence and 1-year prevalence of back pain were assessed as well as the level of disabling back pain. Educational level, professional category and household income served as measures of social status. Associations between social status and back pain have been assessed cross-sectionally using Poisson regression. RESULTS: Educational level was the best predictor for back pain among the assessed social status indicators. Adults with a low educational level had almost a 4-fold risk of reporting disabling back pain compared to subjects with a high educational level. Associations were highest for disabling back pain and attenuated strongly over the point prevalence towards the 1-year prevalence. DISCUSSION: Back pain cannot generally be regarded as a symptom of a low social status. However, social inequality is of major importance regarding the prediction of severe back problems. A better understanding of mediating factors is essential for the prevention and therapy.
Subject(s)
Educational Status , Income , Low Back Pain/epidemiology , Social Class , Adolescent , Adult , Aged , Cross-Sectional Studies , Disability Evaluation , Female , Germany , Health Surveys , Humans , Male , Middle Aged , Risk Factors , Socioeconomic Factors , Young AdultABSTRACT
Health-related quality of life is a multidimensional concept which describes relevant aspects of physical, emotional and social well-being as reported by patients. Numerous generic and disease-specific instruments for measuring health-related quality of life have been developed and in addition preference-based instruments are available for use in health economic evaluation. The SF-36 and EQ-5D questionnaires belong to the most frequently used generic measures of quality of life. The Trauma Outcome Profile (TOP) and the Quality of Life after Brain Injury (QOLIBRI) questionnaires are disease-specific measures designed to assess health-related quality of life after trauma. In the context of a brief description of these questionnaires several examples of their use in studies of patients after trauma are given. These examples show that successful conceptual and methodological developments in quality of life research provide a sound basis for patient-oriented outcome assessment after trauma.
Subject(s)
Disability Evaluation , International Classification of Diseases , Outcome Assessment, Health Care/methods , Quality of Life , Traumatology/methods , Wounds and Injuries/diagnosis , Wounds and Injuries/therapy , Humans , Recovery of Function , Wounds and Injuries/classificationABSTRACT
The focus of this article is the satisfaction and health-related quality of life felt by patients with diabetes mellitus. Taking the LIVE-DE study as an example, it is demonstrated how various regimens of insulin treatment affect patient satisfaction. The standardized Insulin Treatment Experience Questionnaire (ITEQ) was produced for this purpose. It has 28 defined questions and answers. The 28 items describe in eight categories the experiences and problems which diabetic patients have had. It was found that there were significant differences between the insulin glargine and the NPH insulin-based regimens regarding quality of life and satisfaction with the treatment, a difference that ranged from small to moderate in favour of insulin glargine.
Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/psychology , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Patient Satisfaction , Quality of Life , Health Status , Humans , Insulin/analogs & derivatives , Insulin Glargine , Insulin, Long-Acting , Surveys and Questionnaires , Treatment OutcomeABSTRACT
Since the coming into force of the GKV-Wettbewerbsstärkungsgesetz ("Act to strengthen competition in the statutory health insurance system") in April 2007, the Gemeinsame Bundesausschuss (G-BA "Federal Joint Committee") can commission the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG--Institute for Quality and Efficiency in Health Care") with the assessment of costs and benefits of drugs. In January 2008, IQWiG published a working document for consultation describing the proposed methods for carrying out those evaluations. This commentary by the AG Methoden der Gesundheitsökonomischen Evaluation (AG MEG--"Working Group for methods of economic evaluation in health care") provides a critical appraisal and recommendations for the further development of IQWIG's draft guidelines. The core statements of the commentary are as follows: (1) The draft guidelines are unbalanced. Instead of providing comprehensive methodological guidance for health technology assessment, which is the actual task of IQWiG, they deal predominantly with the methods of technology appraisal which is in the responsibility of the decision-making bodies, i.e. of the G-BA and the Spitzenverband Bund der Krankenkassen ("Central Federal Association of Health Insurance Funds"). (2) IQWiG intends to compare the cost-effectiveness of alternative treatment options only within a given therapeutic area. The rationale for this restriction is not clear, as the decision-makers have to determine ceiling prices across therapeutic areas and diseases and effectively the overall volume of health care expenditure, as well. (3) IQWiG aims at carrying out an economic evaluation only if in a preceding benefit assessment a drug has been judged to be superior. Therefore, it has to be assured that the benefit assessment is performed in such a way that its results may be used for the economic assessment. This requires the application of summary scores for the joint measurement of multidimensional endpoints (as, e.g., QALYs), to evaluate community effectiveness instead of efficacy, and to choose a time horizon that is sufficiently long to reflect any differences in the health benefits between the technologies being compared. Furthermore, the comment hints at some additional problems embodied in the draft guidelines and a number of key methodological issues which are not discussed at all in the working document. In summary, the methods currently proposed by IQWiG are not up to the task of conducting economic evaluations. It is strongly recommended to perform a public consultation process for the revised draft guidelines anew.
Subject(s)
Models, Economic , National Health Programs/classification , National Health Programs/standards , Practice Guidelines as Topic , Program Evaluation/methods , Program Evaluation/standards , Cost-Benefit Analysis , Germany , National Health Programs/organization & administrationABSTRACT
In 1998, the German Federal Ministry of Education and Research (BMBF) and the German pension insurance scheme established a funding programme for research in rehabilitation. This initiative led to the establishment of eight regional research networks in which numerous research projects were sponsored for eight years (1998-2005). Within the framework of this funding programme, various self-assessment instruments were developed, adapted or improved in order to measure patient-reported outcomes and predictors. In sum, the analyses meet high psychometric standards. In this paper, a comprehensive review is given in five important assessment fields of rehabilitation research in Germany: Health-related quality of life (generic, disease-specific, children and adolescents, preference-based), evaluation of specific therapy and education programmes, motivation, screening for vocational problems and screening for comorbid mental disorders. The instruments are critically discussed, and perspectives for further research are pointed out.
