Time trade-off study to establish utility decrements in individuals with a spinal cord injury who perform intermittent catheterization.

AIMS: To generate utility decrements for three attributes associated with catheterization for individuals with a spinal cord injury (SCI): the process of catheterization, the physical impact of urinary tract infections (UTIs) and worry associated with hospitalization. MATERIALS AND METHODS: Health state vignettes comprising various levels of the three attributes were developed. Two cohorts of respondents, corresponding to people with SCIs and a sample broadly representative of the UK population, were presented with nine vignettes (three vignettes for the mild, moderate and severe health states in addition to a random set of six vignettes). It was assumed no or a nominal decrement was associated with the mild health state. Utility decrements were derived from analysing the data obtained from the online time trade-off (TTO). A proportion of the SCI cohort (n = 57) also completed the EQ-5D-5L questionnaire. RESULTS: Utility decrements were generated using statistical models for the general population (n = 358), the SCI population (n = 48) and the two populations combined (merged model, n = 406). Results from the two cohorts showed minimal differences. For the merged model, SCI status was not statistically significant. All interaction terms, excluding SCI and the severe level of the physical attribute, were not statistically significant. Compared to the mild level, the greatest utility decrement calculated was the severe level of the emotional (worry) attribute (0.09, p < .001) for the SCI population. A significant decrement of 0.02 (p < .001) was calculated for the moderate level of the emotional attribute for all models. The mean utility score for those with SCI having completed the EQ-5D-5L was 0.371. LIMITATIONS: Modest sample size of respondents from the SCI population (n = 48). CONCLUSIONS: Worry associated with hospitalization had the greatest impact on patients' health-related quality of life (HRQoL). The catheterization process, such as the lubrication and repositioning of the catheter, also impacted on patients' HRQoL.

A controlled comparison of the word repeating technique with a word association task.

The Word Repeating Technique (WRT) is a cognitive defusion technique used in Acceptance and Commitment Therapy (ACT). In this exercise, a word or short phrase is quickly repeated aloud until the context required for the word to have literal meaning changes. This study compared the WRT to a procedure that requires words to retain their meaning [the Implicit Associations Task (IAT)]. If the WRT operates by inducing a loss of meaning in words, one would not expect similar effects from a task requiring literal processing of words. Participants (N = 160) completed either the WRT or IAT with or without a theoretically consistent rationale for performing the task, while an additional 40 participants were in a control condition. Both the WRT and IAT decreased discomfort and believability ratings from pre- to post-test for words that were targeted in the tasks, with the WRT resulting in a larger pre- to post-test decrease for discomfort ratings. Only the WRT decreased the discomfort of words not targeted in the task from pre- to post-test, while neither task decreased the believability of words that were not targeted in the tasks. Providing a rationale did not have an effect for either task. Although the strengths of the effects for the WRT were larger than those for the IAT, both tasks demonstrated effects in the same direction and neither demonstrated effects that were larger in magnitude than what was accounted for by regression to the mean.