A matter of perspective – Objective versus subjective outcomes in the assessment of quality of recovery

Bowyer, Andrea; Royse, Colin

doi:10.1016/j.bpa.2018.02.003

Cited by 11 publications

(7 citation statements)

References 52 publications

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“…Multiple objective outcome measures were used to assess levels of function and pain for study patients. Objective outcome measures provide quality-of-recovery evaluations that are independent from judgment and are therefore less susceptible to bias [ 16–18 ]. These objective measures included a validated Walking Tolerance Test, in which patients were instructed to walk up to 15 minutes at their preferred speed, with the examination stopping at the end of 15 minutes or at the onset of severe symptoms, whichever came first [ 19 ].…”

Section: Methodsmentioning

confidence: 99%

The MOTION **Study: A Randomized Controlled Trial with Objective Real-World Outcomes for Lumbar Spinal Stenosis Patients Treated with the mild®** Procedure: One-Year Results

Deer

Costandi

Washabaugh³

et al. 2022

Pain Medicine

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Objective The purpose of this study is to provide Level-1 objective, real-world outcome data for patients with lumbar spinal stenosis suffering from neurogenic claudication secondary to hypertrophic ligamentum flavum(HLF). Design The MOTION Study is a prospective, multi-center, randomized controlled trial comparing the mild® Procedure as a first-line therapy in combination with non-surgical conventional medical management (CMM) to CMM alone as the active control. Methods Patients in the test group received the mild Procedure at baseline. Both the mild+CMM and the control group were allowed unrestricted access to conventional real-world therapies. Patient reported outcomes included Oswestry Disability Index, Zurich Claudication Questionnaire, and Numeric Pain Rating Scale. A validated Walking Tolerance Test, incidence of subsequent lumbar spine interventions, and occurrence of adverse events were used to measure objective outcomes. Results Sixty-nine patients in each group were analyzed at 1-year follow-up. No device or procedure-related adverse events were reported in either group. Results from all primary and secondary outcome measures showed statistical significance in favor of mild+CMM. Conclusions One-year results of this Level-1 study demonstrated superiority of mild+CMM over the use of CMM-Alone for LSS patients suffering from neurogenic claudication secondary to HLF. Use of the validated Walking Tolerance Test to objectively measure increased ability to walk without severe symptoms provided evidence of statistically-significantly better outcomes for mild+CMM versus CMM-Alone. With no reported device or procedure-related adverse events, the long-standing safety profile of the mild Procedure was reaffirmed. mild is a safe, durable, minimally-invasive procedure that has been shown to be effective as an early interventional therapy for patients suffering from symptomatic LSS.

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Section: Methodsmentioning

confidence: 99%

The MOTION **Study: A Randomized Controlled Trial with Objective Real-World Outcomes for Lumbar Spinal Stenosis Patients Treated with the mild®** Procedure: One-Year Results

Deer

Costandi

Washabaugh³

et al. 2022

Pain Medicine

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“…An event like a hospitalisation causes a response shift; participants make different cognitive appraisals at different moments, resulting in a recalibration, reprioritisation, and reconceptualisation of goals [ 27 – 29 ]. In this study, we used absolute scores for the P-BAS-P (‘what is the status now’) and relative comparison for answering the goal in the open question, where the participant (implicit) has to compare the situation now with how it was at baseline [ 1 ]. These different comparisons require different cognitive processes and therefore cause different forms of response shift.…”

Section: Discussionmentioning

confidence: 99%

“…Objective measures are, for example, length of stay, mortality, or clinical performance indicators. Subjective measures are patient-reported outcomes and are dependent on the judgment of the individual patient; examples are symptom burden, functional status, and health-related quality of life [ 1 ]. These kind of outcomes are often measured to compare different treatments, the effectiveness of alternatives of hospital admission, such as hospital at home [ 2 , 3 ], acute geriatric community hospital [ 4 ], or the effectiveness of better geriatric management of in-hospital patients [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Adaptation of the Patient Benefit Assessment Scale for Hospitalised Older Patients: development, reliability and validity of the P-BAS picture version

Kluit

Rooij

2022

BMC Geriatr

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Background The Patient Benefit Assessment Scale for Hospitalised Older Patients (P-BAS HOP) is a tool developed to both identify the priorities of the individual patient and to measure the outcomes relevant to him/her, resulting in a Patient Benefit Index (PBI), indicating how much benefit the patient had experienced from the hospitalisation. The reliability and the validity of the P-BAS HOP appeared to be not yet satisfactory and therefore the aims of this study were to adapt the P-BAS HOP and transform it into a picture version, resulting in the P-BAS-P, and to evaluate its feasibility, reliability, validity, responsiveness and interpretability. Methods Process of instrument development and evaluation performed among hospitalised older patients including pilot tests using Three-Step Test-Interviews (TSTI), test-retest reliability on baseline and follow-up, comparing the PBI with Intraclass Correlation Coefficient (ICC), and hypothesis testing to evaluate the construct validity. Responsiveness of individual P-BAS-P scores and the PBI with two different weighing schemes were evaluated using anchor questions. Interpretability of the PBI was evaluated with the visual anchor-based minimal important change (MIC) distribution method and computation of smallest detectable change (SDC) based on ICC. Results Fourteen hospitalised older patients participated in TSTIs at baseline and 13 at follow-up after discharge. After several adaptations, the P-BAS-P appeared feasible with good interviewer’s instructions. The pictures were considered relevant and helpful by the participants. Reliability was tested with 41 participants at baseline and 50 at follow-up. ICC between PBI1 and PBI2 of baseline test and retest was 0.76, respectively 0.73. At follow-up 0.86, respectively 0.85. For the construct validity, tested in 169 participants, hypotheses regarding importance of goals were confirmed. Regarding status of goals, only the follow-up status was confirmed, baseline and change were not. The responsiveness of the individual scores and PBI were weak, resulting in poor interpretability with many misclassifications. The SDC was larger than the MIC. Conclusions The P-BAS-P appeared to be a feasible instrument, but there were methodological barriers for the evaluation of the reliability, validity, and responsiveness. We therefore recommend further research into the P-BAS-P.

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“…Examples of objective, often administrative measures are length of stay, mortality, test results or clinical performance indicators. Subjective measures are patient-reported outcomes (PROs), which are dependent on the judgement of the individual patient; examples are symptom burden, functional status and quality of life [ 1 – 3 ]. Although PROs might reflect relevant outcomes from patient perspective better than objective outcomes [ 2 ], they do not always reflect what patients find important, since patient involvement in the development of instruments is rare [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Goal-based outcomes of hospitalisation of older adults are predicted by gender, confidence, quality of life and type of goals

2022

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Purpose Although patient-reported outcome measures (PROMs) might reflect relevant outcomes from patient perspective, they do not always reflect what the individual patient finds important. Our objectives were to assess which PROM was best suited to evaluate patient-relevant outcomes of hospitalisation and to assess which factors predicted this PROM. Methods A longitudinal study was conducted among hospitalised older patients. Three PROMs were compared with the anchor question ‘How much have you benefited from the admission?’: a general quality of life measure: EQ-5D; a measure of daily functioning: Katz-15 and a goal-based measure: achievement of self-defined goals. Predictors were examined using logistic regression analyses. Results We had 185 cases with baseline and follow-up. Accomplishment of self-defined goals showed a large correlation with the anchor question, whereas EQ-5D and Katz-15 showed no significant correlations. The final regression model had four predictors: being man, having higher confidence in goal achievement and good/excellent quality of life increased the odds for goal accomplishment, while having goals in the category alleviating complaints reduced the odds. Conclusion Accomplishment of individual goals represented the benefit experienced by participants best. Subjective indicators of health and functioning are better predictors of goal accomplishment than objective ones. According to participant experience, the hospital appeared successful in managing disease-specific problems, but less successful in ameliorating complaints. Medical decision-making should not only be based on medical indicators, but the input of the patient is at least as important. Quality of life, goals and confidence should be discussed. More attention is needed for symptom experience.

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A matter of perspective – Objective versus subjective outcomes in the assessment of quality of recovery

Cited by 11 publications

References 52 publications

The MOTION **Study: A Randomized Controlled Trial with Objective Real-World Outcomes for Lumbar Spinal Stenosis Patients Treated with the mild®** Procedure: One-Year Results

The MOTION **Study: A Randomized Controlled Trial with Objective Real-World Outcomes for Lumbar Spinal Stenosis Patients Treated with the mild®** Procedure: One-Year Results

Adaptation of the Patient Benefit Assessment Scale for Hospitalised Older Patients: development, reliability and validity of the P-BAS picture version

Goal-based outcomes of hospitalisation of older adults are predicted by gender, confidence, quality of life and type of goals

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A matter of perspective – Objective versus subjective outcomes in the assessment of quality of recovery

Cited by 11 publications

References 52 publications

The MOTION Study: A Randomized Controlled Trial with Objective Real-World Outcomes for Lumbar Spinal Stenosis Patients Treated with the mild® Procedure: One-Year Results

The MOTION Study: A Randomized Controlled Trial with Objective Real-World Outcomes for Lumbar Spinal Stenosis Patients Treated with the mild® Procedure: One-Year Results

Adaptation of the Patient Benefit Assessment Scale for Hospitalised Older Patients: development, reliability and validity of the P-BAS picture version

Goal-based outcomes of hospitalisation of older adults are predicted by gender, confidence, quality of life and type of goals

Contact Info

Product

Resources

About

The MOTION **Study: A Randomized Controlled Trial with Objective Real-World Outcomes for Lumbar Spinal Stenosis Patients Treated with the mild®** Procedure: One-Year Results

The MOTION **Study: A Randomized Controlled Trial with Objective Real-World Outcomes for Lumbar Spinal Stenosis Patients Treated with the mild®** Procedure: One-Year Results