Making Rasch decisions: The use of Rasch analysis in the construction of preference based health related quality of life instruments

Objective: To set out the methodological process for using Rasch analysis alongside traditional psychometric methods in the development of a health state classification that is amenable to valuation. Methods: The overactive bladder questionnaire is used to illustrate a four step process for deriving a reduced health state classification from an existing nonpreference based health related quality of life instrument. Step I excludes items that do not meet the initial validation process and step II uses criteria based on Rasch analysis and psychometric testing to select the final items for the health state classification. In step III, item levels are examined and Rasch analysis is used to explore the possibility of reducing the number of item levels. Step IV repeats steps I to III on alternative data sets in order to validate the selection of items for the health state classification. Conclusions: The techniques described enable the construction of a health state classification amenable for valuation exercises that will allow the derivation of preference weights. Thus, the health related quality of life of patients with conditions, like overactive bladder, can be valued and quality adjustment weights such as quality adjusted life years derived

Making Rasch decisions: The use of Rasch analysis in the construction of preference based health related quality of life instruments

Objective: To set out the methodological process for using Rasch analysis alongside traditional psychometric methods in the development of a health state classification that is amenable to valuation. Methods: The overactive bladder questionnaire is used to illustrate a four step process for deriving a reduced health state classification from an existing nonpreference based health related quality of life instrument. Step I excludes items that do not meet the initial validation process and step II uses criteria based on Rasch analysis and psychometric testing to select the final items for the health state classification. In step III, item levels are examined and Rasch analysis is used to explore the possibility of reducing the number of item levels. Step IV repeats steps I to III on alternative data sets in order to validate the selection of items for the health state classification. Conclusions: The techniques described enable the construction of a health state classification amenable for valuation exercises that will allow the derivation of preference weights. Thus, the health related quality of life of patients with conditions, like overactive bladder, can be valued and quality adjustment weights such as quality adjusted life years derived

Making Rasch decisions: the use of Rasch analysis in the construction of preference based health related quality of life instruments

Objective: To set out the methodological process for using Rasch analysis alongside traditional psychometric methods in the development of a health state classification that is amenable to valuation. Methods: The overactive bladder questionnaire is used to illustrate a four step process for deriving a reduced health state classification from an existing nonpreference based health related quality of life instrument. Step I excludes items that do not meet the initial validation process and step II uses criteria based on Rasch analysis and psychometric testing to select the final items for the health state classification. In step III, item levels are examined and Rasch analysis is used to explore the possibility of reducing the number of item levels. Step IV repeats steps I to III on alternative data sets in order to validate the selection of items for the health state classification. Conclusions: The techniques described enable the construction of a health state classification amenable for valuation exercises that will allow the derivation of preference weights. Thus, the health related quality of life of patients with conditions, like overactive bladder, can be valued and quality adjustment weights such as quality adjusted life years derived.Rasch analysis; health related quality of life; condition specific measure; preference-based measures; overactive bladder syndrome

An assessment of the hopping strategy and inter-limb asymmetry during the triple hop test: a test–retest pilot study

The aims of the present study are to: (1) determine within- and between-session reliability of multiple metrics obtained during the triple hop test; and (2) determine any systematic bias in both the test and inter-limb asymmetry scores for these metrics. Thirteen male young American football athletes performed three trials of a triple hop test on each leg on two separate occasions. In addition to the total distance hopped, manual detection of touch down and toe-off were calculated via video analysis, enabling flight time (for each hop), ground contact time (GCT), reactive strength index (RSI), and leg stiffness (between hops) to be calculated. Results showed all coefficient of variation (CV) values were ≤ 10.67% and intraclass correlation coefficients (ICC) ranged from moderate to excellent (0.53–0.95) in both test sessions. Intrarater reliability showed excellent reliability for all metrics (CV ≤ 3.60%, ICC ≥ 0.97). No systematic bias was evident between test sessions for raw test scores (g = −0.34 to 0.32) or the magnitude of asymmetry (g = −0.19 to 0.43). However, ‘real’ changes in asymmetry (i.e., greater than the CV in session 1) were evident on an individual level for all metrics. For the direction of asymmetry, kappa coefficients revealed poor-to-fair levels of agreement between test sessions for all metrics (K = −0.10 to 0.39), with the exception of the first hop (K = 0.69). These data show that, given the inherent limitations of distance jumped in the triple hop test, practitioners can confidently gather a range of reliable data when computed manually, provided sufficient test familiarization is conducted. In addition, although the magnitude of asymmetry appears to show only small changes between test sessions, limb dominance does appear to fluctuate between test sessions, highlighting the value of also monitoring the direction of the imbalance

Ferric Gluconate Yields Cost-Savings in Hemodialysis Patients with High Ferritin and Low TSAT: Results from the DRIVE Studies

Purpose: One third of hemodialysis patients have high serum ferritin levels and low transferrin saturation (TSAT). The purpose of this analysis was to determine the cost effectiveness of administering 1g of sodium ferric gluconate complex (SFGC: also referred to as ferric gluconate) to patients with serum ferritin \u3e500ng/mL and TSAT ≤25% based on the Dialysis Patients Response to IV Iron with Elevated Ferritin (DRIVE) study and its 6-week observational extension (DRIVE-II). In these studies, IV iron administration resulted in reduced epoetin requirements. Methods: Decision analysis was performed using a time horizon of 12 weeks, consistent with the combined duration of DRIVE and DRIVE II. Treatment effectiveness was based on mean increase in hemoglobin (Hb) for each group (SFGC plus epoetin or epoetin alone) in the intention to treat populations. Costs included drugs (SFGC and epoetin) and hospitalizations due to serious adverse events (SAEs) reported. The primary cost effectiveness measure was cost per g/dL of Hb increase at 12 weeks. Costs were computed from a Medicare perspective using projected 2007 reimbursements. Sensitivity analyses were performed to test the impact of using the safety population, median epoetin and SFGC doses, actual 2005 Medicare reimbursements, median increases in Hb, and SAE rate changes. The model was constructed using TreeAge Pro software. Results: Total cost per patient receiving SFGC plus epoetin was $3675 per g/dL Hb increase, while the total cost per patient receiving epoetin alone was$5065 per g/dL Hb increase. Net savings for SFGC plus epoetin was $1390 per g/dL Hb increase over the 12 week period Sensitivity analyses affirmed the robustness of the model. Conclusion: Administering 1g of SFGC plus epoetin in patients with high ferritin and low TSAT as defined in the DRIVE studies resulted in significant cost-savings compared to epoetin alone

Abuse in the caregiving relationship between older people with memory disorders and family caregivers: A systematic review

Aim To synthesize what is known about elder abuse and relationship factors associated with abuse between caregivers and older people with memory disorders at home. Background Concerns about abuse in the caring relationship between older people with memory disorders and family caregivers have increased. Abuse is associated with negative outcomes on older people's health, quality of life, and zest for life. Abuse in the caring relationship manifests in financial exploitation, neglect, mistreatment, and physical issues. Design Systematic review. Data Sources Databases including Scopus, PubMed/Medline, SveMed+, Cinalh, SonINDEX, and ProQuest were searched using keywords about abuse in the caring relationship between older people with memory disorders and family caregivers at home. Articles published between 2005–2019 were retrieved and underwent data analysis and knowledge synthesis. Review Methods The review was presented under the categories of the dyadic approach of elder abuse in connection with the role of caregiver (risk) and care recipient (vulnerability) by Fulmer et al. (2005). Results The search process led to 12 quantitative studies, including an intervention, a prospective, nine surveys, and a cross‐sectional structural interview. Findings were synthesized and presented under ‘personal’, ‘physical and psychological’, and ‘social’ domains indicating the bilateral roles of caregiver and care recipient leading to abuse. Conclusion This review depicted factors influencing abuse in the caring relationship between older people with memory disorders and their family caregivers at home. They included family caregivers’ psychological issues, knowledge of memory disorders and modifications, previous caring relationship, social support, number of care recipients, and care recipients’ functional level. Impact This review identifies what influences elder abuse by family caregivers using the dyadic approach and explains how abuse can be prevented through suggested strategies. The review findings are relevant to multidisciplinary healthcare providers and can guide the provision of support, screening and assessment, educational programs, and legislative initiatives

Living Well on Haemodialysis: feasibility and acceptability trial of an online Acceptance and Commitment Therapy (ACT) programme for people receiving kidney haemodialysis

Background People receiving kidney haemodialysis need psychological support. Objectives To assess feasibility and acceptability of a 4-week online video-based Acceptance and Commitment Therapy (ACT) programme for people receiving kidney haemodialysis. Design Single group before-and-after study. Participants People with end-stage kidney disease currently receiving dialysis, who had received in-centre haemodialysis at least 90 days in the last two years. Measures Recruitment, retention and engagement (feasibility); weekly and post-programme feedback (acceptability); pre-intervention and 4-week follow-up (potential outcome measures): kidney disease quality of life (KDQOL-SF), psychological flexibility (Acceptance and Action Scale) and acceptance of illness (Acceptance of Illness Scale). Results The study recruited 13 participants of whom 85% completed at least half the programme and 69% completed the whole programme. Health and medical treatment issues were the main known reasons for non-participation and drop-out. Of the 16 separate elements of the programme (four ‘story’ videos and 12 videos explaining ACT techniques), 13 were positively evaluated by at least 75% of participants. Of 11 aspects of the programme, 8 were positively evaluated by at least 75% of participants, and 89% found the programme easy to use, understood how it worked, found it easy to access, trusted the information, had no technical difficulties, and understood the activities. However, only 66.7% agreed the programme was interesting and only 62.5% agreed they enjoyed the programme. All responding participants indicated they would recommend the programme to people starting dialysis. The direction of change was positive for 17/21 potential outcome measures, with significant (p < 0.05) improvements in psychological flexibility and energy/fatigue. Conclusions An online video-based ACT intervention was feasible and acceptable for people receiving kidney haemodialysis and the results provide pilot data for a planned larger trial

Pre-pregnancy predictors of hypertension in pregnancy among Aboriginal and Torres Strait Islander women in north Queensland, Australia; a prospective cohort study

BACKGROUND Compared to other Australian women, Indigenous women are frequently at greater risk for hypertensive disorders of pregnancy. We examined pre-pregnancy factors that may predict hypertension in pregnancy in a cohort of Aboriginal and Torres Strait Islander women in north Queensland. METHODS Data on a cohort of 1009 Indigenous women of childbearing age (15–44 years) who participated in a 1998–2000 health screening program in north Queensland were combined with 1998–2008 Queensland hospitalisations data using probabilistic data linkage. Data on the women in the cohort who were hospitalised for birth (n = 220) were further combined with Queensland perinatal data which identified those diagnosed with hypertension in pregnancy. RESULTS Of 220 women who gave birth, 22 had hypertension in the pregnancy after their health check. The mean age of women with and without hypertension was similar (23.7 years and 23.9 years respectively) however Aboriginal women were more affected compared to Torres Strait Islanders. Pre-pregnancy adiposity and elevated blood pressure at the health screening program were predictors of a pregnancy affected by hypertension. After adjusting for age and ethnicity, each 1 cm increase in waist circumference showed a 4% increased risk for hypertension in pregnancy (PR 1.04; 95% CI; 1.02-1.06); each 1 point increase in BMI showed a 9% adjusted increase in risk (1.09; 1.04-1.14). For each 1 mmHg increase in baseline systolic blood pressure there was an age and ethnicity adjusted 6% increase in risk and each 1 mmHg increase in diastolic blood pressure showed a 7% increase in risk (1.06; 1.03-1.09 and 1.07; 1.03-1.11 respectively). Among those free of diabetes at baseline, the presence of the metabolic syndrome (International Diabetes Federation criteria) predicted over a three-fold increase in age-ethnicity-adjusted risk (3.5; 1.50-8.17). CONCLUSIONS Pre-pregnancy adiposity and features of the metabolic syndrome among these young Aboriginal and Torres Strait Islander women track strongly to increased risk of hypertension in pregnancy with associated risks to the health of babies.Sandra K Campbell, John Lynch, Adrian Esterman and Robyn McDermot