Psychometric properties of the Brief Pain Inventory among patients with osteoarthritis undergoing total hip replacement surgery

<p>Abstract</p> <p>Background</p> <p>Pain is a cardinal symptom of osteoarthritis (OA) of the hip and important for deciding when to operate. This study assessed the internal consistency reliability, validity and responsiveness of the Brief Pain Inventory (BPI) among patients with OA undergoing total hip replacement (THR).</p> <p>Methods</p> <p>We prospectively included 250 of 356 patients who were accepted to the waiting list for primary THR surgery. All participants responded to the BPI, WOMAC and SF-36 at baseline and 1 year after surgery.</p> <p>Results</p> <p>Internal consistency reliability (Cronbach's α) was >0.80 for the BPI, the WOMAC and five of the eight SF-36 scales The pattern of associations of the two BPI scales with corresponding and non-corresponding scales of the WOMAC and SF-36 largely supported the construct validity of the BPI. The responsiveness indices for change from baseline to 1 year after THR ranged from 1.52 to 2.05 for the BPI scales, from 1.69 to 2.84 for the WOMAC scales, and from 0.25 (general health) to 2.77 (bodily pain) for the SF-36 scales.</p> <p>Conclusions</p> <p>The BPI showed acceptable reliability, construct validity and responsiveness in patients with OA undergoing THR. BPI is short and therefore is easy to use and score, though the instrument offers few advantages over and duplicates scales of more comprehensive instruments, such as the WOMAC and SF-36.</p

Ord- og setningsforståing i lys av spesifikke språkvanskar : ei samanlikning av utvikling av ordforståing og setningsforståing hos ei gruppe barn med svak språkforståing og ei gruppe barn med typisk utvikling

Bakgrunn og føremål: Undersøkinga er ein delstudie knytt til studien ”Ut med språket” (UMS). UMS-studien er eit samarbeid mellom Statped Vest, Universitetet i Bergen og ein kommune i kvart av fylka, Rogaland, Hordaland, Sogn og Fjordane og Møre og Romsdal. Studien er longitudinell og omfattar barn frå 5-8 år der føremålet er å identifisere 5-åringar som står i fare for å utvikle lese-, skrive- og/eller matematikkvanskar, utgreie dei med eit sett av kognitive testar og trene dei med databaserte treningsprogram. Føremålet med delstudien er å samanlikne dei barna i UMS-studien som har svakast språkforståing ved 5 års alder (språksvakegruppa) på deira utvikling av ord- og setningsforståing, med dei resterande barna (typiskgruppa) ved 6, 7, og 8 års alder. Det er også av interesse å sjå om der i språksvakegruppa, er barn i risikosona for å ha spesifikke språkvanskar (SSV). Resultat og konklusjon: Analysane viser at det ikkje er ein signifikant skilnad mellom språksvakegruppa og typiskgruppa på ordforståing, medan det er ein signifikant skilnad mellom gruppene på setningsforståing. Den signifikante skilnaden mellom gruppene på setningsforståing, kan gi indikasjonar på at enkelte av barna i utvalet har SSV. Vanskar med grammatikken ser ut til å vere ein sentral vanske for SSV barn, og sensitive risikomarkørar er morfologi og syntaks. I fylgje dagens forsking, er hypotesa om begrensa prosesseringskapasitet i arbeidsminnet sentral i forståinga av barn med SSV. Ved hjelp av TROG, ser det ut som om ein kan få informasjon om både grammatiske vanskar og mogleg avgrensa spennvidde i prosesseringa og/eller minnet

Ord- og setningsfortåing i lys av spesifikke språkvanskar : ei samanlikning av utvikling av ordforståing og setningsforståing hos ei gruppe barn med svak språkforståing og ei gruppe barn med typisk utvikling

Bakgrunn og føremål Undersøkinga er ein delstudie knytt til studien ”Ut med språket” (UMS). UMS-studien er eit samarbeid mellom Statped Vest, Universitetet i Bergen og ein kommune i kvart av fylka, Rogaland, Hordaland, Sogn og Fjordane og Møre og Romsdal. Studien er longitudinell og omfattar barn frå 5-8 år der føremålet er å identifisere 5-åringar som står i fare for å utvikle lese-, skrive- og/eller matematikkvanskar, utgreie dei med eit sett av kognitive testar og trene dei med databaserte treningsprogram. Føremålet med delstudien er å samanlikne dei barna i UMS-studien som har svakast språkforståing ved 5 års alder (språksvakegruppa) på deira utvikling av ord- og setningsforståing, med dei resterande barna (typiskgruppa) ved 6, 7, og 8 års alder. Det er også av interesse å sjå om der i språksvakegruppa, er barn i risikosona for å ha spesifikke språkvanskar (SSV). Problemstilling Undersøkinga si problemstilling er formulert i to punkt: • Har gruppa med svak språkforståing ved 5 års alder utvikla seg signifikant annleis frå 6 – 8 år på ord- og setningsforståing enn gruppa med ei typisk utvikling målt med BPVS og TROG? Korleis kan ein i så fall beskrive og forklare skilnaden? • Er der ei undergruppe barn i språksvakegruppa som kan seiast å vere i risikosona for å ha spesifikke språkvanskar (SSV)? Metode Metoden er kvantitativ, og undersøkinga har eit kvasieksperimentelt design. Datamaterialet er samla inn ved hjelp av testar. Utvalet består av totalt 44 barn som er delt inn i to grupper på bakgrunn av prestasjonar på språktestane BPVS og TROG ved 5 års alder. Statistikkprogrammet Statistica er brukt for bearbeiding og systematisering av datamaterialet. Det blir brukt både ein ikkje-parametrisk og ein parametrisk tilnærming til analyse av data. Resultat og konklusjon Analysane viser at det ikkje er ein signifikant skilnad mellom språksvakegruppa og typiskgruppa på ordforståing, medan det er ein signifikant skilnad mellom gruppene på setningsforståing. Den signifikante skilnaden mellom gruppene på setningsforståing, kan gi indikasjonar på at enkelte av barna i utvalet har SSV. Vanskar med grammatikken ser ut til å vere ein sentral vanske for SSV barn, og sensitive risikomarkørar er morfologi og syntaks. I fylgje dagens forsking, er hypotesa om begrensa prosesseringskapasitet i arbeidsminnet sentral i forståinga av barn med SSV. Ved hjelp av TROG, ser det ut som om ein kan få informasjon om både grammatiske vanskar og mogleg avgrensa spennvidde i prosesseringa og/eller minnet

Cutpoints for mild, moderate and severe pain in patients with osteoarthritis of the hip or knee ready for joint replacement surgery

<p>Abstract</p> <p>Background</p> <p>Cutpoints (CPs) for mild, moderate and severe pain are established and used primarily in cancer pain. In this study, we wanted to determine the optimal CPs for mild, moderate, and severe pain in joint replacement surgery candidates with osteoarthritis (OA) of the hip or knee, and to validate the different CPs.</p> <p>Methods</p> <p>Patients (n = 353) completed the Brief Pain Inventory (BPI), the WOMAC Arthritis Index, and the SF-36 health status measure. Optimal CPs for categorizing average pain with three severity levels were derived using multivariate analysis of variance, using different CP sets for average pain as the independent variable and seven interference items from the BPI as the dependent variable. To validate the CPs, we assessed if patients in the three pain severity groups differed in pain as assessed with WOMAC and SF-36, and if BPI average pain with the optimal CPs resulted in higher correlation with pain dimensions of the WOMAC and SF-36 than other CPs.</p> <p>Results</p> <p>The optimal CPs on the 0–10 point BPI scale were CP (4,6) among hip patients and CP (4,7) among knee patients. The resulting pain severity groups differed in pain, as assessed with other scales than those used to derive the CPs. The optimal CPs had the highest association of average pain with WOMAC pain scores.</p> <p>Conclusion</p> <p>CPs for pain severity differed somewhat for patients with OA of the hip and knee. The association of BPI average pain scores categorized according to the optimal CPs with WOMAC pain scores supports the validity of the derived optimal CPs.</p

Interventions for the treatment of oral cavity and oropharyngeal cancer:chemotherapy

&lt;b&gt;Background:&lt;/b&gt; Oral cavity and oropharyngeal cancers are frequently described as part of a group of oral cancers or head and neck cancer. Treatment of oral cavity cancer is generally surgery followed by radiotherapy, whereas oropharyngeal cancers, which are more likely to be advanced at the time of diagnosis, are managed with radiotherapy or chemoradiation. Surgery for oral cancers can be disfiguring and both surgery and radiotherapy have significant functional side effects, notably impaired ability to eat, drink and talk. The development of new chemotherapy agents, new combinations of agents and changes in the relative timing of surgery, radiotherapy, and chemotherapy treatments may potentially bring about increases in both survival and quality of life for this group of patients.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Objectives:&lt;/b&gt; To determine whether chemotherapy, in addition to radiotherapy and/or surgery for oral cavity and oropharyngeal cancer results in improved survival, disease free survival, progression free survival, locoregional control and reduced recurrence of disease. To determine which regimen and time of administration (induction, concomitant or adjuvant) is associated with better outcomes.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Search strategy:&lt;/b&gt; Electronic searches of the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE, AMED were undertaken on 28th July 2010. Reference lists of recent reviews and included studies were also searched to identify further trials.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Selection criteria:&lt;/b&gt; Randomised controlled trials where more than 50% of participants had primary tumours in the oral cavity or oropharynx, and which compared the addition of chemotherapy to other treatments such as radiotherapy and/or surgery, or compared two or more chemotherapy regimens or modes of administration, were included.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Data collection and analysis:&lt;/b&gt; Trials which met the inclusion criteria were assessed for risk of bias using six domains: sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting and other possible sources of bias. Data were extracted using a specially designed form and entered into the characteristics of included studies table and the analysis sections of the review. The proportion of participants in each trial with oral cavity and oropharyngeal cancers are recorded in Additional Table 1.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Main results:&lt;/b&gt; There was no statistically significant improvement in overall survival associated with induction chemotherapy compared to locoregional treatment alone in 25 trials (hazard ratio (HR) of mortality 0.92, 95% confidence interval (CI) 0.84 to 1.00). Post-surgery adjuvant chemotherapy was associated with improved overall survival compared to surgery +/- radiotherapy alone in 10 trials (HR of mortality 0.88, 95% CI 0.79 to 0.99), and there was an additional benefit of adjuvant concomitant chemoradiotherapy compared to radiotherapy in 4 of these trials (HR of mortality 0.84, 95% CI 0.72 to 0.98). Concomitant chemoradiotherapy resulted in improved survival compared to radiotherapy alone in patients whose tumours were considered unresectable in 25 trials (HR of mortality 0.79, 95% CI 0.74 to 0.84). However, the additional toxicity attributable to chemotherapy in the combined regimens remains unquantified.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Authors' conclusions:&lt;/b&gt; Chemotherapy, in addition to radiotherapy and surgery, is associated with improved overall survival in patients with oral cavity and oropharyngeal cancers. Induction chemotherapy is associated with a 9% increase in survival and adjuvant concomitant chemoradiotherapy is associated with a 16% increase in overall survival following surgery. In patients with unresectable tumours, concomitant chemoradiotherapy showed a 22% benefit in overall survival compared with radiotherapy alone.&lt;p&gt;&lt;/p&gt

Decline in Health-Related Quality of Life reported by more than half of those waiting for joint replacement surgery: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>In many healthcare systems, people with severe joint disease wait months to years for joint replacement surgery. There are little empirical data on the health consequences of this delay and it is unclear whether people with substantial morbidity at entry to the waiting list continue to deteriorate further while awaiting surgery. This study investigated changes in Health-Related Quality of Life (HRQoL), health status and psychological distress among people waiting for total hip (THR) and knee replacement (TKR) surgery at a major metropolitan Australian public hospital.</p> <p>Methods</p> <p>134 patients completed questionnaires including the Assessment of Quality of Life (AQoL) instrument, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kessler Psychological Distress Scale after entering an orthopaedic waiting list (baseline) and before surgery (preadmission). To quantify potential decline in wellbeing, we calculated the proportion of people experiencing clinically important deterioration using published guidelines and compared HRQoL and psychological distress outcomes with population norms.</p> <p>Results</p> <p>Most participants (69%) waited ≥6 months for surgery (median 286 days, IQR 169-375 days). Despite poor physical and psychological wellbeing at baseline, there was an overall deterioration in HRQoL during the waiting period (mean AQoL change -0.04, 95%CI -0.08 to -0.01), with 53% of participants experiencing decline in HRQoL (≥0.04 AQoL units). HRQoL prior to surgery remained substantially lower than Australian population norms (mean sample AQoL 0.37, 95%CI 0.33 to 0.42 vs mean population AQoL 0.83, 95%CI 0.82 to 0.84). Twenty-five per cent of participants showed decline in health status (≥9.6 WOMAC units) over the waiting period and prevalence of high psychological distress remained high at preadmission (RR 3.5, 95%CI 2.8 to 4.5). Most participants considered their pain (84%), fatigue (76%), quality of life (73%) and confidence in managing their health (55%) had worsened while waiting for surgery.</p> <p>Conclusions</p> <p>Despite substantial initial morbidity, over half of the participants awaiting joint replacement experienced deterioration in HRQoL during the waiting period. These data provide much-needed evidence to guide health professionals and policymakers in the design of care pathways and resource allocation for people who require joint replacement surgery.</p