Meaningful change in cancer-specific quality-of-life scores: Differences between improvement and worsening
ABSTRACT There has been increased recent attention to the clinical meaningfulness of group change scores on health-related quality of life (HRQL) questionnaires. It has been assumed that improvements and declines of comparable magnitude have the same meaning or value.
We assessed 308 cancer patients with the Functional Assessment of Cancer Therapy (FACT) and a Global Rating of Change. Patients were classified into five levels of change in HRQL and its dimensions based upon their responses to retrospective ratings of change after 2 months: sizably worse, minimally worse, no change, minimally better, and sizably better. Raw score and standardized score changes on the FACT-G subscales and total score were then compared across different categories of patient-rated change.
The relationship between actual FACT change scores and retrospective ratings of change was modest but usually statistically significant (r: 0.07 to 0.35). Change scores associated with each retrospective rating category were evaluated to determine estimates of meaningful difference. Patients who reported global worsening of HRQL dimensions had considerably larger change scores than those reporting comparable global improvements. Although related to a ceiling effect, this remained true even after removing cases that began near the ceiling of the questionnaire.
Relatively small gains in HRQL have significant value. Comparable declines may be less meaningful, perhaps due to patients' tendency to minimize personal negative evaluations about one's condition. This has important implications for the interpretation of the meaningfulness of change scores in HRQL questionnaires. Factors such as adaptation to disease, response shift, dispositional optimism and the need for signs of clinical improvement may be contributing to the results and should be investigated in future studies.
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ABSTRACT: In recent years, the popularity of ultramarathons has increased. During these com-petitions, musculoskeletal problems are very common. Among the more frequent of those problems is the onset of muscle pain, which is defined in the literature as delayed-onset mus-cle soreness (DOMS). The present study aimed to collect epidemiological data regarding the onset of musculoskel-etal problems during the Tor des Geants (International ultramarathon race of 330 km in length and 24,000 m in elevation difference) and to describe the effects of massage on reducing pain and overall perceived improvement in a sample of 25 athletes who complained of DOMS. Two hundred and twenty-one treatments were performed on 220 ultramarathon runners, of which 207 were males and 34 were females; the age group most represented ranged from 40 to 50 years. The most common symptom was pain, which occurred in more than 95% of cases, and the most affected area was the lower extremities (90% of subjects). In the analysed subjects, treatment with massage generated a significant (p < 0.0001) improvement. The numeric pain rating scale (NPRS) value was 3.6 points on average (SD 2.1) after massage, and there were no cases of worsening DOMS after massage as determined using the patient global impression of change (PGIC). The values of minimal clinically important difference (MCID) in DOMS manage-ment were calculated on the basis of the ROC curves and two other anchor-based methods in the PGIC and were 2.8e3.9 points on the NPRS. In the context analysed, massage was an effec-tive treatment to reduce DOMS during the onset of symptoms.Journal of bodywork and movement therapies 11/2014; DOI:10.1016/j.jbmt.2014.11.008
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ABSTRACT: Multi-item questionnaires are frequently used to measure outcomes in randomized controlled trials (RCTs) in patients with sciatica. Knowing the minimaly important change (MIC) values for these instruments will facilitate interpretation of change scores. MIC values have been shown to be dependent on baseline values. The question is whether they also depend on the type of intervention. To estimate the MIC of the Roland Morris Disability Questionnaire (modified 23 item version) (RMDQ) and of intensity of leg pain measured by a Visual Analogue Scale (VAS) in patients with sciatica and to assess to what extent MIC values depend on type of intervention and on baseline values. This is a secondary analysis of RCT data of the effects of early surgery vs. prolonged conservative treatment in patients with sciatica. Baseline and 8-week data were used to assess MIC of the RMDQ-23 and VAS leg pain. We used the receiver operator characteristic (ROC) method to assess the MIC. Global Perceived Recovery (rated 8 weeks after baseline) was used as anchor. Subgroups were created based on type of treatment and baseline severity. The MIC value of the RMDQ-23 for the total group of sciatica patients was 7.5. The values were 8.1 and 6.9 for surgery and conservative treatment, respectively. For high and low baseline values, the MICs were 9.0 and 4.9, respectively, irrespective of treatment received. The MIC values of the VAS leg pain were 34.4 for the total group. For surgery and conservative treatment, the MIC values were 38.5 and 30.4, respectively, whereas for groups with high and low baseline values, MIC values of 53.5 and 17.2 were found. The MIC values of the RMDQ-23 and VAS leg pain were found to be highly dependent on their baseline values, although the type of intervention appeared to influence the MIC value only slightly. Copyright © 2014 Elsevier Inc. All rights reserved.Journal of Clinical Epidemiology 11/2014; DOI:10.1016/j.jclinepi.2014.07.008 · 5.48 Impact Factor
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ABSTRACT: This is the first extensive interdisciplinary research in Romania focusing on psychosocial aspects of hospitalized adult cancer patients that includes data from a multi-center questionnaire screening and multivariate analysis. According to the tumor location, our mixed sample includes 420 adult oncology patients, 342 with malignant and 78 with benign tumors. Results show that in our sample 16.9% of cancer patients are not aware of their oncologic diagnosis, 47.5% are clinically depressed, 46.7% experience anxiety disorders and 28.1% report low quality of life. Based on our results, we propose the routine use of self-administered questionnaires for better identification of psychosocial needs. (C) 2013 The Authors. Published by Elsevier Ltd.Procedia - Social and Behavioral Sciences 07/2013; 82:32-38. DOI:10.1016/j.sbspro.2013.06.221