Alison Woodcock

Problems with the performance of the SF-36 among people with type 2 diabetes in general practice.

Objective: To validate the short form-36 (SF-36) among people with type 2 diabetes in general practice, and to make comparisons with the Audit of Diabetis Dependent Quality of Life (ADDQoL). Design: Postal survey with one reminder. Setting: Four general practices. Patients: One hundred and eighty-four eligible patients (30–70 years) with type 2 diabetes on 14 general practitioner lists. Measures: SF-36 response rates, distribution of dimension scores and internal consistency. Median scores in relation to sociodemography and self-reported health. Comparisons with ADDQoL scores. Results: One hundred and thirty-one patients responded (71%). Distributions of SF-36 dimension scores were mostly skewed. Internal consistency and construct validity were acceptable, with predictable sociodemographic trends. People with illness related to or unrelated to diabetes scored significantly lower on most dimensions. SF-36 dimension scores correlated best with relevant diabetes-specific ADDQoL scores amongst respondents reporting no comorbidity. Conclusions: Although valid and reliable, SF-36 scores are strongly affected by non-diabetic comorbidity in type 2 diabetes, supporting the complementary use of a diabetes-specific measure, providing information about the impact of diabetes specifically.

Diabetes care from diagnosis: effects of training in patient-centred care on beliefs, attitudes and behaviour of primary care professionals.

In a randomised trial, general practitioners and nurses in 21 practices were trained in patient-centred consulting and use of materials for people with Type 2 diabetes (GPs 0.5 days; nurses 1.5 days; two optional follow-up half-days). Twenty practices formed the comparison group. Professional beliefs, attitudes and behaviour were measured (pre-trial, close-of-course and end-of-trial), supported by patient reports of nurse behaviour (141 trained: 108 comparison patients, 1 year after diagnosis). A total of 49 practice nurses responded (29 trained; 20 comparison). Trained nurses rated relative importance of patient-centred to professional-centred care as greater than comparison nurses. Trained nurses became less keen on the approach during the trial, and perceived time constraints persisted. Patients diagnosed later in the study were less likely to recognise intervention materials. Trained nurses rated delivery of important aspects of care and satisfaction with style of care as lower than comparison nurses, but patients were more positive about delivery of care from trained than comparison nurses. Although nurses rated patient-centred care as important, whether or not they had been trained as part of the trial, the short, generalizable training programme significantly reduced nurse perceptions of their ability to deliver it. Nonetheless, patients reported that important aspects of diabetes care were delivered more if their nurses had been trained in patient-centred consulting. This raises issues concerning measurement scales completed by trained professionals.

A primary care nurse-delivered walking intervention in older adults: PACE (pedometer accelerometer consultation evaluation)-lift cluster randomised controlled trial

Background Brisk walking in older people can increase step-counts and moderate to vigorous intensity physical activity (MVPA) in ≥10-minute bouts, as advised in World Health Organization guidelines. Previous interventions have reported step-count increases, but not change in objectively measured MVPA in older people. We assessed whether a primary care nurse-delivered complex intervention increased objectively measured step-counts and MVPA. Methods and Findings A total of 988 60–75 year olds, able to increase walking and randomly selected from three UK family practices, were invited to participate in a parallel two-arm cluster randomised trial; randomisation was by household. Two-hundred-ninety-eight people from 250 households were randomised between 2011 and 2012; 150 individuals to the intervention group, 148 to the usual care control group. Intervention participants received four primary care nurse physical activity (PA) consultations over 3 months, incorporating behaviour change techniques, pedometer step-count and accelerometer PA intensity feedback, and an individual PA diary and plan. Assessors were not blinded to group status, but statistical analyses were conducted blind. The primary outcome was change in accelerometry assessed average daily step-counts between baseline and 3 months, with change at 12 months a secondary outcome. Other secondary outcomes were change from baseline in time in MVPA weekly in ≥10-minute bouts, accelerometer counts, and counts/minute at 3 months and 12 months. Other outcomes were adverse events, anthropometric measures, mood, and pain. Qualitative evaluations of intervention participants and practice nurses assessed the intervention’s acceptability. At 3 months, eight participants had withdrawn or were lost to follow-up, 280 (94%) individuals provided primary outcome data. At 3 months changes in both average daily step-counts and weekly MVPA in ≥10-minute bouts were significantly higher in the intervention than control group: by 1,037 (95% CI 513–1,560) steps/day and 63 (95% CI 40–87) minutes/week, respectively. At 12 months corresponding differences were 609 (95% CI 104–1,115) steps/day and 40 (95% CI 17–63) minutes/week. Counts and counts/minute showed similar effects to steps and MVPA. Adverse events, anthropometry, mood, and pain were similar in the two groups. Participants and practice nurses found the intervention acceptable and enjoyable. Conclusions The PACE-Lift trial increased both step-counts and objectively measured MVPA in ≥10-minute bouts in 60–75 year olds at 3 and 12 months, with no effect on adverse events. To our knowledge, this is the first trial in this age group to demonstrate objective MVPA increases and highlights the value of individualised support incorporating objective PA assessment in a primary care setting. Trial Registration Controlled-Trials.com ISRCTN42122561

Psychometric evaluation of the MacDQoL individualised measure of the impact of macular degeneration on quality of life

BackgroundThe MacDQoL is an individualised measure of the impact of macular degeneration (MD) on quality of life (QoL). There is preliminary evidence of its psychometric properties and sensitivity to severity of MD. The aim of this study was to carry out further psychometric evaluation with a larger sample and investigate the measures sensitivity to MD severity.MethodsPatients with MD (n = 156: 99 women, 57 men, mean age 79 ± 13 years), recruited from eye clinics (one NHS, one private) completed the MacDQoL by telephone interview and later underwent a clinic vision assessment including near and distance visual acuity (VA), comfortable near VA, contrast sensitivity, colour recognition, recovery from glare and presence or absence of distortion or scotoma in the central 10° of the visual field.ResultsThe completion rate for the MacDQoL items was 99.8%. Of the 26 items, three were dropped from the measure due to redundancy. A fourth was retained in the questionnaire but excluded when computing the scale score. Principal components analysis and Cronbachs alpha (0.944) supported combining the remaining 22 items in a single scale. Lower MacDQoL scores, indicating more negative impact of MD on QoL, were associated with poorer distance VA (better eye r = -0.431 p < 0.001; worse eye r = -0.350 p < 0.001; binocular vision r = -0.419 p < 0.001) and near VA (better eye r = -0.326 p < 0.001; worse eye r = -0.226 p < 0.001; binocular vision r = -0.326 p < 0.001). Poorer MacDQoL scores were associated with poorer contrast sensitivity (better eye r = 0.392 p < 0.001; binocular vision r = 0.423 p < 0.001), poorer colour recognition (r = 0.417 p < 0.001) and poorer comfortable near VA (r = -0.283, p < 0.001). The MacDQoL differentiated between those with and without binocular scotoma (U = 1244 p < 0.001).ConclusionThe MacDQoL 22-item scale has excellent internal consistency reliability and a single-factor structure. The measure is acceptable to respondents and the generic QoL item, MD-specific QoL item and average weighted impact score are related to several measures of vision. The MacDQoL demonstrates that MD has considerable negative impact on many aspects of QoL, particularly independence, leisure activities, dealing with personal affairs and mobility. The measure may be valuable for use in clinical trials and routine clinical care.

Validation of the HIV Treatment Satisfaction Questionnaire (HIVTSQ)

Human immunodeficiency virus (HIV) therapies need to be both effective and acceptable. The 10-item HIV Treatment Satisfaction Questionnaire (HIVTSQ) was validated amongst 150 HIV-1 sero-positive individuals, receiving one of two protease inhibitors as part of combined therapy in an open-label randomised trial. Scale and subscale scoring was determined psychometrically. It was hypothesised that satisfaction with control would be greater amongst those with lower viral loads, satisfaction with side-effects would be inversely related to severity of adverse events and satisfaction with the new treatment would be greater than with the control treatment. Principal components analyses suggested that patient ratings of nine items can be summed to compute the total satisfaction scale (Cronbachs α 0.82), and/or divided into subscales: general satisfaction/clinical (α 0.80) and lifestyle/ease (α 0.74). One item (asking how demanding the treatment was) needs modification before inclusion. The HIVTSQ showed construct validity: viral load correlated negatively (Spearmans r − 0.33 p < 0.01) with satisfaction with HIV control; those with <400 copies HIV-1 RNA/ml were more satisfied with HIV control than those with higher viral loads (Mann–Whitney p < 0.01); adverse event grade correlated r − 0.18 (p < 0.05) with satisfaction with side-effects. The HIVTSQ was sensitive to differences between groups: compared with patients in the control group, those receiving the new treatment had significantly higher perceived flexibility and lifestyle/ease scores at week 8 (Mann–Whitney p < 0.01). Patient perceptions did not simply mirror clinical measures, highlighting the importance of measuring patient views.

Patient-reported outcomes following islet cell or pancreas transplantation (alone or after kidney) in Type 1 diabetes: a systematic review

Diabet. Med. 27, 812–822 (2010)

The MacDQoL Individualized Measure of the Impact of Macular Degeneration on Quality of Life: Reliability and Responsiveness

PURPOSE To investigate the MacDQoL test-retest reliability and sensitivity to change in vision over a period of one year in a sample of patients with age-related macular degeneration (AMD). DESIGN A prospective, observational study. METHOD Patients with AMD from an ophthalmologists list (n = 135) completed the MacDQoL questionnaire by telephone interview and underwent a vision assessment on two occasions, one year apart. RESULTS Among participants whose vision was stable over one year (n = 87), MacDQoL scores at baseline and follow-up were highly correlated (r = 0.95; P < .0001). Twelve of the 22 scale items had intraclass correlations of >.80; only two were correlated <.7. There was no difference between baseline and follow-up scores (P = .85), indicating excellent test-retest reliability. Poorer quality of life (QoL) at follow-up, measured by the MacDQoL present QoL overview item, was associated with deterioration in both the better eye and binocular distance visual acuity [VA] (r = 0.29; P = .001, r = 0.21; P = .016, respectively; n = 135). There was a positive correlation between deterioration in the MacDQoL average weighted impact score and deterioration in both binocular near VA and reading speed (r = 0.20; P = .019, r = 0.18; P = .041, respectively; n = 135). CONCLUSION The MacDQoL has excellent test-retest reliability. Its sensitivity to change in vision status was demonstrated in correlational analyses. The measure indicates that the negative impact of AMD on QoL increases with increasing severity of visual impairment.

Fermented milk containing Bifidobacterium lactis DN-173 010 improved self-reported digestive comfort amongst a general population of adults. A randomized, open-label, controlled, pilot study.

AIM:  Some probiotics improve digestive comfort of people with Irritable Bowel Syndrome, but this needs confirmation in a healthy population. The objective of this pilot study was to investigate the effect of consuming fermented milk containing the probiotics Bifidobacterium lactis DN‐173010 and yoghourt strains (test product) on digestive comfort and symptoms amongst adults without diagnosed gastrointestinal disorders.

Developing a training programme in patient-centred consulting for evaluation in a randomised controlled trial; diabetes care from diagnosis in British primary care

AIM To develop a feasible/theoretically based training programme in patient-centred consulting, for evaluation in a randomised controlled trial of diabetes care from diagnosis. METHODS The programme was developed with four primary care teams and their patients in an action research framework, with observation of diabetes review consultations before and after training, and evaluated by questionnaire after each training session, among 23 general practitioners and 32 practice nurses from 21 practices in the trial. RESULTS The observation study identified opportunities and obstacles to introducing a patient-centred approach into daily practice, especially in relation to time management and skill needs. The modified training programme was rated highly by participating general practitioners and nurses. CONCLUSIONS Developing training programmes with the help of participating primary care teams ensures relevance and feasibility. Patient-centred consulting demands a shift from habitual consulting patterns. Practitioners are implementing the approach in practice, and the impact on patients is now under evaluation in the randomised controlled trial.

Returning Back Pain Patients to Work: How Private Musculoskeletal Practitioners Outside the National Health Service Perceive Their Role (an Interview Study)

Background Private musculoskeletal practitioners treat a large section of people with back pain, and could play an important role in returning and maintaining patients to work. Method We conducted a qualitative study to explore the self-perceived role of such practitioners in the UK. We interviewed 44 practitioners, including chiropractors, osteopaths and physiotherapists. Results Thematic analysis of the interview transcripts indicated that return to work is a high priority for patients, many of whom are self-employed. Although in general work was perceived as beneficial to health, practitioners perceived work as a threat for some of their back pain patients. They perceived their role as giving ergonomic, postural and exercise based advice, but were more reluctant to address psychosocial problems related to back pain. A common view was that patients’ reluctance to take a break from work impacted badly on their condition, and many practitioners advocated a short time off work duties to focus on rehabilitation. Contact with employers was very limited, and determined by the patients’ request. Conclusion In summary, the study identifies several areas in which further education could expand the role of musculoskeletal practitioners and benefit their back pain patients. However, further study is required to determine whether these results are generalisable beyond the limits of this qualitative study UK based study.