R. Trafford Crump

Analyzing the 22-item Sino-Nasal Outcome Test using item response theory

The 22‐item Sino‐Nasal Outcome Test (SNOT‐22) is a widely applied patient‐reported outcome instrument used to assess the severity of symptoms associated with chronic rhinosinusitis. The purpose of this study was to evaluate the measurement performance of the SNOT‐22 instrument on an item‐level basis, in a sample of patients awaiting elective surgery for chronic rhinosinusitis.

Reliability, Validity, and Feasibility of Direct Elicitation of Children's Preferences for Health States: A Systematic Review.

Background. Children’s preferences for health states represent an important perspective when comparing the value of alternative health care interventions related to pediatric medicine, and are fundamental to comparative effectiveness research. However, there is debate over whether these preference data can be collected and used. Purpose. The purpose of this study was to establish psychometric properties of eliciting preferences for health states from children using direct methods. Data Sources. Ovid Medline, PsycINFO, Scopus, EconLit. Study Selection. English studies, published after 1990, were identified using Medical Subject Headings or keywords. Results were reviewed to confirm that the study was based on: 1) a sample of children, and 2) preferences for health states. Data Extraction. Standardized data collection forms were used to record the preference elicitation method used, and any reported evidence regarding the validity, reliability, or feasibility of the method. Data Synthesis. Twenty-six studies were ultimately included in the analysis. The standard gamble and time tradeoff were the most commonly reported direct preference elicitation methods. Seven studies reported validity, four reported reliability, and nine reported feasibility. Of the validity reports, construct validity was assessed most often. Reliability reports typically involved interclass correlation coefficient. For feasibility, four studies reported completion rates. Limitations. The search was limited to four databases and restricted to English studies published after 1990. Only evidence available in published studies were considered; measurement properties may have been tested in pilot or pre-studies but were not published, and are not included in this review. Conclusion. The few studies found through this systematic review demonstrate that there is little empirical evidence on which to judge the use of direct preference elicitation methods with children regarding health states.

Establishing utility values for the 22-item Sino-Nasal Outcome Test (SNOT-22) using a crosswalk to the EuroQol-five-dimensional questionnaire-three-level version (EQ-5D-3L): SNOT-22 crosswalk to EQ-5D-3L utility values

Chronic rhinosinusitis (CRS) is a common condition for which there are numerous medical and surgical treatments. The 22‐item Sino‐Nasal Outcome Test (SNOT‐22) is a patient‐reported outcome measure often used with patients diagnosed with CRS. However, there are no utility values associated with the SNOT‐22, limiting its use in comparative effectiveness research. The purpose of this study was to establish utilities for the SNOT‐22 by mapping responses to utility values associated with the EuroQol–5‐dimensional questionnaire–3‐level version (EQ‐5D‐3L).

Diabetic bladder dysfunction: A review

Diabetic bladder dysfunction affects almost half of all diabetic patients, making it one of the most common complications of diabetes mellitus. The clinical presentation of diabetic bladder dysfunction can be varied and may be extremely bothersome to patients, negatively impacting their quality of life. Despite this, it remains understudied and under-represented in the medical literature. This review summarizes the current literature on pathophysiology, clinical presentation, urodynamic findings, evaluation, and management. Through this, we hope to provide guidance to clinicians involved with the management of this condition.

Psychometric validation of the Stoma-QOL questionnaire in a Canadian cross-sectional sample of colostomy and ileostomy patients

Abstract Objectives: The Stoma-QOL questionnaire is a patient-reported outcome (PRO) used to measure quality of life in patients with ileostomy or colostomy. This study assesses the Stoma-QOL’s overall and item-level psychometric characteristics in patients with temporary stomas, and whether stoma-related quality of life differs by demographic characteristics. Materials and methods: Analysis of cross-sectional observational PRO data from hospitals in Vancouver, Canada. Patients registered for elective ileostomy or colostomy closure, over the age of 18, and able to read English were eligible for participation. Emergent and cancer-related cases were excluded. One-way analysis of variance was used to test for demographic differences in Stoma-QOL scores. Cronbach’s alpha was used for reliability, and Rasch item-response theory was used to assess overall and item characteristics. Results: 120 patients were included. No statistically significant difference in Stoma-QOL scores was found by age, sex, or socioeconomic status. Reliability was 0.93. Mean item responses ranged from 1.77 to 3.55 and item-total correlation ranged from 0.51 to 0.77. The Rasch item-response theory model demonstrated significant misfit, likely due to the misfit of item 9, which asks about sexuality, and high residual correlations between item pairs 6 and 8 about fatigue, and items 16 and 17 about social relationships. Conclusions: The Stoma-QOL questionnaire is a well-designed PRO for measuring stoma-related quality of life. Demographic variables do not appear to have a strong influence on Stoma-QOL scores. Item 9 demonstrated misfit but removal likely does not improve the instrument. Future research should focus on revising items 6, 8, 16, and 17.

Evaluation of the Fecal Incontinence Quality of Life Scale (FIQL) using item response theory reveals limitations and suggests revisions

PurposeThe Fecal Incontinence Quality of Life Scale (FIQL) is a commonly used patient-reported outcome measure for fecal incontinence, often used in clinical trials, yet has not been validated in English since its initial development. This study uses modern methods to thoroughly evaluate the psychometric characteristics of the FIQL and its potential for differential functioning by gender.MethodsThis study analyzed prospectively collected patient-reported outcome data from a sample of patients prior to colorectal surgery. Patients were recruited from 14 general and colorectal surgeons in Vancouver Coastal Health hospitals in Vancouver, Canada. Confirmatory factor analysis was used to assess construct validity. Item response theory was used to evaluate test reliability, describe item-level characteristics, identify local item dependence, and test for differential functioning by gender.Results236 patients were included for analysis, with mean age 58 and approximately half female. Factor analysis failed to identify the lifestyle, coping, depression, and embarrassment domains, suggesting lack of construct validity. Items demonstrated low difficulty, indicating that the test has the highest reliability among individuals who have low quality of life. Five items are suggested for removal or replacement. Differential test functioning was minimal.ConclusionsThis study has identified specific improvements that can be made to each domain of the Fecal Incontinence Quality of Life Scale and to the instrument overall. Formatting, scoring, and instructions may be simplified, and items with higher difficulty developed. The lifestyle domain can be used as is. The embarrassment domain should be significantly revised before use.

Investigating the effect of early bladder management in patients with chronic kidney disease and diabetes: Lessons learned from a failed pilot study

Luc A. Wittig; J. Matthew Andrews ; R. Trafford Crump; Kevin V. Carlson; Richard J. Baverstock Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary AB; Division of Urology, Department of Surgery, Memorial University, St. Johns, NL; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary AB; Vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary AB; Canada

Incidence and burden of comorbid pain and depression in patients with chronic rhinosinusitis awaiting endoscopic sinus surgery in Canada

BackgroundThis study sheds important light on the association between sino-nasal symptoms and global quality of life in patients with chronic rhinosinusitis waiting for endoscopic sinus surgery. Using patient-reported information collected pre-operatively, the primary objective was to report on patients’ pre-surgical sino-nasal symptoms and their association with self-reported pain and depression. The secondary objective was to report on levels of depression and pain among patients in the sample reporting severe sleep problems.MethodsThis is a cross-sectional study of patient-reported outcomes collected prospectively from a cohort of 261 patients assigned to the wait list for elective endoscopic sinus surgery in a large urban region of Canada.ResultsYounger patients and patients with other medical comorbidities were most likely to report significant symptoms of chronic rhinosinusitis and substantial associated pain and depression. In the primary analyses, patients reporting significant symptoms of chronic rhinosinusitis were more likely to report moderate depression or high pain (p < 0.01). Subsequently, chronic rhinosinusitis patients with severe sleep problems were 82% likely to report moderate or severe depression and pain.ConclusionPreoperative management of depression and pain may be considered in order to improve the health-related quality of life of patients waiting for ESS. As depression and pain were highly prevalent, patients with severe sleep problems may be candidates for prioritized access.

Patient educational technologies and their use by patients diagnosed with localized prostate cancer

BackgroundTwo urology practices in Calgary, Canada use patient educational technology (PET) as a core component of their clinical practice. The purpose of this study was to determine how patients interact with PET designed to inform them about their treatment options for clinically localized prostate cancer.MethodsA PET library was developed with 15 unique prostate-related educational modules relating to diagnosis, treatment options, and potential side effects. The PET collected data regarding its use, and those data were used to conduct a retrospective analysis. Descriptive analyses were conducted and comparisons made between patients’ utilization of the PET library during first and subsequent access; Pearson’s Chi-Square was used to test for statistical significance, where appropriate.ResultsEvery patient (n = 394) diagnosed with localized prostate cancer was given access to the PET library using a unique identifier. Of those, 123 logged into the library and viewed at least one module and 94 patients logged into the library more than once. The average patient initially viewed modules pertaining to their diagnosis. Viewing behavior significantly changed in subsequent logins, moving towards modules pertaining to treatment options, decision making, and post-surgical information.DiscussionAs observed through the longitudinal utilization of the PET library, information technology offers clinicians an opportunity to provide an interactive platform to meet patients’ dynamic educational needs. Understanding these needs will help inform the development of more useful PETs.ConclusionThe informational needs of patients diagnosed with clinically localized prostate cancer changed throughout the course of their diagnosis and treatment.