Background: Clinicians are currently challenged to support older adults to maintain a certain level of Functional Independence (FI). FI is defined as "functioning physically safely and independent from another person, within one's own context". A Core Outcome Set was developed to measure FI. The purpose of this study was to assess discriminative validity of the Core Outcome Set FI (COSFI) in a population of Dutch older adults (≥ 65 years) with different levels of FI. Secondary objective was to assess to what extent the underlying domains 'coping', 'empowerment' and 'health literacy' contribute to the COSFI in addition to the domain 'physical capacity'. Methods: A population of 200 community-dwelling older adults and older adults living in residential care facilities were evaluated by the COSFI. The COSFI contains measurements on the four domains of FI: physical capacity, coping, empowerment and health literacy. In line with the COSMIN Study Design checklist for Patient-reported outcome measurement instruments, predefined hypotheses regarding prediction accuracy and differences between three subgroups of FI were tested. Testing included ordinal logistic regression analysis, with main outcome prediction accuracy of the COSFI on a proxy indicator for FI. Results: Overall, the prediction accuracy of the COSFI was 68%. For older adults living at home and depending on help in (i)ADL, prediction accuracy was 58%. 60% of the preset hypotheses were confirmed. Only physical capacity measured with Short Physical Performance Battery was significantly associated with group membership. Adding health literacy with coping or empowerment to a model with physical capacity improved the model significantly (p < 0.01). Conclusions: The current composition of the COSFI, did not yet meet the COSMIN criteria for discriminative validity. However, with some adjustments, the COSFI potentially becomes a valuable instrument for clinical practice. Context-related factors, like the presence of a spouse, also may be a determining factor in this population. It is recommended to include context-related factors in further research on determining FI in subgroups of older people.
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Studies evaluating the effects of power training in older adults use a variety of measurement tools and outcome parameters, limiting comparability of results and calling the validity of conclusions into question. This study aimed to identify a core outcome set (COS) to measure the effects of power training in older adults, encompassing the function, activities, and participation domain of the International Classification of Functioning, Disease, and Health (ICF). Twenty-one tests were evaluated based on their ability to measure muscle power and the effects of power training. Our methodology consisted of two Delphi survey rounds and an expert panel meeting using modified Nominal Group Technique. The COS consisted of tests considered most feasible for clinical practice and least burdensome for older adults. The COS included the Squat Jump Test (paired with accelerometery-based instrumentation) and the Timed Up-and-Go Test for the function and function and activities domain, respectively. No test was identified for the participation domain, however, experts proposed using daily-life accelerometery until more suitable outcome measures are defined and validated. This study addresses a critical research gap in standardised assessment protocols, and contributes to a multifaceted approach to measuring the impact of power training in older adults.
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Interdisciplinary multimodal pain therapy (IMPT) is a biopsychosocial treatment approach for patients with chronic pain that comprises at least psychological and physiotherapeutic interventions. Core outcome sets (COSs) are currently developed in different medical fields to standardize and improve the selection of outcome domains, and measurement instruments in clinical trials, to make trial results meaningful, to pool trial results, and to allow indirect comparison between interventions. The objective of this study was to develop a COS of patient-relevant outcome domains for chronic pain in IMPT clinical trials. An international, multiprofessional panel (patient representatives [n = 5], physicians specialized in pain medicine [n = 5], physiotherapists [n = 5], clinical psychologists [n = 5], and methodological researchers [n = 5]) was recruited for a 3-stage consensus study, which consisted of a mixed-method approach comprising an exploratory systematic review, a preparing online survey to identify important outcome domains, a face-to-face consensus meeting to agree on COS domains, and a second online survey (Delphi) establishing agreement on definitions for the domains included. The panel agreed on the following 8 domains to be included into the COS for IMPT: pain intensity, pain frequency, physical activity, emotional wellbeing, satisfaction with social roles and activities, productivity (paid and unpaid, at home and at work, inclusive presentism and absenteeism), health-related quality of life, and patient's perception of treatment goal achievement. The complexity of chronic pain in a biopsychosocial context is reflected in the current recommendation and includes physical, mental, and social outcomes. In a subsequent step, measurement instruments will be identified via systematic reviews.
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BACKGROUND: Value-based healthcare (VBHC) is increasingly implemented in healthcare worldwide. Transparent measurement of the outcomes most important and relevant to patients is essential in VBHC, which is supported by a core set of most important quality indicators and outcomes. Therefore, the aim of this study was to develop a VBHC-burns core set for adult burn patients.METHODS: A three-round modified national Delphi study, including 44 outcomes and 24 quality indicators, was conducted to reach consensus among Dutch patients, burn care professionals and researchers. Items were rated on a nine-point Likert scale and selected if ≥ 70% in each group considered an item 'important'. Subsequently, instruments quantifying selected outcomes were identified based on a literature review and were chosen in a consensus meeting using recommendations from the Dutch consensus-based standard set and the Dutch Centre of Expertise on Health Disparities. Time assessment points were chosen to reflect the burn care and patient recovery process. Finally, the initial core set was evaluated in practice, leading to the adapted VBHC-burns core set.RESULTS: Twenty-seven patients, 63 burn care professionals and 23 researchers participated. Ten outcomes and four quality indicators were selected in the Delphi study, including the outcomes pain, wound healing, physical activity, self-care, independence, return to work, depression, itching, scar flexibility and return to school. Quality indicators included shared decision-making (SDM), the number of patients receiving aftercare, determination of burn depth, and assessment of active range of motion. After evaluation of its use in clinical practice, the core set included all items except SDM, which are assessed by 9 patient-reported outcome instruments or measured in clinical care. Assessment time points included are at discharge, 2 weeks, 3 months, 12 months after discharge and annually afterwards.CONCLUSION: A VBHC-burns core set was developed, consisting of outcomes and quality indicators that are important to burn patients and burn care professionals. The VBHC-burns core set is now systemically monitored and analysed in Dutch burn care to improve care and patient relevant outcomes. As improving burn care and patient relevant outcomes is important worldwide, the developed VBHC-burns core set could be inspiring for other countries.
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For older adults, acute hospitalization is a high-risk event with poor health outcomes, including functional decline. In absence of practical guidelines and high quality randomized controlled trials, this Delphi study was conducted. The aim of this study was to obtain consensus on an exercise intervention program, a core outcome set (COS) and handover information to prevent functional decline or restore physical function in acutely hospitalized older patients transitioning from hospital to home. An internal panel of experts in the field of exercise interventions for acutely hospitalized older adults were invited to join the study. In the Delphi study, relevant topics were recognized, statements were formulated and ranked on a 9-point Likert scale in two additional rounds. To reaching consensus, a score of 7–9 was classified as essential. Results were expressed as median and semi-interquartile range (SIQR), and consensus threshold was set at SIQR≤0.5. Fifteen international experts from eight countries participated in the panel. The response rate was 93%, 93% and 80% for the three rounds respectively. After three rounds, consensus was reached on 167 of the 185 (90.3%) statements, of which ninety-five (51.4%) were ranked as essential (median Likert-score ≥7.0, SIQR ≤0.5). This Delphi study provides starting points for developing an exercise intervention, a COS and handover information. The results of this Delphi study can assist physical therapists to provide a tailored exercise intervention for older patients with complex care needs after hospital discharge, to prevent functional decline and/or restore physical function.
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BACKGROUND: Mobility is a key determinant and outcome of healthy ageing but its definition, conceptual framework and underlying constructs within the physical domain may need clarification for data comparison and sharing in ageing research. This study aimed to (1) review definitions and conceptual frameworks of mobility, (2) explore agreement on the definition of mobility, conceptual frameworks, constructs and measures of mobility, and (3) define, classify and identify constructs.METHODS: A three-step approach was adopted: a literature review and two rounds of expert questionnaires (n = 64, n = 31, respectively). Agreement on statements was assessed using a five-point Likert scale; the answer options 'strongly agree' or 'agree' were combined. The percentage of respondents was subsequently used to classify agreements for each statement as: strong (≥ 80%), moderate (≥ 70% and < 80%) and low (< 70%).RESULTS: A variety of definitions of mobility, conceptual frameworks and constructs were found in the literature and among respondents. Strong agreement was found on defining mobility as the ability to move, including the use of assistive devices. Multiple constructs and measures were identified, but low agreements and variability were found on definitions, classifications and identification of constructs. Strong agreements were found on defining physical capacity (what a person is maximally capable of, 'can do') and performance (what a person actually does in their daily life, 'do') as key constructs of mobility.CONCLUSION: Agreements on definitions of mobility, physical capacity and performance were found, but constructs of mobility need to be further identified, defined and classified appropriately. Clear terminology and definitions are essential to facilitate communication and interpretation in operationalising the physical domain of mobility as a prerequisite for standardisation of mobility measures.
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Background: Adverse outcome pathway (AOP) networks are versatile tools in toxicology and risk assessment that capture and visualize mechanisms driving toxicity originating from various data sources. They share a common structure consisting of a set of molecular initiating events and key events, connected by key event relationships, leading to the actual adverse outcome. AOP networks are to be considered living documents that should be frequently updated by feeding in new data. Such iterative optimization exercises are typically done manually, which not only is a time-consuming effort, but also bears the risk of overlooking critical data. The present study introduces a novel approach for AOP network optimization of a previously published AOP network on chemical-induced cholestasis using artificial intelligence to facilitate automated data collection followed by subsequent quantitative confidence assessment of molecular initiating events, key events, and key event relationships. Methods: Artificial intelligence-assisted data collection was performed by means of the free web platform Sysrev. Confidence levels of the tailored Bradford-Hill criteria were quantified for the purpose of weight-of-evidence assessment of the optimized AOP network. Scores were calculated for biological plausibility, empirical evidence, and essentiality, and were integrated into a total key event relationship confidence value. The optimized AOP network was visualized using Cytoscape with the node size representing the incidence of the key event and the edge size indicating the total confidence in the key event relationship. Results: This resulted in the identification of 38 and 135 unique key events and key event relationships, respectively. Transporter changes was the key event with the highest incidence, and formed the most confident key event relationship with the adverse outcome, cholestasis. Other important key events present in the AOP network include: nuclear receptor changes, intracellular bile acid accumulation, bile acid synthesis changes, oxidative stress, inflammation and apoptosis. Conclusions: This process led to the creation of an extensively informative AOP network focused on chemical-induced cholestasis. This optimized AOP network may serve as a mechanistic compass for the development of a battery of in vitro assays to reliably predict chemical-induced cholestatic injury.
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ObjectiveTo develop sets of core and optional recommended domains for describing and evaluating Osteoarthritis Management Programs (OAMPs), with a focus on hip and knee Osteoarthritis (OA).DesignWe conducted a 3-round modified Delphi survey involving an international group of researchers, health professionals, health administrators and people with OA. In Round 1, participants ranked the importance of 75 outcome and descriptive domains in five categories: patient impacts, implementation outcomes, and characteristics of the OAMP and its participants and clinicians. Domains ranked as “important” or “essential” by ≥80% of participants were retained, and participants could suggest additional domains. In Round 2, participants rated their level of agreement that each domain was essential for evaluating OAMPs: 0 = strongly disagree to 10 = strongly agree. A domain was retained if ≥80% rated it ≥6. In Round 3, participants rated remaining domains using same scale as in Round 2; a domain was recommended as “core” if ≥80% of participants rated it ≥9 and as “optional” if ≥80% rated it ≥7.ResultsA total of 178 individuals from 26 countries participated; 85 completed all survey rounds. Only one domain, “ability to participate in daily activities”, met criteria for a core domain; 25 domains met criteria for an optional recommendation: 8 Patient Impacts, 5 Implementation Outcomes, 5 Participant Characteristics, 3 OAMP Characteristics and 4 Clinician Characteristics.ConclusionThe ability of patients with OA to participate in daily activities should be evaluated in all OAMPs. Teams evaluating OAMPs should consider including domains from the optional recommended set, with representation from all five categories and based on stakeholder priorities in their local context.
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Background: Due to the globally increasing demand for care, innovation is important to maintain quality, safety, effectiveness, patient sensitivity, and outcome orientation. Health care technologies could be a solution to innovate, maintain, or improve the quality of care and simultaneously decrease nurses’ workload. Currently, nurses are rarely involved in the design of health care technologies, mostly due to time constraints with clinical nursing responsibilities and limited exposure to technology and design disciplines. To ensure that health care technologies fit into nurses’ core and routine practice, nurses should be actively involved in the design process. Objective: The aim of the present study was to explore the main requirements for nurses’ active participation in the design of health care technologies. Design: An exploratory descriptive qualitative design was used which helps to both understand and describe a phenomenon. Participants: Twelve nurses from three academic hospitals in the Netherlands participated in this study. Method: Data were collected from semistructured interviews with hospital nurses experienced in design programs and thematically analysed. Results: Four themes were identified concerning the main requirements for nurses to participate in the design of health care technologies: (1) nurses’ motivations to participate, (2) the process of technology development, (3) required competence to participate (such as assertiveness, creative thinking, problem solving skills), and (4) facilitating and organizing nurses’ participation. Conclusion: Nurses experience their involvement in the design process as essential, distinctive, and meaningful but experience few possibilities to combine this work with their current workload, flows, routines, and requirements. To participate in the design of health care technologies nurses need motivation and specific competencies. Organizations should facilitate time for nurses to acquire the required competencies and to be intentionally involved in technology design and development activities.
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Introduction The Integrated Recovery Scales (IRS) was developed by the Dutch National Expertise board for routine outcome monitoring with severe mental illnesses. This board aimed to develop a multidimensional recovery measure directed at 1. clinical recovery, 2. physical health, 3. social recovery (work, social contacts, independent living) and 4. existential, personal recovery. The measure had to be short, suited for routine outcome monitoring and present the perspective of both mental health professionals and service users with severe mental illnesses. All aspects are assessed over a period of the pas 6 months. Objectives The objective of this research is validation of the Integral Recovery Scales and to test the revelance for clinical practice and police evaluation. Methods The instrument was tested with 500 individuals with severe mental illnesses (80% individuals with a psychotic disorder), of whom 200 were followed up for 1 year. For the questions concerning clinical recovery, physical health and social recovery mental health care workers conducted semi structured interviews with people living with serious illnesses. The questions concerning personal health were self-rated. We analyzed interrater reliability, convergent and divergent validity and sensitivity to change. Results The instrument has a good validity and is easy to complete for service users and mental health care workers and appropriate for clinical and policy evaluation goals. Conclusions The Integrated Recovery Scales can be a useful instrument for a simple and meaningful routine outcome monitoring. Page: 121
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