Search

Summary: Background & aims: Numerous nutrition screening tools for the hospital setting have been developed. The aim of this systematic review is to study construct or criterion validity and predictive validity of nutrition screening tools for the general hospital setting. Methods: A systematic review of English, French, German, Spanish, Portuguese and Dutch articles identified via MEDLINE, Cinahl and EMBASE (from inception to the 2nd of February 2012). Additional studies were identified by checking reference lists of identified manuscripts. Search terms included key words for malnutrition, screening or assessment instruments, and terms for hospital setting and adults. Data were extracted independently by 2 authors. Only studies expressing the (construct, criterion or predictive) validity of a tool were included. Results: 83 studies (32 screening tools) were identified: 42 studies on construct or criterion validity versus a reference method and 51 studies on predictive validity on outcome (i.e. length of stay, mortality or complications). None of the tools performed consistently well to establish the patients' nutritional status. For the elderly, MNA performed fair to good, for the adults MUST performed fair to good. SGA, NRS-2002 and MUST performed well in predicting outcome in approximately half of the studies reviewed in adults, but not in older patients. Conclusions: Not one single screening or assessment tool is capable of adequate nutrition screening as well as predicting poor nutrition related outcome. Development of new tools seems redundant and will most probably not lead to new insights. New studies comparing different tools within one patient population are required. [Copyright &y& Elsevier]

Purpose – The purpose of the current study is to develop a generic and short questionnaire to measure work performance at the individual level – the Individual Work Performance Questionnaire (IWPQ). The IWPQ was based on a four-dimensional conceptual framework, in which individual work performance consisted of task performance, contextual performance, adaptive performance, and counterproductive work behavior. Design/methodology/approach – After pilot-testing, the 47-item IWPQ was field-tested amongst a representative sample of 1,181 Dutch blue, pink, and white collar workers. Factor analysis was used to examine whether the four-dimensional conceptual framework could be confirmed. Rasch analysis was used to examine the functioning of the items in more detail. Finally, it was examined whether generic scales could be constructed. Findings – A generic, three-dimensional conceptual framework was identified, in which individual work performance consisted of task performance, contextual performance, and counterproductive work behavior. Generic, short scales could be constructed that fitted the Rasch model. Research limitations/implications – A generic, short questionnaire can be used to measure individual work performance across occupational sectors. In future versions of the IWPQ, more difficult items should be added to improve discriminative ability at the high ranges of the scale. Originality/value – This study shows that, using Rasch analysis, a generic and short questionnaire can be used to measure individual work performance. [ABSTRACT FROM AUTHOR]

Abstract: Objective: When designing prediction models by complete case analysis (CCA), missing information in either baseline (predictors) or outcomes may lead to biased results. Multiple imputation (MI) has been shown to be suitable for obtaining unbiased results. This study provides researchers with an empirical illustration of the use of MI in a data set on low back pain, by comparing MI with the more commonly used CCA. Effects will be shown of imputing missing information on the composition and performance of prognostic models, distinguishing imputation of missing values in baseline characteristics and outcome data. Methods: Data came from the Beliefs about Backpain cohort, a study of psychologic obstacles to recovery in primary care back pain patients in the United Kingdom. Candidate predictors included demographics, back pain characteristics, and psychologic variables. Complete case analysis was compared with MI within patients with complete outcome but missing baseline data (n = 809) and patients with missing baseline or outcome data (n = 1591). Multiple imputation was performed by a Multiple Imputation by Chained Equations procedure. Results: Cases with missing outcome data (n = 782, 49.1%) or with missing baseline data (n = 116, 8%) both differed from complete cases regarding the distribution of some predictors and more often had a poor outcome. When comparing CCA with MI, model composition showed to be affected. Conclusions: Complete case analysis can give biased results, even when only small amounts of data are missing. Now that MI is available in standard statistical software, we recommend that it be used to handle missing data. [Copyright &y& Elsevier]

Summary: Background & aims: There is no valid, fast and easy-to-apply set of criteria to determine (risk of) undernutrition in community-dwelling older persons. The aim of this study was to develop and validate such criteria. Methods: Selection of potential anthropometric and undernutrition-related items was based on consensus literature. The criteria were developed using 15-year mortality in community-dwelling older persons ≥ 65 years (Longitudinal Aging Study Amsterdam, n = 1687) and validated in an independent sample (InCHIANTI, n = 1142). Results: Groups distinguished were: (1) undernutrition (mid-upper arm circumference <25 cm or involuntary weight loss ≥4 kg/6 months); (2) risk of undernutrition (poor appetite and difficulties climbing staircase); and (3) no undernutrition (others). Respective hazard ratio’s for 15-year mortality were: (1) 2.22 (95% CI 1.83–2.69); and (2) 1.57 (1.22–2.01) ((3) = reference). The area under the curve (AUC) was 0.55. Comparable results were found stratified by sex, excluding cancer/obstructive lung disease/(past) smoking, using 6-year mortality, and applying results to the InCHIANTI study (hazard ratio’s 2.12 and 2.46, AUC 0.59). Conclusions: The developed set of criteria (SNAQ65+) for determining (risk of) undernutrition in community-dwelling older persons shows good face validity and moderate predictive validity based on the consistent association with mortality in a second independent study sample. [Copyright &y& Elsevier]

Abstract: We evaluated whether patients with self-reported whiplash differed in perceived pain, functional limitation and prognosis from patients with other painful neck complaints. Data from three Dutch trials and an English trial were used all evaluating conservative treatment in neck pain patients in primary care. All patients had non-specific neck pain. Information on any trauma or injury came from self-report at baseline. We compared frequencies of baseline variables and outcome at short-term and long term for whiplash and non-trauma neck pain patients separately. The total study population consisted of 804 neck pain patients. Of these patients 133 reported (16.5%) that an injury was the cause of their neck pain. In all trials there were 17–18% more male patients in the whiplash group. At follow-up pain decreased between 12 and 28%, function 10%, and 25–50% of patients recovered in all trials. Post-treatment improvements in pain, function and recovery were comparable between whiplash and non-trauma patients. We also found no different prognostic factors between whiplash and non-trauma patients. Overall we found in a population with mild to moderate pain no clinically relevant differences between patients with self-reported whiplash and patients with other painful neck complaints. The findings suggest that whiplash patients with mild to moderate pain should not be considered a specific subgroup of patients with non-specific neck pain. [Copyright &y& Elsevier]

Abstract: Background: The long-term course of long-standing low back pain is largely unknown since long-term data are scarce. Objective: We examined the course of self-reported low back pain in the prospective population-based Doetinchem cohort over a period of 10years. Methods: Between 1993 and 2007, around 5700 randomly selected men and women in four age groups of originally 20–29, 30–39, 40–49, 50–59years were measured three times. Logistic regression analysis was used to study the association of sociodemographic (gender, age, education, work status) and lifestyle characteristics (BMI, smoking, physical activity) with persistent and new episodes of long-standing low back pain. Results: The prevalence of long-standing low back pain is quite stable over a 10year period, approximately 20% on population level. On individual level, around 30% of the population was completely free of low back pain during the entire period, 6% can be characterized as persistent back pain sufferers. Individuals with persistent and a varying pattern have a more unhealthy lifestyle (BMI and smoking) than those without low back pain. Age, smoking, obesity and not having a paid job are associated with 10-year persistent back pain in the general population, whereas age and not having a paid job are associated in those with long-lasting back pain at baseline. New episodes of long-standing back pain are relatively frequent among women and smokers. Conclusions: Low back pain in the population is characterized as very dynamic which challenges epidemiological studies highly. Long-term information on the course of back pain is needed to define severe subgroups. [Copyright &y& Elsevier]

Abstract: Objective: The aim of this study was to obtain an overview of the methodological quality of studies on the measurement properties of neck pain and disability questionnaires and to describe how well various aspects of the design and statistical analyses of studies on measurement properties are performed. Methods: A systematic review was performed of published studies on the measurement properties of neck pain and disability questionnaires. Two reviewers independently rated the quality of the studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. This checklist was developed in an international Delphi consensus study. Results: A total of 47 articles were included on the measurement properties of 8 different questionnaires. The methodological quality of the included studies was adequate on some aspects (often, adequate statistical analyses are used for assessing reliability, measurement error, and construct validity) but can be improved on other aspects. The most important methodological aspects that need to be improved are as follows: assessing unidimensionality in internal consistency analysis, stable patients and similar test conditions in studies on reliability and measurement error, and more emphasis on the relevance and comprehensiveness of the items in content validity studies. Furthermore, it is recommended that studies on construct validity and responsiveness should be based on predefined hypotheses and that better statistical methods should be used in responsiveness studies. Conclusion: Considering the importance of adequate measurement properties, it is concluded that, in the field of measuring neck pain and disability, there is room for improvement in the methodological quality of studies measurement properties. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of this study is to describe the characteristics, practice characteristics, and opinions of chiropractors and the sociodemographic characteristics and the type of complaint of patients presenting to chiropractors in Belgium. Methods: In 2008, all doctors of chiropractic in Belgium (N = 101) were asked to provide personal sociodemographic and practice-specific information via postal questionnaires. The participating practitioners presented written questionnaires to a maximum of 10 consecutive patients to collect sociodemographic and clinical data on the patients. Descriptive analyses were used. Results: In total, 80 doctors of chiropractic (79.2%, n = 80/101) participated, providing information on 517 patients. Belgian doctors of chiropractic are predominantly male (75%), have a mean age of 44 (SD = 14) years, and have been in practice for 18 years on average. They typically treat neck and/or low back pain with or without radiating pain (85% of all complaints). Patients have a mean age of 43 (SD = 16.4) years, 54% are female, and most patients are employed (70%). Patients present with musculoskeletal complaints of moderate intensity, averaging 5 on a 0 to 10 numeric rating scale. Chiropractors spend, on average, 36 minutes on a new patient and 15 minutes on follow-up consultations. Diversified technique (93%) is the most often used technique, followed by mechanical-assisted (Activator) spinal manipulative therapy (41%). Ergonomic advice and instruction in exercise therapy are most often used in conjunction with spinal manipulative therapy. Most chiropractors would like to have the legal authority to request diagnostic imaging (87%). Conclusions: This is the first study describing doctors of chiropractic and their patients in Belgium. Chiropractors in Belgium primarily focus on the treatment of neuromusculoskeletal complaints in adults, with emphasis on the spine. Patients presenting to the chiropractor consult with musculoskeletal complaints of moderate intensity that moderately affect their activities of daily living. [Copyright &y& Elsevier]

Aims To identify prognostic indicators independently associated with poor outcome of physiotherapy intervention in women with primary or recurrent stress urinary incontinence (stress UI). Methods A prospective cohort study was performed in physiotherapy practices in primary care to identify prognostic indicators 12 weeks after initiation of physiotherapy intervention. Patients were referred by general practitioners or urogynecologists. Risk factors for stress UI were examined as potential prognostic indicators of poor outcome. The primary outcomes were defined as poor outcome on the binary Leakage Severity scale (LS scale) and the binary global perceived effectiveness (GPE) score. Results Two hundred sixty-seven women, with a mean age of 47.7 (SD = 8.3), with stress UI for at least 6 months were included. At 12 weeks, 43% and 59% of the women were considered recovered on the binary LS scale and the binary GPE score, respectively. Prognostic indicators associated with poor outcome included 11 indicators based on the binary LS scale and 8 based on the binary GPE score. The prognostic indicators shared by both models show that poor recovery was associated with women with severe stress UI, POP-Q stage > II, poor outcome of physiotherapy intervention for a previous UI episode, prolonged second stage of labor, BMI > 30, high psychological distress, and poor physical health. Conclusions This study provides robust evidence of clinically meaningful prognostic indicators of poor short-term outcome. These findings need to be confirmed by replication studies. Neurourol. Urodynam. 29:336-343, 2010. © 2009 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Abstract: The aim was to determine if psychological factors favourably influence the short and long-term outcome of patients with sub-acute neck pain in terms of global perceived recovery, pain, using a Numerical Rating Scale (NRS) and functional disability, using the Neck Disability Index (NDI). This study was conducted within the framework of a randomised clinical trial comparing two types of conservative therapy in 146 patients with sub-acute neck pain. Multilevel techniques were used for data-analysis. The short and long term results for the three outcomes were very diverse. The sub-scales of the used questionnaires, i.e. the Pain Coping and Cognition List (PCCL), and the 4 Dimensional Symptom Questionnaire (4DSQ), did not contribute significantly to all of the multilevel models. Only the factor ‘fear of movement’ was consistently and significantly present in the univariable analysis for all outcomes at both follow-up measurements. The explained variance in the short term ranged from 16% to 30%, and from 6% to 34% in the long term. This can be considered to be low. We conclude that all psychological factors showed a considerable variation on the specific measurement and time point used. Only ‘fear of movement’ consistently impedes short term and long term recovery. Further prognostic research is needed to achieve more consistent results. [Copyright &y& Elsevier]

Abstract: Psychometric analyses, such as factor analysis, internal consistency and construct validity analysis, are well known and frequently applied methods in the development of health related patient reported outcomes. These statistical indexes shed very little light on how respondents interpret individual items, or on the meaning of their responses. In this study, the Pain Coping and Cognition List (PCCL), a quantitatively validated psychological questionnaire developed to assess chronic pain, has been subjected to a qualitative research method: the Three Step Test Interview (TSTI), an observational technique that aims to identify problems with self reported questionnaires. It consists of three phases: 1) concurrent thinking aloud; 2) a retrospective interview; 3) a semi-structured interview. Participants with sub-acute neck pain distinguished six different types of problems: long complicated formulations, composite questions, irrelevant questions, lacking frame of reference, problematic words, and wrongly interpreted questions. This study illustrates that qualitative methods have an added value when developing self-report questionnaires because some of the problems that were highlighted that cannot be identified using quantitative methods only. Therefore, we recommend that a full qualitative study should be an integral part of the development of questionnaires. The TSTI method is very useful for this purpose. [Copyright &y& Elsevier]

Abstract: Objective: Determining “minimally important change” (MIC) facilitates the interpretation of change scores on multi-item instruments. This article focuses on how MIC values should be interpreted when applied to individual patients. Study Design and Setting: The MIC value of a hypothetical questionnaire “Q” was determined in a sample of 400 patients who improved and 100 patients who did not improve, using the receiver operating characteristic (ROC) method, and three methods to quantify the uncertainty. Results: The MIC value on questionnaire Q was 10.5. Firstly, the 95% confidence interval (CI) of the MIC value (for questionnaire Q: 5.6–14.2) quantifies the uncertainty of the estimation of the MIC value. Secondly, “how sure we are that this MIC value holds for every patient” is quantified by the values for sensitivity (74%) and specificity (91%). Thirdly, the smallest detectable change (SDC) on questionnaire Q is calculated (16.0) to consider whether the MIC value (10.5) falls outside or within the measurement error. Conclusion: For application in clinical research and practice, MIC values are always considered at the individual level, but determined in groups of patients. The interpretation comes with different forms of uncertainty. To appreciate the uncertainty, knowledge of the underlying distributions of change scores is indispensable. [Copyright &y& Elsevier]