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Clement R.C.,University of North Carolina at Chapel Hill | Welander A.,Boston Consulting Group | Stowell C.,International Consortium for Health Outcomes Measurement | Cha T.D.,Massachusetts General Hospital | And 23 more authors.
Acta Orthopaedica | Year: 2015

Background and purpose-Outcome measurement has been shown to improve performance in several fields of healthcare. This understanding has driven a growing interest in value-based healthcare, where value is defined as outcomes achieved per money spent. While low back pain (LBP) constitutes an enormous burden of disease, no universal set of metrics has yet been accepted to measure and compare outcomes. Here, we aim to define such a set.Patients and methods-An international group of 22 specialists in several disciplines of spine care was assembled to review literature and select LBP outcome metrics through a 6-round modified Delphi process. The scope of the outcome set was degenerative lumbar conditions.Results-Patient-reported metrics include numerical pain scales, lumbar-related function using the Oswestry disability index, health-related quality of life using the EQ-5D-3L questionnaire, and questions assessing work status and analgesic use. Specific common and serious complications are included. Recommended follow-up intervals include 6, 12, and 24 months after initiating treatment, with optional follow-up at 3 months and 5 years. Metrics for risk stratification are selected based on pre-existing tools.Interpretation-The outcome measures recommended here are structured around specific etiologies of LBP, span a patients entire cycle of care, and allow for risk adjustment. Thus, when implemented, this set can be expected to facilitate meaningful comparisons and ultimately provide a continuous feedback loop, enabling ongoing improvements in quality of care. Much work lies ahead in implementation, revision, and validation of this set, but it is an essential first step toward establishing a community of LBP providers focused on maximizing the value of the care we deliver. © 2015 Nordic Orthopaedic Federation.


Dwan T.M.,Griffith University | Ownsworth T.,Griffith University | Chambers S.,Griffith University | Walker D.G.,NEWRO Foundation | Shum D.H.K.,Griffith University
Frontiers in Oncology | Year: 2015

Approaches to classifying neuropsychological impairment after brain tumor vary according to testing level (individual tests, domains or global index) and source of reference (i.e., norms, controls and premorbid functioning). This study aimed to compare rates of impairment according to different classification approaches. Participants were 44 individuals (57% female) with a primary brain tumor diagnosis (mean age = 45.6 years) and 44 matched control participants (59% female, mean age = 44.5 years). All participants completed a test battery that assesses premorbid IQ (Wechsler Adult Reading Test), attention/processing speed (Digit Span, Trail Making Test A), memory (Hopkins Verbal Learning Test - Revised, Rey-Osterrieth Complex Figure-recall) and executive function (Trail Making Test B, Rey- Osterrieth Complex Figure copy, Controlled Oral Word Association Test). Results indicated that across the different sources of reference, 86-93% of participants were classified as impaired at a test-specific level, 61-73% were classified as impaired at a domain-specific level, and 32-50% were classified as impaired at a global level. Rates of impairment did not significantly differ according to source of reference (p>.05); however, at the individual participant level, classification based on estimated premorbid IQ was often inconsistent with classification based on the norms or controls. Participants with brain tumor performed significantly poorer than matched controls on tests of neuropsychological functioning, including executive function (p=001) and memory (p<.001), but not attention/processing speed (p>.05). These results highlight the need to examine individuals' performance across a multi-faceted neuropsychological test battery to avoid over- or under-estimation of impairment. © 2015 Dwan, Ownsworth, Chambers, Walker and Shum.


PubMed | Griffith University and NEWRO Foundation
Type: | Journal: Frontiers in oncology | Year: 2015

Approaches to classifying neuropsychological impairment after brain tumor vary according to testing level (individual tests, domains, or global index) and source of reference (i.e., norms, controls, and pre-morbid functioning). This study aimed to compare rates of impairment according to different classification approaches. Participants were 44 individuals (57% female) with a primary brain tumor diagnosis (mean age=45.6years) and 44 matched control participants (59% female, mean age=44.5years). All participants completed a test battery that assesses pre-morbid IQ (Wechsler adult reading test), attention/processing speed (digit span, trail making test A), memory (Hopkins verbal learning test-revised, Rey-Osterrieth complex figure-recall), and executive function (trail making test B, Rey-Osterrieth complex figure copy, controlled oral word association test). Results indicated that across the different sources of reference, 86-93% of participants were classified as impaired at a test-specific level, 61-73% were classified as impaired at a domain-specific level, and 32-50% were classified as impaired at a global level. Rates of impairment did not significantly differ according to source of reference (p>0.05); however, at the individual participant level, classification based on estimated pre-morbid IQ was often inconsistent with classification based on the norms or controls. Participants with brain tumor performed significantly poorer than matched controls on tests of neuropsychological functioning, including executive function (p=0.001) and memory (p<0.001), but not attention/processing speed (p>0.05). These results highlight the need to examine individuals performance across a multi-faceted neuropsychological test battery to avoid over- or under-estimation of impairment.

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