Dataset Information

Improving multimorbidity measurement using individualized disease-specific quality of life impact assessments: predictive validity of a new comorbidity index.

ABSTRACT:

Background

Interpretation of health-related quality of life (QOL) outcomes requires improved methods to control for the effects of multiple chronic conditions (MCC). This study systematically compared legacy and improved method effects of aggregating MCC on the accuracy of predictions of QOL outcomes.

Methods

Online surveys administered generic physical (PCS) and mental (MCS) QOL outcome measures, the Charlson Comorbidity Index (CCI), an expanded chronic condition checklist (CCC), and individualized QOL Disease-specific Impact Scale (QDIS) ratings in a developmental sample (N = 5490) of US adults. Controlling for sociodemographic variables, regression models compared 12- and 35-condition checklists, mortality vs. population QOL-weighting, and population vs. individualized QOL weighting methods. Analyses were cross-validated in an independent sample (N = 1220) representing the adult general population. Models compared estimates of variance explained (adjusted R²) and model fit (AIC) for generic PCS and MCS across aggregation methods at baseline and nine-month follow-up.

Results

In comparison with sociodemographic-only regression models (MCS R² = 0.08, PCS = 0.09) and Charlson CCI models (MCS R² = 0.12, PCS = 0.16), increased variance was accounted for using the 35-item CCC (MCS R² = 0.22, PCS = 0.31), population MCS/PCS QOL weighting (R² = 0.31-0.38, respectively) and individualized QDIS weighting (R² = 0.33 & 0.42). Model R² and fit were replicated upon cross-validation.

Conclusions

Physical and mental outcomes were more accurately predicted using an expanded MCC checklist, population QOL rather than mortality CCI weighting, and individualized rather than population QOL weighting for each reported condition. The 3-min combination of CCC and QDIS ratings (QDIS-MCC) warrant further testing for purposes of predicting and interpreting QOL outcomes affected by MCC.

SUBMITTER: McEntee ML

PROVIDER: S-EPMC9277868 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BackgroundRepeat power ability (RPA) assessments are a valuable evaluation of an athlete's ability to repeatedly perform high intensity movements. Establishing the most reliable and valid loaded jump RPA assessment and method to quantify RPA has yet to be determined. This study aimed to compare the reliability and validity of an RPA assessment performed with loaded squat jumps (SJ) or countermovement jumps (CMJ) using force-time derived mean and peak power output.Materials and methodsRPA was quantified using calculations of average power output, a fatigue index and a percent decrement score for all repetitions and with the first and last repetitions removed. Validity was established by comparing to a 30 second Bosco repeated jump test (30BJT). Eleven well-trained male field hockey players performed one set of 20 repetitions of both SJs (20SJ) and CMJs (20CMJ) on separate occasions using a 30% one repetition maximum half squat load. These assessments were repeated 7 days apart to establish inter-test reliability. On a separate occasion, each participant performed the 30BJT.ResultsThe reliability of average peak power for 20SJ and 20CMJ was acceptable (CV < 5%; ICC > 0.9), while average mean power reliability for 20CMJ (CV < 5%; ICC > 0.9) was better than 20SJ (CV > 5%; ICC > 0.8). Percent decrement of 20CMJ peak power, with the first and final jump removed from the percent decrement calculation (PD%CMJpeak18), was the most reliable measurement of power output decline (CV < 5 %; ICC > 0.8). Average mean and peak power for both RPA protocols had moderate to strong correlations with 30BJT average mean and peak power (r = 0.5-0.8; p< 0.05-0.01). No RPA measurements of power decline were significantly related to BJT measurements of power decline.ConclusionsThese findings indicate that PD%CMJpeak18 is the most reliable measure of RPA power decline. The lack of relationship between power decline in the loaded RPA and the 30BJT assessment suggest that each assessment may be measuring a different physical quality. These results provide sport science practitioners with additional methods to assess RPA and provide useful information on the reliability and validity of these outcome measures. Additional research needs to be performed to examine the reliability and validity of the novel RPA assessments in other athletic populations and to determine the sensitivity of these measurements to training and injury.

Project description:BackgroundMultimorbidity is both an individual and societal problem. For society, patients with multimorbidity increase healthcare costs. For the individual, living with multimorbidity is complex, and there is an inverse relationship between a patient's Quality of Life (QoL) and their number of chronic conditions. Numerous intervention studies target these problems, yet there is no multimorbidity-specific patient-reported outcome measure (PROM) developed specifically for this group with adequate measurement properties to assess QoL. This study explores what overall needs regarding QoL are affected by living with multimorbidity through qualitative interviews. With this, we conceptualise Needs-based QoL specifically for this group, ensuring high content validity (regarding relevance and comprehensiveness) of using the Needs-based approach to measure their QoL. This is essential as this preliminary study leads to the development of the MultiMorbidity Questionnaire (MMQ), a PROM measuring QoL among patients with multimorbidity.MethodsThis study draws upon qualitative interviews with fifteen patients with multimorbidity based on a semi-structured interview guide following the Needs-based approach. This approach allowed the patients to cover needs relevant for their QoL in relation to the complexities of living with multimorbidity. The transcribed interviews were thematically analysed, inspired by Braun and Clarke's reflexive approach.ResultsAnalysis of the interviews resulted in the construction of six intertwined domains relevant to patients with multimorbidity, covering their Needs-based QoL; "Physical ability", "Self-determination", "Security", "Partner and social life", "Self-image", and "Personal finances". "Physical limitations" and "Personal finances" were stated as core needs implicating the other domains.ConclusionThis study shows six intertwined overall domains relevant for patients with multimorbidity regarding their Needs-based QoL; "Physical ability", "Self-determination", "Security", "Partner and social life", "Self-image", and "Personal finances". These needs are relevant in a Danish context, with a generally high standard of living. Based on this conceptual framework of Need-based QoL for patients with multimorbidity, we will develop items for a new patient-reported outcome measure called the MMQ.

Project description:Autologous hematopoietic stem cell transplantation (AHCT) improves survival in patients with multiple myeloma (MM) but is associated with morbidity and nonrelapse mortality (NRM). Hematopoietic cell transplant comorbidity index (HCT-CI) was shown to predict risk of NRM and survival after allogeneic transplantation. We tested the utility of HCT-CI as a predictor of NRM and survival in patients with MM undergoing AHCT. We analyzed outcomes of 1156 patients of AHCT after high-dose melphalan reported to the Center for International Blood and Marrow Transplant Research. Individual comorbidities were prospectively collected at the time of AHCT. The impact of HCT-CI and other potential prognostic factors, including Karnofsky performance score (KPS), on NRM and survival were studied in multivariate Cox regression models. HCT-CI score was 0, 1, 2, 3, and >3 in 42%, 18%, 13%, 13%, and 14% of the study cohort, respectively. Subjects were stratified into 3 risk groups: HCT-CI score of 0 (42%) versus HCT-CI score of 1 to 2 (32%) versus HCT-CI score > 2 (26%). Higher HCT-CI was associated with lower KPS < 90 (33% of subjects score of 0 versus 50% in HCT-CI score > 2). HCT-CI score > 2 was associated with melphalan dose reduction (22% versus 10% in score 0 cohort). One-year NRM was low at 2% (95% confidence interval, 1% to 4%) and did not correlate with HCT-CI score (P = .9). On multivariate analysis, overall survival was inferior in groups with HCT-CI score of 1 to 2 (relative risk, 1.37, [95% confidence interval, 1.01 to 1.87], P = .04) and HCT-CI score > 2 (relative risk, 1.5 [95% confidence interval, 1.09 to 2.08], P = .01). Overall survival was also inferior with KPS < 90 (P < .001), IgA subtype (P ≤ .001), those receiving >1 pretransplant induction regimen (P = .007), and those with resistant disease at the time of AHCT (P < .001). AHCT for MM is associated with low NRM, and death is predominantly related to disease progression. Although a higher HCT-CI score did not predict NRM, it was associated with inferior survival.