Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2015

Open Access 01-12-2015 | Research

The psychometric performance of generic preference-based measures for patients with pressure ulcers

Authors: Simon Palfreyman, Brendan Mulhern

Published in: Health and Quality of Life Outcomes | Issue 1/2015

Login to get access

Abstract

Background

Pressure ulcers are wounds that result from reduced mobility, and can have a significant impact on morbidity, mortality and quality of life. As pressure ulcers are a consequence of a wide range of conditions and interventions, it is unclear whether the best means of capturing the quality of life impacts is via generic or condition specific Patient Reported Outcome Measures (PROMs). The aim of this study was to investigate the psychometric performance of the generic EQ-5D and SF-6D amongst patients identified as having or being at risk of developing pressure ulceration.

Methods

A survey of patients who were using pressure relieving mattresses and other equipment was undertaken within inpatient and community settings using a handheld tablet and postal survey. Data on EQ-5D-3L, SF-12 (used to calculate SF-6D), an EQ-5D dignity bolt-on question, demographic and wound specific questions were collected. Convergent validity was assessed using Spearman’s correlations, and agreement using Bland-Altman plots. Known group validity was assessed by examining whether the instruments discriminated between different pressure ulcer severity groups. Multivariate linear regression was used to examine the impact of a range of pressure ulcer related variables.

Results

The total number of participants was 307, including 273 from the acute setting (52 % response rate) and 41 from the community (32 %). SF-6D and EQ-5D were moderately correlated (0.61), suggesting that both instruments were capturing similar quality of life impacts. Both measures were able to significantly discriminate between groups based on the ulcer grade. Presence of a pressure ulcer and number of comorbidities were significant explanatory variables of EQ-5D and SF-6D score.

Conclusions

The results suggest that generic PROMs can effectively capture the impact of pressure ulcers on quality of life, although there are significant challenges in collecting data from this group of patients related to poor clinical condition and mental capacity. The most effective method for obtaining survey data was through the hand held devices and interviewers.
Literature
1.
Stinson M, Gillan C, Porter-Armstrong A. A literature review of pressure ulcer prevention: weight shift activity cost of pressure care and role of the occupational therapist. Br J Occup Ther. 2013;76(4):169–78.CrossRef
2.
Bennett G, Dealey C, Posnett J. The cost of pressure ulcers in the UK. Age Ageing. 2004;33(3):230–5.PubMedCrossRef
3.
Dealey C, Posnett J, Walker A. The cost of pressure ulcers in the United Kingdom. J Wound Care. 2012;21(6):261–6.PubMedCrossRef
4.
5.
Drummond MF, McGuire A. Economic evaluation in health care: merging theory with practice. New York: Oxford University Press; 2001.
6.
Whitehead SJ, Ali S. Health outcomes in economic evaluation: the QALY and utilities. Br Med Bull. 2010;96(1):5–21.PubMedCrossRef
7.
Mulhern B, Rowen D, Brazier J, Smith S, Romeo R, Tait C, et al. Development of DEMQOL-U and DEMQOL-PROXY-U: generation of preference-based indices from DEMQOL and DEMQOL-PROXY for use in economic evaluation. Health Technol Assess. 2013;17(5):1–140.CrossRef
8.
Stevens K, Palfreyman S. The use of qualitative methods in developing the descriptive systems of preference-based measures of health-related quality of life for use in economic evaluation. Value Health. 2012;15(8):991–8.PubMedCrossRef
9.
Rowen D, Brazier J, Young T, Gaugris S, Craig BM, King MT, et al. Deriving a preference-based measure for cancer using the EORTC QLQ-C30. Value Health. 2011;14(5):721–31.PubMedCrossRef
10.
Versteegh MM, Leunis A, Uyl-de Groot CA, Stolk EA. Condition-specific preference-based measures: benefit or burden? Value Health. 2012;15(3):504–13.PubMedCrossRef
11.
Moore Z, Cowman S. Quality of life and pressure ulcers: a literature review. Wounds UK. 2009;5(1):58–65.
12.
Franks PJ, Winterberg H, Moffatt CJ. Health-related quality of life and pressure ulceration assessment in patients treated in the community. Wound Repair Regen. 2002;10(3):133–40.PubMedCrossRef
13.
Essex HN, Clark M, Sims J, Warriner A, Cullum N. Health-related quality of life in hospital inpatients with pressure ulceration: assessment using generic health-related quality of life measures. Wound Repair Regen. 2009;17(6):797–805.PubMedCrossRef
14.
Clark M. Pressure ulcers and quality of life. Nurs Stand. 2002;16(22):74–80.CrossRef
15.
Gorecki C, Brown JM, Cano S, Lamping DL, Briggs M, Coleman S, et al. Development and validation of a new patient-reported outcome measure for patients with pressure ulcers: the PU-QOL instrument. Health Qual Life Outcomes. 2013;11:95.PubMedCentralPubMedCrossRef
16.
17.
Gorecki C, Closs SJ, Nixon J, Briggs M. Patient-reported pressure ulcer pain: a mixed-methods systematic review. J Pain Symptom Manage. 2011;42(3):443–59.PubMedCrossRef
18.
Hopkins A, Dealey C, Bale S, Defloor T, Worboys F. Patient stories of living with a pressure ulcer. J Adv Nurs. 2006;56(4):345–53.PubMedCrossRef
19.
Langemo DK, Melland H, Hanson D, Olson B, Hunter S. The lived experience of having a pressure ulcer: a qualitative analysis. Adv Skin Wound Care. 1999;13(5):225–35.
20.
Spilsbury K, Nelson A, Cullum N, Iglesias C, Nixon J, Mason S. Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives. J Adv Nurs. 2007;57(5):494–504.PubMedCrossRef
21.
Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, et al. Impact of pressure ulcers on quality of life in older patients: a systematic review. J Am Geriatr Soc. 2009;57(7):1175–83.PubMedCrossRef
22.
Dolynchuk K, Keast D, Campbell K, Houghton P, Orsted H, Sibbald G, et al. Best practices for the prevention and treatment of pressure ulcers. Ostomy Wound Manage. 2000;46(11):38–52.PubMed
23.
Beldon P. Problems encountered managing pressure ulceration of the sacrum. Br J Community Nurs. 2008;13(6):S6–12.
24.
Kayser-Jones JS, Beard RL, Sharpp TJ. Case study: dying with a stage IV pressure ulcer. Am J Nurs. 2009;109(1):40–8.PubMedCrossRef
25.
Fogerty MD, Abumrad NN, Nanney L, Arbogast PG, Poulose B, Barbul A. Risk factors for pressure ulcers in acute care hospitals. Wound Repair Regen. 2008;16(1):11–8.PubMedCrossRef
26.
Lindgren M, Unosson M, Krantz AM, Ek AC. Pressure ulcer risk factors in patients undergoing surgery. J Adv Nurs. 2005;50(6):605–12.PubMedCrossRef
27.
Horn SD, Bender SA, Ferguson ML, Smout RJ, Bergstrom N, Taler G, et al. The National pressure ulcer long term care study: pressure ulcer development in long term care residents. J Am Geriatr Soc. 2004;52(3):359–67.PubMedCrossRef
28.
White-Chu EF, Flock P, Struck B, Aronson L. Pressure ulcers in long-term care. Clin Geriatr Med. 2011;27(2):241–58.PubMedCrossRef
29.
Dorsett P, Geraghty T. Health-related outcomes of people with spinal cord injury a 10 year longitudinal study. Spinal Cord. 2008;46(5):386–91.PubMedCrossRef
30.
Shahin ES, Dassen T, Halfens RJ. Pressure ulcer prevalence and incidence in intensive care patients: a literature review. Nurs Crit Care. 2008;13(2):71–9.PubMedCrossRef
31.
Iizaka S, Okuwa M, Sugama J, Sanada H. The impact of malnutrition and nutrition-related factors on the development and severity of pressure ulcers in older patients receiving home care. Clin Nutr. 2010;29(1):47–53.PubMedCrossRef
32.
Allman RM, Goode PS, Patrick MM, Burst N, Bartolucci AA. Pressure ulcer risk factors among hospitalized patients with activity limitation. JAMA. 1995;273(11):865–70.PubMedCrossRef
33.
Maklebust J, Magnan MA. Risk factors associated with having a pressure ulcer: a secondary data analysis. Adv Wound Care. 1994;7(6):25–7.PubMed
34.
EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199.CrossRef
35.
Jenkinson C, Layte R. Development and testing of the UK SF-12. J Health Serv Res. 1997;2(1):14–8.
36.
Dixon S. The Sheffield dignity questionnaire. PRO Newletter. 2011;46:9–11.
37.
Dixon S, Palfreyman SJ, Shackley P, Brazier J. What is dignity? ScHARR Discussion Paper: A literature review and conceptual mapping; 2011.
38.
39.
Kaltenthaler E, Whitfield MD, Walters SJ, Akehurst RL, Paisley S. UK, USA and Canada: how do their pressure ulcer prevalence and incidence data compare? J Wound Care. 2001;10:530–5.PubMedCrossRef
40.
Baharestani MM, Black JM, Carville K, Clark M, Cuddigan JE, Dealey C, et al. Dilemmas in measuring and using pressure ulcer prevalence and incidence: an international consensus. Int Wound J. 2009;6(2):97–104.PubMedCrossRef
41.
Szende A, Oppe M, Devlin N. EQ-5D value sets: inventory comparative review and user guide Springer: EuroQol group monograph. 2007.
42.
Bansback N, Brazier J, Tsuchiya A, Anis A. Using a discrete choice experiment to estimate health state utility values. J Health Econ. 2012;31(1):306–18.PubMedCrossRef
43.
Mulhern B, Bansback N, Brazier J, Buckingham K, Cairns J, Devlin N, et al. Preparatory study for the revaluation of the EQ-5D tariff: methodology report. Health Technol Assess. 2014;18:12.CrossRef
44.
Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ. 2002;21(2):271–92.PubMedCrossRef
45.
Brazier JE, Roberts J. The estimation of a preference-based measure of health from the SF-12. Med Care. 2004;42(9):851–9.PubMedCrossRef
46.
Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I Conceptual framework and item selection. Med Care. 1992;30(6):473–83.PubMedCrossRef
47.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale NJ: Erlbaum; 1988.
48.
Bland MJ, Altman D. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;327(8476):307–10.CrossRef
49.
Stevenson R, Collinson M, Henderson V, Wilson L, Dealey C, McGinnis E, et al. The prevalence of pressure ulcers in community settings: an observational study. Int J Nurs Stud. 2013;50(11):1550–7.PubMedCrossRef
50.
Cox J. Predictors of pressure ulcers in adult critical care patients. Am J Crit Care. 2011;20(5):364–75.PubMedCrossRef
51.
Capon A, Pavoni N, Mastromattei A, Di Lallo D. Pressure ulcer risk in long‐term units: prevalence and associated factors. J Adv Nurs. 2007;58(3):263–72.PubMedCrossRef
Metadata
Title
The psychometric performance of generic preference-based measures for patients with pressure ulcers
Authors
Simon Palfreyman
Brendan Mulhern
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2015
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-015-0307-4

Other articles of this Issue 1/2015

Health and Quality of Life Outcomes 1/2015 Go to the issue

Research

Validation of the Questionnaire to Identify Knee Symptoms (QuIKS) using Rasch analysis

Research

Adverse childhood experiences and health-related quality of life in adulthood: revelations from a community needs assessment

Review

A systematic review of instruments for measuring outcomes in economic evaluation within aged care

Research

Validation and cross-cultural adaptation of the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) in Serbian patients

Research

Evaluation of smoking-specific and generic quality of life measures in current and former smokers in Germany and the United States

Research

Cognitive emotion regulation: characteristics and effect on quality of life in women with breast cancer