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How can quality of life researchers make their work more useful to health workers and their patients?

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Abstract

To make optimal use of data from randomized trials in clinical decision-making, clinicians require knowledge of the magnitude of treatment effects. Reports of trials including quality of life data often fail to report results that provide interpretable estimates of magnitude of effect. Strategies that investigators could use to remedy this problem include reporting mean differences between groups in relation to the minimal important difference and reporting the proportion of patients who benefit from treatment and the associated number needed to treat. Techniques are available that allow investigators to use the same strategies in reporting pooled estimates from meta-analyses, even when studies use different instruments to measure the same construct. These reporting approaches, as well as ensuring access to data from individual items, will also help those developing decision aids to use quality of life data.

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References

  1. Guyatt, G., Gutterman, D., Baumann, M. H., Addrizzo-Harris, D., Hylek, E. M., Phillips, B., Raskob, G., Lewis, S. Z., & Schunemann, H. (2006). Grading strength of recommendations and quality of evidence in clinical guidelines: Report from an American college of chest physicians task force. Chest, 129, 174–181.

    Article  PubMed  Google Scholar 

  2. Guyatt, G. H., Osoba, D., Wu, A. W., Wyrwich, K. W., & Norman, G. R. (2002). Methods to explain the clinical significance of health status measures. Mayo Clin Proc, 77, 371–383.

    PubMed  Google Scholar 

  3. Schunemann, H. J., Akl, E. A., & Guyatt, G. H. (2006). Interpreting the results of patient reported outcome measures in clinical trials: The clinician's perspective. Health Qual Life Outcomes, 4, 62.

    Article  PubMed  Google Scholar 

  4. Brozek, J. L., Guyatt, G. H., & Schunemann, H. J. (2006). How a well-grounded minimal important difference can enhance transparency of labelling claims and improve interpretation of a patient reported outcome measure. Health Qual Life Outcomes, 4, 69.

    Article  PubMed  Google Scholar 

  5. Gary, R. (2006). Exercise self-efficacy in older women with diastolic heart failure: results of a walking program and education intervention. J Gerontol Nurs, 32, 31–39, quiz 40-1.

    Google Scholar 

  6. Naunheim, K. S., Wood, D. E., Mohsenifar, Z., Sternberg, A. L., Criner, G. J., DeCamp, M. M., Deschamps, C. C., Martinez, F. J., Sciurba, F. C., Tonascia, J., & Fishman, A. P. (2006). Long-term follow-up of patients receiving lung-volume-reduction surgery versus medical therapy for severe emphysema by the National Emphysema Treatment Trial Research Group. Ann Thorac Surg, 82, 431–443.

    Article  PubMed  Google Scholar 

  7. Burns, J., Crosbie, J., Ouvrier, R., & Hunt, A. (2006). Effective orthotic therapy for the painful cavus foot: A randomized controlled trial. J Am Podiatr Med Assoc, 96, 205–211.

    PubMed  Google Scholar 

  8. Broderick, J. E., Junghaenel, D. U., & Schwartz, J. E. (2005). Written emotional expression produces health benefits in fibromyalgia patients. Psychosom Med, 67, 326–334.

    Article  PubMed  Google Scholar 

  9. Mui, W. L., Ng, C. S., Fung, T. M., Cheung, F. K., Wong, C. M., Ma, T. H., Bn, M. Y., & Ng, E. K. (2006). Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: A double-blind randomized controlled trial. Ann Surg, 244, 27–33.

    Article  PubMed  Google Scholar 

  10. Wong, R. K., Paul, N., Ding, K., Whitehead, M., Brundage, M., Fyles, A., Wilke, D., Nabid, A., Fortin, A., Wilson, D., McKenzie, M., Ackerman, I., Souhami, L., Chabot, P., & Pater, J. (2006). 5-Hydroxytryptamine-3 receptor antagonist with or without short-course dexamethasone in the prophylaxis of radiation induced emesis: A placebo-controlled randomized trial of the National Cancer Institute of Canada Clinical Trials Group (SC19). J Clin Oncol, 24, 3458–3464.

    Article  PubMed  CAS  Google Scholar 

  11. Weaver, A. L., Messner, R. P., Storms, W. W., Polis, A. B., Najarian, D. K., Petruschke, R. A., Geba, G. P., & Tershakovec, A. M. (2006). Treatment of patients with osteoarthritis with rofecoxib compared with nabumetone. J Clin Rheumatol, 12, 17–25.

    Article  PubMed  Google Scholar 

  12. Bacigalupo, A., Lamparelli, T., Barisione, G., Bruzzi, P., Guidi, S., Alessandrino, P. E., di Bartolomeo, P., Oneto, R., Bruno, B., Sacchi, N., van Lint, M. T., & Bosi, A. (2006). Thymoglobulin prevents chronic graft-versus-host disease, chronic lung dysfunction, and late transplant-related mortality: Long-term follow-up of a randomized trial in patients undergoing unrelated donor transplantation. Biol Blood Marrow Transplant, 12, 560–565.

    Article  PubMed  Google Scholar 

  13. Forrow, L., Taylor, W. C., & Arnold, R. M. (1992). Absolutely relative: How research results are summarized can affect treatment decisions. Am J Med, 92, 121–124.

    Article  PubMed  CAS  Google Scholar 

  14. Naylor, C. D., Chen, E., & Strauss, B. (1992). Measured enthusiasm: Does the method of reporting trial results alter perceptions of therapeutic effectiveness? Ann Intern Med, 117, 916–921.

    PubMed  CAS  Google Scholar 

  15. Malenka, D. J., Baron, J. A., Johansen, S., Wahrenberger, J. W., & Ross, J. M. (1993). The framing effect of relative and absolute risk. J Gen Intern Med, 8, 543–548.

    Article  PubMed  CAS  Google Scholar 

  16. Kosinski, M., Zhao, S. Z., Dedhiya, S., Osterhaus, J. T., & Ware, J. E. Jr. (2000). Determining minimally important changes in generic and disease-specific health-related quality of life questionnaires in clinical trials of rheumatoid arthritis. Arthritis Rheum, 43, 1478–1487.

    Article  PubMed  CAS  Google Scholar 

  17. Kulkarni, A. V. (2006). Distribution-based and anchor-based approaches provided different interpretability estimates for the Hydrocephalus Outcome Questionnaire. J Clin Epidemiol, 59, 176–184.

    Article  PubMed  Google Scholar 

  18. Coeytaux, R. R., Kaufman, J. S., Chao, R., Mann, J. D., & Devellis, R. F. (2006). Four methods of estimating the minimal important difference score were compared to establish a clinically significant change in Headache Impact Test. J Clin Epidemiol, 59, 374–380.

    Article  PubMed  Google Scholar 

  19. Jaeschke, R., Singer, J., & Guyatt, G. H. (1989). Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials, 10, 407–415.

    Article  PubMed  CAS  Google Scholar 

  20. Deyo, R. A., & Inui, T. S. (1984). Toward clinical applications of health status measures: Sensitivity of scales to clinically important changes. Health Serv Res, 19, 275–289.

    PubMed  CAS  Google Scholar 

  21. Thompson, M. S., Read, J. L., Hutchings, H. C., Paterson, M., & Harris, E. D. Jr. (1988). The cost effectiveness of auranofin: Results of a randomized clinical trial. J Rheumatol, 15, 35–42.

    PubMed  CAS  Google Scholar 

  22. Fergusson, D., Aaron, S. D., Guyatt, G., & Hebert, P. (2002). Post-randomisation exclusions: The intention to treat principle and excluding patients from analysis. Bmj, 325, 652–654.

    Article  PubMed  Google Scholar 

  23. Furukawa, T. (1999). From effect size into number needed to treat. Lancet, 353, 1680.

    Article  PubMed  CAS  Google Scholar 

  24. Brooks, W. B., Jordan, J. S., Divine, G. W., Smith, K. S., & Neelon, F. A. (1990). The impact of psychologic factors on measurement of functional status. Assessment of the sickness impact profile. Med Care, 28, 793–804.

    Article  PubMed  CAS  Google Scholar 

  25. Fletcher, A., McLoone, P., & Bulpitt, C. (1988). Quality of life on angina therapy: A randomised controlled trial of transdermal glyceryl trinitrate against placebo. Lancet, 2, 4–8.

    Article  PubMed  CAS  Google Scholar 

  26. King, T. K., Ali, N., & Briscoe, W. A. (1973). Treatment of hypoxia with 24 percent oxygen. A new approach to the interpretation of data collected in a pulmonary intensive care unit. Am Rev Respir Dis, 108, 19–29.

    PubMed  CAS  Google Scholar 

  27. Bergner, M., Bobbitt, R. A., Carter, W. B., & Gilson, B. S. (1981). The Sickness Impact Profile: Development and final revision of a health status measure. Med Care, 19, 787–805.

    Article  PubMed  CAS  Google Scholar 

  28. Ware, J. E. Jr., Manning, W. G. Jr., Duan, N., Wells, K. B., & Newhouse, J. P. (1984). Health status and the use of outpatient mental health services. Am Psychol, 39, 1090–1100.

    Article  PubMed  Google Scholar 

  29. Mossey, J. M., & Shapiro, E. (1982). Self-rated health: A predictor of mortality among the elderly. Am J Public Health, 72, 800–808.

    Article  PubMed  CAS  Google Scholar 

  30. Idler, E. L., & Angel, R. J. (1990). Self-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study. Am J Public Health, 80, 446–452.

    PubMed  CAS  Google Scholar 

  31. Brook, R. H., Ware, J. E. Jr., Rogers, W. H., Keeler, E. B., Davies, A. R., Donald, C. A., Goldberg, G. A., Lohr, K. N., Masthay, P. C., & Newhouse, J. P. (1983). Does free care improve adults’ health? Results from a randomized controlled trial. N Engl J Med, 309, 1426–1434.

    Article  PubMed  CAS  Google Scholar 

  32. Goldstein, R. S., Todd, T. R., Guyatt, G., Keshavjee, S., Dolmage, T. E., van Rooy, S., Krip, B., Maltais, F., LeBlanc, P., Pakhale, S., & Waddell, T. K. (2003). Influence of lung volume reduction surgery (LVRS) on health related quality of life in patients with chronic obstructive pulmonary disease. Thorax, 58, 405–410.

    Article  PubMed  CAS  Google Scholar 

  33. Goldstein, R. S., Gort, E. H., Stubbing, D., Avendano, M. A., & Guyatt, G. H. (1994). Randomised controlled trial of respiratory rehabilitation. Lancet, 344, 1394–1397.

    Article  PubMed  CAS  Google Scholar 

  34. Guyatt, G. H., Juniper, E. F., Walter, S. D., Griffith, L. E., & Goldstein, R. S. (1998). Interpreting treatment effects in randomised trials. Bmj, 316, 690–693.

    PubMed  CAS  Google Scholar 

  35. Derose, K., Kanouse, D., Weidmer, B., Weech-Maldonado, R., Garcia, R., & Hays, R. (in press). Developing a Spanish-language sample report for CAHPS. Joint Commission Journal on Quality and Patient Safety.

  36. Burge, P. S., Calverley, P. M., Jones, P. W., Spencer, S., Anderson, J. A., & Maslen, T. K. (2000). Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: The ISOLDE trial. Bmj, 320, 1297–1303.

    Article  PubMed  CAS  Google Scholar 

  37. Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003). Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Med Care, 41, 582–592.

    Article  PubMed  Google Scholar 

  38. Norman, G. R., Sridhar, F. G., Guyatt, G. H., & Walter, S. D. (2001). Relation of distribution- and anchor-based approaches in interpretation of changes in health-related quality of life. Med Care, 39, 1039–1047.

    Article  PubMed  CAS  Google Scholar 

  39. Supina, A. L., Feeny, D. H., Carroll, L. J., & Johnson, J. A. (2006). Misinterpretation with norm-based scoring of health status in adults with type 1 diabetes. Health Qual Life Outcomes, 4, 15.

    Article  PubMed  Google Scholar 

  40. Guyatt, G., Hayward, R., Richardson, W. S., Green, L., Wilson, M., Sinclair, J., Cook, D., Glasziou, P., Detsky, A., & Bass, E. (2002). Moving from evidence to action. In G. R. Guyatt & D. Rennie (Eds.), The Users’ Guides to the Medical Literature: A Manual for Evidence-based Clinical Practice. Chicago, Illinois: AMA publications.

  41. Oxman, A., Guyatt, G., Jaeschke, R., Montori, V. (2002). Summarizing the evidence. In G. R. Guyatt & D. Rennie (Eds.), The Users’ Guides to the Medical Literature: A Manual for Evidence-based Clinical Practice. Chicago, Illinois: AMA publications.

  42. Cohen, J. (1988). Statistical power analysis in the behavioral sciences. Hillsdale, NJ: Erlbaum.

  43. Lacasse, Y., Wong, E., Guyatt, G. H., King, D., Cook, D. J., & Goldstein, R. S. (1996). Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet, 348, 1115–1119.

    Article  PubMed  CAS  Google Scholar 

  44. Charles, C., Whelan, T., & Gafni, A. (1999). What do we mean by partnership in making decisions about treatment? Bmj, 319, 780–782.

    PubMed  CAS  Google Scholar 

  45. Guyatt, G. H., Haynes, R. B., Jaeschke, R. Z., Cook, D. J., Green, L., Naylor, C. D., Wilson, M. C., & Richardson, W. S. (2000). Users’ Guides to the Medical Literature: XXV. Evidence-based medicine: Principles for applying the Users’ Guides to patient care. Evidence-based Medicine Working Group. Jama, 284, 1290–1296.

    Article  PubMed  CAS  Google Scholar 

  46. O’Connor, A. M., Legare, F., & Stacey, D. (2003). Risk communication in practice: The contribution of decision aids. Bmj, 327, 736–740.

    Article  PubMed  Google Scholar 

  47. Whelan, T. J., & Loprinzi, C. (2005). Physician/patient decision aids for adjuvant therapy. J Clin Oncol, 23, 1627–1630.

    Article  PubMed  Google Scholar 

  48. Akl, E. A., Grant, B. J. B., Guyatt, G. H., Montori, V. M., & Schu¨nemann, H. J. (in press). A decision aid for COPD patients considering inhaled steroid therapy: development and before and after pilot testing. BMC Med Inform Decis Making.

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Acknowledgments

We are grateful for the very helpful advice that Dr. Tim Whelan gave us regarding making quality of life data helpful for those developing decision aids.

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Correspondence to Gordon Guyatt.

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Guyatt, G., Schunemann, H. How can quality of life researchers make their work more useful to health workers and their patients?. Qual Life Res 16, 1097–1105 (2007). https://doi.org/10.1007/s11136-007-9223-3

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