Lloyd Melanie A, Tang Clarice Y, Callander Emily J, Janus Edward D, Karahalios Amalia, Skinner Elizabeth H, Lowe Stephanie, Karunajeewa Harin A
1Department of Physiotherapy, Western Health, St Albans, Victoria 3021 Australia.
2Melbourne Medical School - Western Precinct, The University of Melbourne, St Albans, Victoria 3021 Australia.
Pilot Feasibility Stud. 2019 Jul 27;5:97. doi: 10.1186/s40814-019-0481-y. eCollection 2019.
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, but few studies have evaluated the feasibility of routine patient-reported outcome measures (PROMs) in this illness. This study investigates the feasibility and limitations of three credible PROM instruments in a representative hospitalized cohort to identify potential barriers to routine application.
A sample of multimorbid hospitalized subjects meeting a standardized CAP definition was recruited. Demographic and clinical data of those able and unable to participate in PROM assessment were compared. The EQ-5D-5L, CAP-Sym 18 Questionnaire, and Late-Life Function and Disability Instrument (LLFDI) were administered (via face-to-face interview) at admission and discharge and (via phone interview or mail) at 30 and 90 days post-discharge. Feasibility measures included the proportion of individuals able to participate in assessment, attrition rates, data completeness, and instrument completion times. Scores at admission and 30 days post-discharge were examined for association with age.
Of 82 subjects screened, 44 (54%) participated. Cognitive impairment ( = 12, 15%) commonly precluded participation. Seventeen (39%) participants were lost to follow-up by 90 days. Missing data at item level was negligible for all instruments, regardless of the mode of completion. Completion of the three instruments collectively in a face-to-face interview took a median of 17 min (IQ range 13-21) per participant. The burden of reported symptoms at admission was higher for younger participants aged 18-74 years (mean (standard deviation)) CAP-Sym 18 score at admission 34.2 (18.6) vs. 19.0 (11.3) for those aged ≥ 75 years.
Routine application of PROMs can provide valuable information relating to multiple aspects of clinical recovery for individuals hospitalized with CAP. However, heterogeneous demographic characteristics and complex underlying health status introduce challenges to feasibility and interpretability of these instruments in this population.
ClinicalTrials.gov, NCT02835040.
社区获得性肺炎（CAP）是全球发病和死亡的主要原因之一，但很少有研究评估在这种疾病中常规患者报告结局测量（PROMs）的可行性。本研究调查了三种可靠的PROM工具在具有代表性的住院队列中的可行性和局限性，以确定常规应用的潜在障碍。
招募符合标准化CAP定义的多病住院受试者样本。比较了能够和不能参与PROM评估的受试者的人口统计学和临床数据。在入院时和出院时（通过面对面访谈）以及出院后30天和90天（通过电话访谈或邮件）发放欧洲五维度健康量表（EQ-5D-5L）、CAP-18症状问卷（CAP-Sym 18 Questionnaire）和老年功能与残疾量表（LLFDI）。可行性指标包括能够参与评估的个体比例、失访率、数据完整性和工具完成时间。检查入院时和出院后30天的评分与年龄的相关性。
在筛查的82名受试者中，44名（54%）参与。认知障碍（n = 12，15%）通常妨碍参与。到90天时，17名（39%）参与者失访。无论完成方式如何，所有工具在项目层面的缺失数据都可以忽略不计。在面对面访谈中，每位参与者完成这三种工具总共用时中位数为17分钟（四分位距13 - 21分钟）。18 - 74岁的年轻参与者入院时报告症状的负担更高（均值（标准差）），入院时CAP-Sym 18评分为34.2（18.6），而75岁及以上者为19.0（11.3）。
PROMs的常规应用可为CAP住院患者临床康复的多个方面提供有价值的信息。然而，不同的人口统计学特征和复杂的基础健康状况给这些工具在该人群中的可行性和可解释性带来了挑战。
ClinicalTrials.gov，NCT02835040。
