Nancy Mayo - Academia.edu (original) (raw)

Papers by Nancy Mayo

Physical Therapy

Background and Purpose. The Stroke Rehabilitation Assessment of Movement (STREAM) is a new clinic... more Background and Purpose. The Stroke Rehabilitation Assessment of Movement (STREAM) is a new clinical measurement tool for evaluating the recovery of voluntary movement and basic mobility following stroke. This article presents the results of 3 substudies examining the reliability (interrater and intrarater) and internal consistency of STREAM scores. Subjects and Methods. A "direct-observation reliability study" was conducted on 20 patients who had strokes and were in a rehabilitation setting. Pairs of raters from a group of 6 participating therapists provided data to judge interrater agreement. A "videotaped assessments reliability study" was done to assess intrarater and interrater agreement on the scoring of videotaped performances using the STREAM measure and involved 4 videotaped assessments that were viewed and rated on 2 occasions by 20 physical therapists. The internal consistency of the STREAM scores was evaluated for 26 patients who had strokes and who demonstrated the full range of motor ability. Results. The reliability of the STREAM scores was demonstrated by generalizability correlation coefficients of .99 for total scores and of .96 to .99 for subscale scores. The internal consistency of the STREAM scores was demonstrated by Cronbach alphas of greater than .98 on the subscales and overall. Conclusion and Discussion. These high levels of reliability support the use of the STREAM instrument for the measurement of motor recovery following stroke. Further work on the validity and responsiveness of the STREAM measure is in progress. ͓Daley K, Mayo N, Wood-Dauphinée S. Reliability of scores on the Stroke Rehabilitation Assessment of Movement (STREAM) measure. Phys Ther. 1998;78:8 -23.͔

Canadian Medical Association Journal

Currently there is no agreement on the optimal time to treatment of breast cancer; however, given... more Currently there is no agreement on the optimal time to treatment of breast cancer; however, given the considerable emphasis on early detection, one would expect a similar emphasis on early treatment. The purpose of our study was to assess the time interval to surgery from initiation of diagnosis among Quebec women with breast cancer and to examine the influence on waiting time of age, pattern of care and cancer stage. Methods: Records of physician fee-for-service claims and of hospital admissions were obtained for all Quebec women who underwent an invasive procedure for the diagnosis or treatment of breast cancer between 1992 and 1998. Waiting time was calculated as the number of days between the first diagnostic procedure and surgical treatment. Results: There were 29 606 episodes of breast cancer surgery among 28 100 women: 5922 mastectomies and 23 684 lumpectomies. The absolute number of episodes of breast cancer treated with surgery rose from 3626 in 1992 to 5162 in 1998. The overall median waiting time was 34 days (interquartile range [IQR] 19-62); 13.5% of the women waited longer than 90 days. The median waiting time rose from 29 days (IQR 15-54) in 1992 to 42 days (IQR 24-72) in 1998, representing a relative increase of 37% (95% confidence interval [CI] 32%-43%) after adjusting for age and cancer stage. The median waiting time increased with the number of diagnostic procedures, from 24 days (IQR 14-42) with 1 procedure to 48 days (IQR 27-84) with 3 procedures to 72 days (IQR 43-121) with 4 procedures, representing adjusted relative increases of 97% (95% CI 91%-103%) and 194% (95% CI 181%-208%), respectively. The proportion of women receiving 3 or more diagnostic procedures before surgery increased steadily over the study period, from 19.2% in 1992 to 33.0% in 1998. The median waiting time was shorter with more advanced stages of cancer: 53 days (IQR 30-86) for carcinoma in situ, 35 (IQR 20-62) for localized disease, 28 (IQR 16-49) for regional disease and 24 (IQR 11-52) for disseminated disease. Interpretation: Waiting time between initial diagnosis and first surgery for breast cancer has increased substantially in Quebec between 1992 and 1998. Possible explanations include increased demand, decreased resources and changes in patterns of care. P ractice guidelines for breast cancer emphasize that the work-up of a lump in the breast should be completed as soon as possible after detection. 1 Currently there is no agreement on what the optimal time to treatment should be, and decisions of both patients and health care providers influence the time from detection to treatment. Delays can arise if a women is reluctant to seek medical follow-up for a suspicious breast lesion or if health care providers are unable to evaluate and treat the lesion as quickly as they might wish. Evidence is lacking on the minimum delay that would have a negative impact on survival. Sainsbury and associates, 2 in a retrospective analysis of data for 36 222 patients in Great Britain, found no evidence that delays of more than 90 days from family physician referral to

Archives of Physical Medicine and Rehabilitation

ABSTRACT

American Journal of Epidemiology

American Journal of Epidemiology

ABSTRACT

BMC Neurology, 2015

Up to half of all people with HIV infection have some degree of cognitive impairment. This impair... more Up to half of all people with HIV infection have some degree of cognitive impairment. This impairment is typically mild, but nonetheless often disabling. Although early detection of cognitive impairment offers the greatest hope of effective intervention, there are important barriers to this goal in most clinical settings. These include uncertainty about how self-reported cognitive symptoms relate to objective impairments, and the paucity of bedside measurement tools suitable for mild deficits. Clinicians need guidance in interpreting cognitive symptoms in this population, and a brief cognitive measurement tool targeted to mild impairment. We addressed these two problems together here. The objective of this study was to determine the extent to which performance on cognitive tests and self-reported cognitive symptoms form a unidimensional construct. Two hundred three HIV+ individuals completed the Montreal Cognitive Assessment, computerized cognitive tasks and a questionnaire eliciting cognitive symptoms. Rasch measurement theory was applied to determine whether patient-reported and performance items could be combined to measure cognition as a unidimensional latent construct. Performance-based items and cognitive symptoms are arranged hierarchically along the same continuum of cognitive ability, forming a measure with thresholds covering a broad spectrum of ability that has good internal reliability. The cognitive symptoms that fit the measurement model relate to important aspects of everyday life, providing evidence that the identified construct is meaningful. This finding lays the foundation for a rapid measure of cognitive ability in people with HIV infection that is feasible for routine clinical use, and shows that some cognitive symptoms are systematically related to performance in this population.

Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine

Rehabilitation professionals rarely ask questions about the etiology of health events or outcomes... more Rehabilitation professionals rarely ask questions about the etiology of health events or outcomes and may not have formal training or relevant experience in the design of studies whose intent is to identify causal factors. the case-control study, which is one design used to answer questions about etiology, is particularly difficult to understand and research has shown that this study design label is often used incorrectly. this paper outlines the main features of case-control studies, with a particular focus on sampling strategies. the goal is to educate clinical rehabilitation colleagues about the fundamental principles of this powerful epidemiologic design. examples illustrate how the parameters of cumulative incidence, incidence-density, and prevalence are estimated and the effect of sampling strategy on these parameters. also shown is how sampling strategy affects conclusions drawn about the effects of an exposure on outcome. even when used appropriately, case-control studies are methodologically complex to design and analyze to ensure an unbiased answer to the research question. the hypothetical and reallife examples given here could be used as course material to educate rehabilitation researchers.

Stroke

Purpose To develop and verify a model of participation post stroke, as a domain of health related... more Purpose To develop and verify a model of participation post stroke, as a domain of health related quality of life.

Healthcare policy = Politiques de sante

Background : This study was conducted among surgically treated breast cancer patients in Quebec t... more Background : This study was conducted among surgically treated breast cancer patients in Quebec to determine waiting time between surgery and post-operative radiation therapy and factors influencing it. Methods : Records of fee-for-service claims and hospitalizations were obtained for all women who, between 1992 and 1998, underwent an invasive procedure for nonmetastatic breast cancer. Waiting time was defined as the time between either the last surgical procedure or the last cycle of chemotherapy and the initiation of radiation therapy. Hierarchical linear regression models were used to identify predictors of waiting time. Results : Over seven years, 29,072 episodes of breast cancer treatments were identified, of which 17,684 included radiation therapy. The number of cases increased by 5.5% per year, but concurrent broadening of indications for radiation therapy led to an increase in the number of breast cancer patients receiving radiation therapy of 9% per year. In hierarchical linear modelling, comparing 1998 to 1992, median waiting time increased by 63% (95% confidence interval [CI] 35%-97%) in patients not receiving chemotherapy and by 35% (95% CI 3%-88%) in patients receiving chemotherapy. Other predictors of shorter waiting times were localized cancer stage, breast-conserving surgery, early consultation with a radiation oncologist, having surgery in a centre with a radiation therapy facility, living close to a radiation therapy facility and living in a higher socio-economic area. Interpretation : Using administrative databases to evaluate waiting times is feasible. Explanations of the increased waiting time include increased demand, insufficient resources and changes in the indications for breast-conserving surgery and radiation therapy.

Quality of Life Research, 2015

The content validity of patient-reported outcomes (PROs) commonly used to measure postoperative r... more The content validity of patient-reported outcomes (PROs) commonly used to measure postoperative recovery is unknown. The objective of this study was to develop a conceptual framework for recovery after abdominal surgery and to analyze the content of PRO instruments against this conceptual framework. Qualitative methods were used to develop a conceptual framework for recovery. Patients undergoing abdominal surgery and healthcare professionals were interviewed. Recovery-related concepts were identified using a thematic analysis, and concepts were then linked to the International Classification of Functioning, Disability and Health (ICF). The contents of eight PRO instruments that have been used to measure recovery were then examined using this conceptual framework. A total of 17 patients and 15 healthcare professionals were interviewed. A total of 22 important recovery-related concepts were identified and linked to the ICF. The four most important concepts were "Energy level," "Sensation of pain," "General physical endurance," and "Carrying out daily routine." The number of important recovery-related concepts covered by each instrument ranged from 1 to 22 (mean 7.3 concepts). The SF36 (n = 22), European Organization for the Treatment and Research of Cancer Quality-of-Life Questionnaire-C30 (n = 20), and the Gastrointestinal Quality-of-Life Index (n = 19) covered the greatest number of important recovery concepts. No instrument covered all of the important concepts. The comparison of the contents of PRO instruments commonly used to measure postoperative recovery after abdominal surgery demonstrated major gaps in the representation of concepts that are important to patients and healthcare professionals.

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 17, 2001

Currently there is no agreement on the optimal time to treatment of breast cancer; however, given... more Currently there is no agreement on the optimal time to treatment of breast cancer; however, given the considerable emphasis on early detection, one would expect a similar emphasis on early treatment. The purpose of our study was to assess the time interval to surgery from initiation of diagnosis among Quebec women with breast cancer and to examine the influence on waiting time of age, pattern of care and cancer stage. Records of physician fee-for-service claims and of hospital admissions were obtained for all Quebec women who underwent an invasive procedure for the diagnosis or treatment of breast cancer between 1992 and 1998. Waiting time was calculated as the number of days between the first diagnostic procedure and surgical treatment. There were 29,606 episodes of breast cancer surgery among 28,100 women: 5922 mastectomies and 23,684 lumpectomies. The absolute number of episodes of breast cancer treated with surgery rose from 3626 in 1992 to 5162 in 1998. The overall median waiti...

Physical therapy, 1999

The Stroke Rehabilitation Assessment of Movement (STREAM) is a new clinical measurement tool for ... more The Stroke Rehabilitation Assessment of Movement (STREAM) is a new clinical measurement tool for evaluating the recovery of voluntary movement and basic mobility following stroke. This article presents the results of 3 substudies examining the reliability (interrater and intrarater) and internal consistency of STREAM scores. A "direct-observation reliability study" was conducted on 20 patients who had strokes and were in a rehabilitation setting. Pairs of raters from a group of 6 participating therapists provided data to judge interrater agreement. A "videotaped assessments reliability study" was done to assess intrarater and interrater agreement on the scoring of videotaped performances using the STREAM measure and involved 4 videotaped assessments that were viewed and rated on 2 occasions by 20 physical therapists. The internal consistency of the STREAM scores was evaluated for 26 patients who had strokes and who demonstrated the full range of motor ability. Th...

Physical therapy, 2003

The Stroke Rehabilitation Assessment of Movement (STREAM) is a relatively new measure of voluntar... more The Stroke Rehabilitation Assessment of Movement (STREAM) is a relatively new measure of voluntary movement and basic mobility. The main objectives of this study were: (1) to examine the relationship of the STREAM to other measures of impairment and disability and (2) to compare its usefulness for evaluating effects of stroke and rehabilitation and for assessing change over time with that of other measures of impairment and disability. The performance of 63 patients with acute stroke on the STREAM and other measures of impairment and disability was evaluated during the first week after stroke and 4 weeks and 3 months later. Scores on the STREAM were associated with scores on the Box and Block test, Balance Scale, Barthel Index, gait speed, and the Timed "Up Go" Test (with Pearson correlation coefficients ranging from .57 to .80) and were associated with categories of the Barthel Index and Balance Scale. The STREAM's ability to predict discharge destination from the acu...

Health and quality of life outcomes, 2003

Health-related quality of life (HRQL) is a key issue in disabling conditions like stroke. Unfortu... more Health-related quality of life (HRQL) is a key issue in disabling conditions like stroke. Unfortunately, HRQL is often difficult to quantify in a comprehensive measure that can be used in cost analyses. Preference-based HRQL measures meet this challenge. To date, there are no existing preference-based HRQL measure for stroke that could be used as an outcome in clinical and economic studies of stroke. The aim of this study was to develop the first stroke-specific health index, the Preference-based Stroke Index (PBSI). The PBSI includes 10 items; walking, climbing stairs, physical activities/sports, recreational activities, work, driving, speech, memory, coping and self-esteem. Each item has a 3-point response scale. Items known to be impacted by a stroke were selected. Scaling properties and preference-weights obtained from individuals with stroke and their caregivers were used to develop a cumulative score. Compared to the EQ-5D, the PBSI showed no ceiling effect in a high-functioni...

Medical care, 2003

Practice guidelines for breast cancer emphasize the importance of establishing an accurate diagno... more Practice guidelines for breast cancer emphasize the importance of establishing an accurate diagnosis using a minimum number of procedures and selecting optimal treatment regimens. Understanding the determinants of waiting time is essential to develop optimum interventions to reduce delay. The purpose of this study is to estimate the extent to which variability in 1) the number of procedures before surgery and 2) waiting time from initial procedure to surgery are explainable by factors related to the woman, to the provider, and to the care setting. Records of physicians' fee-for-service claims were obtained for 23,370 women undergoing breast cancer surgery in Quebec between 1992 and 1997. Multilevel logistic regression was used to determine predictors of having multiple procedures before surgery. Hierarchical linear regression models were used to identify predictors of waiting time, separately for women with lymph node involvement and without this involvement. Overall, 23% of the...

Medical care, 2005

Case-mix adjustment is widely used in health services research to ensure that groups being compar... more Case-mix adjustment is widely used in health services research to ensure that groups being compared are equivalent on variables predicting outcome. There has been considerable development and testing of comorbidity indices derived from diagnostic codes recorded in administrative databases, but increasingly, the benefit of clinical information and patient reported ratings of health and functional status is being recognized. One type of information that is highly valued but has so far not been captured by administrative health databases is functional status indicators (FSI). The purpose of this study was to estimate the extent to which prediction of health outcomes can be improved on by including information on functional status indicators (FSI). The data for the current study was obtained from a clustered randomized trial evaluating computerized decision support for managing drug therapy in the elderly, conducted from 1997 to 1998. A total of 107 primary care physicians participated ...

Physical Therapy

Background and Purpose. The Stroke Rehabilitation Assessment of Movement (STREAM) is a new clinic... more Background and Purpose. The Stroke Rehabilitation Assessment of Movement (STREAM) is a new clinical measurement tool for evaluating the recovery of voluntary movement and basic mobility following stroke. This article presents the results of 3 substudies examining the reliability (interrater and intrarater) and internal consistency of STREAM scores. Subjects and Methods. A "direct-observation reliability study" was conducted on 20 patients who had strokes and were in a rehabilitation setting. Pairs of raters from a group of 6 participating therapists provided data to judge interrater agreement. A "videotaped assessments reliability study" was done to assess intrarater and interrater agreement on the scoring of videotaped performances using the STREAM measure and involved 4 videotaped assessments that were viewed and rated on 2 occasions by 20 physical therapists. The internal consistency of the STREAM scores was evaluated for 26 patients who had strokes and who demonstrated the full range of motor ability. Results. The reliability of the STREAM scores was demonstrated by generalizability correlation coefficients of .99 for total scores and of .96 to .99 for subscale scores. The internal consistency of the STREAM scores was demonstrated by Cronbach alphas of greater than .98 on the subscales and overall. Conclusion and Discussion. These high levels of reliability support the use of the STREAM instrument for the measurement of motor recovery following stroke. Further work on the validity and responsiveness of the STREAM measure is in progress. ͓Daley K, Mayo N, Wood-Dauphinée S. Reliability of scores on the Stroke Rehabilitation Assessment of Movement (STREAM) measure. Phys Ther. 1998;78:8 -23.͔

Canadian Medical Association Journal

Currently there is no agreement on the optimal time to treatment of breast cancer; however, given... more Currently there is no agreement on the optimal time to treatment of breast cancer; however, given the considerable emphasis on early detection, one would expect a similar emphasis on early treatment. The purpose of our study was to assess the time interval to surgery from initiation of diagnosis among Quebec women with breast cancer and to examine the influence on waiting time of age, pattern of care and cancer stage. Methods: Records of physician fee-for-service claims and of hospital admissions were obtained for all Quebec women who underwent an invasive procedure for the diagnosis or treatment of breast cancer between 1992 and 1998. Waiting time was calculated as the number of days between the first diagnostic procedure and surgical treatment. Results: There were 29 606 episodes of breast cancer surgery among 28 100 women: 5922 mastectomies and 23 684 lumpectomies. The absolute number of episodes of breast cancer treated with surgery rose from 3626 in 1992 to 5162 in 1998. The overall median waiting time was 34 days (interquartile range [IQR] 19-62); 13.5% of the women waited longer than 90 days. The median waiting time rose from 29 days (IQR 15-54) in 1992 to 42 days (IQR 24-72) in 1998, representing a relative increase of 37% (95% confidence interval [CI] 32%-43%) after adjusting for age and cancer stage. The median waiting time increased with the number of diagnostic procedures, from 24 days (IQR 14-42) with 1 procedure to 48 days (IQR 27-84) with 3 procedures to 72 days (IQR 43-121) with 4 procedures, representing adjusted relative increases of 97% (95% CI 91%-103%) and 194% (95% CI 181%-208%), respectively. The proportion of women receiving 3 or more diagnostic procedures before surgery increased steadily over the study period, from 19.2% in 1992 to 33.0% in 1998. The median waiting time was shorter with more advanced stages of cancer: 53 days (IQR 30-86) for carcinoma in situ, 35 (IQR 20-62) for localized disease, 28 (IQR 16-49) for regional disease and 24 (IQR 11-52) for disseminated disease. Interpretation: Waiting time between initial diagnosis and first surgery for breast cancer has increased substantially in Quebec between 1992 and 1998. Possible explanations include increased demand, decreased resources and changes in patterns of care. P ractice guidelines for breast cancer emphasize that the work-up of a lump in the breast should be completed as soon as possible after detection. 1 Currently there is no agreement on what the optimal time to treatment should be, and decisions of both patients and health care providers influence the time from detection to treatment. Delays can arise if a women is reluctant to seek medical follow-up for a suspicious breast lesion or if health care providers are unable to evaluate and treat the lesion as quickly as they might wish. Evidence is lacking on the minimum delay that would have a negative impact on survival. Sainsbury and associates, 2 in a retrospective analysis of data for 36 222 patients in Great Britain, found no evidence that delays of more than 90 days from family physician referral to

Archives of Physical Medicine and Rehabilitation

ABSTRACT

American Journal of Epidemiology

American Journal of Epidemiology

ABSTRACT

BMC Neurology, 2015

Up to half of all people with HIV infection have some degree of cognitive impairment. This impair... more Up to half of all people with HIV infection have some degree of cognitive impairment. This impairment is typically mild, but nonetheless often disabling. Although early detection of cognitive impairment offers the greatest hope of effective intervention, there are important barriers to this goal in most clinical settings. These include uncertainty about how self-reported cognitive symptoms relate to objective impairments, and the paucity of bedside measurement tools suitable for mild deficits. Clinicians need guidance in interpreting cognitive symptoms in this population, and a brief cognitive measurement tool targeted to mild impairment. We addressed these two problems together here. The objective of this study was to determine the extent to which performance on cognitive tests and self-reported cognitive symptoms form a unidimensional construct. Two hundred three HIV+ individuals completed the Montreal Cognitive Assessment, computerized cognitive tasks and a questionnaire eliciting cognitive symptoms. Rasch measurement theory was applied to determine whether patient-reported and performance items could be combined to measure cognition as a unidimensional latent construct. Performance-based items and cognitive symptoms are arranged hierarchically along the same continuum of cognitive ability, forming a measure with thresholds covering a broad spectrum of ability that has good internal reliability. The cognitive symptoms that fit the measurement model relate to important aspects of everyday life, providing evidence that the identified construct is meaningful. This finding lays the foundation for a rapid measure of cognitive ability in people with HIV infection that is feasible for routine clinical use, and shows that some cognitive symptoms are systematically related to performance in this population.

Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine

Rehabilitation professionals rarely ask questions about the etiology of health events or outcomes... more Rehabilitation professionals rarely ask questions about the etiology of health events or outcomes and may not have formal training or relevant experience in the design of studies whose intent is to identify causal factors. the case-control study, which is one design used to answer questions about etiology, is particularly difficult to understand and research has shown that this study design label is often used incorrectly. this paper outlines the main features of case-control studies, with a particular focus on sampling strategies. the goal is to educate clinical rehabilitation colleagues about the fundamental principles of this powerful epidemiologic design. examples illustrate how the parameters of cumulative incidence, incidence-density, and prevalence are estimated and the effect of sampling strategy on these parameters. also shown is how sampling strategy affects conclusions drawn about the effects of an exposure on outcome. even when used appropriately, case-control studies are methodologically complex to design and analyze to ensure an unbiased answer to the research question. the hypothetical and reallife examples given here could be used as course material to educate rehabilitation researchers.

Stroke

Purpose To develop and verify a model of participation post stroke, as a domain of health related... more Purpose To develop and verify a model of participation post stroke, as a domain of health related quality of life.

Healthcare policy = Politiques de sante

Background : This study was conducted among surgically treated breast cancer patients in Quebec t... more Background : This study was conducted among surgically treated breast cancer patients in Quebec to determine waiting time between surgery and post-operative radiation therapy and factors influencing it. Methods : Records of fee-for-service claims and hospitalizations were obtained for all women who, between 1992 and 1998, underwent an invasive procedure for nonmetastatic breast cancer. Waiting time was defined as the time between either the last surgical procedure or the last cycle of chemotherapy and the initiation of radiation therapy. Hierarchical linear regression models were used to identify predictors of waiting time. Results : Over seven years, 29,072 episodes of breast cancer treatments were identified, of which 17,684 included radiation therapy. The number of cases increased by 5.5% per year, but concurrent broadening of indications for radiation therapy led to an increase in the number of breast cancer patients receiving radiation therapy of 9% per year. In hierarchical linear modelling, comparing 1998 to 1992, median waiting time increased by 63% (95% confidence interval [CI] 35%-97%) in patients not receiving chemotherapy and by 35% (95% CI 3%-88%) in patients receiving chemotherapy. Other predictors of shorter waiting times were localized cancer stage, breast-conserving surgery, early consultation with a radiation oncologist, having surgery in a centre with a radiation therapy facility, living close to a radiation therapy facility and living in a higher socio-economic area. Interpretation : Using administrative databases to evaluate waiting times is feasible. Explanations of the increased waiting time include increased demand, insufficient resources and changes in the indications for breast-conserving surgery and radiation therapy.

Quality of Life Research, 2015

The content validity of patient-reported outcomes (PROs) commonly used to measure postoperative r... more The content validity of patient-reported outcomes (PROs) commonly used to measure postoperative recovery is unknown. The objective of this study was to develop a conceptual framework for recovery after abdominal surgery and to analyze the content of PRO instruments against this conceptual framework. Qualitative methods were used to develop a conceptual framework for recovery. Patients undergoing abdominal surgery and healthcare professionals were interviewed. Recovery-related concepts were identified using a thematic analysis, and concepts were then linked to the International Classification of Functioning, Disability and Health (ICF). The contents of eight PRO instruments that have been used to measure recovery were then examined using this conceptual framework. A total of 17 patients and 15 healthcare professionals were interviewed. A total of 22 important recovery-related concepts were identified and linked to the ICF. The four most important concepts were "Energy level," "Sensation of pain," "General physical endurance," and "Carrying out daily routine." The number of important recovery-related concepts covered by each instrument ranged from 1 to 22 (mean 7.3 concepts). The SF36 (n = 22), European Organization for the Treatment and Research of Cancer Quality-of-Life Questionnaire-C30 (n = 20), and the Gastrointestinal Quality-of-Life Index (n = 19) covered the greatest number of important recovery concepts. No instrument covered all of the important concepts. The comparison of the contents of PRO instruments commonly used to measure postoperative recovery after abdominal surgery demonstrated major gaps in the representation of concepts that are important to patients and healthcare professionals.

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 17, 2001

Currently there is no agreement on the optimal time to treatment of breast cancer; however, given... more Currently there is no agreement on the optimal time to treatment of breast cancer; however, given the considerable emphasis on early detection, one would expect a similar emphasis on early treatment. The purpose of our study was to assess the time interval to surgery from initiation of diagnosis among Quebec women with breast cancer and to examine the influence on waiting time of age, pattern of care and cancer stage. Records of physician fee-for-service claims and of hospital admissions were obtained for all Quebec women who underwent an invasive procedure for the diagnosis or treatment of breast cancer between 1992 and 1998. Waiting time was calculated as the number of days between the first diagnostic procedure and surgical treatment. There were 29,606 episodes of breast cancer surgery among 28,100 women: 5922 mastectomies and 23,684 lumpectomies. The absolute number of episodes of breast cancer treated with surgery rose from 3626 in 1992 to 5162 in 1998. The overall median waiti...

Physical therapy, 1999

The Stroke Rehabilitation Assessment of Movement (STREAM) is a new clinical measurement tool for ... more The Stroke Rehabilitation Assessment of Movement (STREAM) is a new clinical measurement tool for evaluating the recovery of voluntary movement and basic mobility following stroke. This article presents the results of 3 substudies examining the reliability (interrater and intrarater) and internal consistency of STREAM scores. A "direct-observation reliability study" was conducted on 20 patients who had strokes and were in a rehabilitation setting. Pairs of raters from a group of 6 participating therapists provided data to judge interrater agreement. A "videotaped assessments reliability study" was done to assess intrarater and interrater agreement on the scoring of videotaped performances using the STREAM measure and involved 4 videotaped assessments that were viewed and rated on 2 occasions by 20 physical therapists. The internal consistency of the STREAM scores was evaluated for 26 patients who had strokes and who demonstrated the full range of motor ability. Th...

Physical therapy, 2003

The Stroke Rehabilitation Assessment of Movement (STREAM) is a relatively new measure of voluntar... more The Stroke Rehabilitation Assessment of Movement (STREAM) is a relatively new measure of voluntary movement and basic mobility. The main objectives of this study were: (1) to examine the relationship of the STREAM to other measures of impairment and disability and (2) to compare its usefulness for evaluating effects of stroke and rehabilitation and for assessing change over time with that of other measures of impairment and disability. The performance of 63 patients with acute stroke on the STREAM and other measures of impairment and disability was evaluated during the first week after stroke and 4 weeks and 3 months later. Scores on the STREAM were associated with scores on the Box and Block test, Balance Scale, Barthel Index, gait speed, and the Timed "Up Go" Test (with Pearson correlation coefficients ranging from .57 to .80) and were associated with categories of the Barthel Index and Balance Scale. The STREAM's ability to predict discharge destination from the acu...

Health and quality of life outcomes, 2003

Health-related quality of life (HRQL) is a key issue in disabling conditions like stroke. Unfortu... more Health-related quality of life (HRQL) is a key issue in disabling conditions like stroke. Unfortunately, HRQL is often difficult to quantify in a comprehensive measure that can be used in cost analyses. Preference-based HRQL measures meet this challenge. To date, there are no existing preference-based HRQL measure for stroke that could be used as an outcome in clinical and economic studies of stroke. The aim of this study was to develop the first stroke-specific health index, the Preference-based Stroke Index (PBSI). The PBSI includes 10 items; walking, climbing stairs, physical activities/sports, recreational activities, work, driving, speech, memory, coping and self-esteem. Each item has a 3-point response scale. Items known to be impacted by a stroke were selected. Scaling properties and preference-weights obtained from individuals with stroke and their caregivers were used to develop a cumulative score. Compared to the EQ-5D, the PBSI showed no ceiling effect in a high-functioni...

Medical care, 2003

Practice guidelines for breast cancer emphasize the importance of establishing an accurate diagno... more Practice guidelines for breast cancer emphasize the importance of establishing an accurate diagnosis using a minimum number of procedures and selecting optimal treatment regimens. Understanding the determinants of waiting time is essential to develop optimum interventions to reduce delay. The purpose of this study is to estimate the extent to which variability in 1) the number of procedures before surgery and 2) waiting time from initial procedure to surgery are explainable by factors related to the woman, to the provider, and to the care setting. Records of physicians' fee-for-service claims were obtained for 23,370 women undergoing breast cancer surgery in Quebec between 1992 and 1997. Multilevel logistic regression was used to determine predictors of having multiple procedures before surgery. Hierarchical linear regression models were used to identify predictors of waiting time, separately for women with lymph node involvement and without this involvement. Overall, 23% of the...

Medical care, 2005

Case-mix adjustment is widely used in health services research to ensure that groups being compar... more Case-mix adjustment is widely used in health services research to ensure that groups being compared are equivalent on variables predicting outcome. There has been considerable development and testing of comorbidity indices derived from diagnostic codes recorded in administrative databases, but increasingly, the benefit of clinical information and patient reported ratings of health and functional status is being recognized. One type of information that is highly valued but has so far not been captured by administrative health databases is functional status indicators (FSI). The purpose of this study was to estimate the extent to which prediction of health outcomes can be improved on by including information on functional status indicators (FSI). The data for the current study was obtained from a clustered randomized trial evaluating computerized decision support for managing drug therapy in the elderly, conducted from 1997 to 1998. A total of 107 primary care physicians participated ...