Responsiveness, Stability, and Validity of Patient-Reported Outcomes in Aphasia

失语症患者报告结果的反应性、稳定性和有效性

• 批准号: 8979089
• 负责人: William D. Hula
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-01 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8979089
• 关键词: Accountability; Address; Affect; Affordable Care Act; Aftercare; Agreement; Ambulatory Care Facilities; Aphasia; Aphasia Tests; Benchmarking; Caring; Clinical; Clinical Research; Cognitive; Collaborations; Communication; Communication impairment; Computers; Data; Development; Discipline; Evaluation; Factor Analysis; Family member; Frequencies; Funding; Goals; Health; Health Personnel; Healthcare; Impairment; Intervention; Language; Measurement; Measures; Methods; Modeling; Outcome; Outcome Measure; Participant; Pathologist; Patient Care; Patient Outcomes Assessments; Patients; Performance; Personal Satisfaction; Persons; Physical Function; Population; Program Evaluation; Property; Provider; Psychometrics; Qualitative Research; Rehabilitation Outcome; Reporting; Research; Research Methodology; Research Personnel; Sampling; Speech; Structure; Testing; Time; Treatment outcome; Veterans; aphasia rehabilitation; base; evidence base; experience; health care quality; improved; individual patient; language impairment; negative mood; payment; person centered; public health relevance; rehabilitation service; response; social; tool; trait; treatment response

 DESCRIPTION (provided by applicant): Aphasia is a communication disorder that affects 80,000 people per year and estimates suggest that VHA outpatient clinics see 2000 new cases of aphasia each year. As in other healthcare disciplines, speech-language pathologists are increasingly called upon to document the impact of their interventions with respect to functioning, activities, and social participation. One response has been the development of patient-reported outcome (PRO) measures for a range of health conditions. The goal of this proposal is to enhance the validity and clinically utility o a new PRO measure for veterans with aphasia, the Aphasia Communication Outcome Measure (ACOM). This tool will assist clinicians and researchers in responding to growing mandates to focus on patients' experiences in improving the quality and efficiency of care. In the initial fiel trial of the ACOM, a plausible and clinically useful measurement model for the ACOM was identified; its covariance-based reliability was estimated to be high; and it was found to correlat positively with other measures of communicative functioning and language performance as predicted. The next steps in maximizing the ACOM's clinical utility are to assess its sensitivity t change over time, the stability of its measurement model, and its relationships to other relevant variables. First, the responsiveness of the ACOM to treatment-related change will be assessed in collaboration with 3 independent VA RR&D-funded treatment studies by collecting pre- and post-treatment data from at least 60 participants to test whether the ACOM demonstrates reliable positive change in response to treatment. Estimates of its responsiveness and minimally important difference scores will be obtained. Second, confirmatory tests of the ACOM measurement model and the stability of its item parameters will be conducted in a sample of 300 participants with aphasia in order to verify that its internal structure applies to the intende population. Test-retest stability of score estimates in the absence of treatment will also be assessed this sample. Third, in a sub-sample of 240 participants with aphasia, correlations among the ACOM, a performance-based measure of language impairment, and concurrent PRO measures of communication, cognitive, and physical functioning will be estimated to evaluate convergence with more related constructs and discriminant evidence for less related constructs. We will also use data collected from this subsample to assess the unique contribution of ACOM for predicting communication-related well-being over and above a measure of language impairment and a PRO measure of general negative mood. The outcomes of this proposal will include (1) estimates of the responsiveness of the ACOM to treatment and benchmarks for interpretation, (2) evidence supporting the validity of the ACOM's internal structure and the stability of its item parameters, and (2) evidence supporting claims that the ACOM in fact measures the underlying construct of patient-reported communicative functioning.

 描述（由申请人提供）： 失语症是一种沟通障碍，每年影响 80,000 人，估计 VHA 门诊诊所每年会发现 2000 例新的失语症病例，与其他医疗保健学科一样，越来越多的语言病理学家被要求记录其干预措施的影响。一项应对措施是针对一系列健康状况制定患者报告结果（PRO）措施，该提案的目标是提高其有效性和临床实用性。针对患有失语症的退伍军人的新 PRO 措施，即失语症沟通结果测量 (ACOM)，该工具将帮助参议员和研究人员应对不断增长的任务，以在最初的现场试验中关注患者的体验。 ACOM 是一种合理且在临床上有用的 ACOM 测量模型；估计其基于协方差的可靠性很高；并且发现它与预测的交流功能和语言表现的其他测量呈正相关。最大化 ACOM 的临床效用是评估其随时间变化的敏感性、测量模型的稳定性及其与其他相关变量的关系。首先，将与 3 个独立的机构合作评估 ACOM 对治疗相关变化的反应。 VA RR&D 资助的治疗研究，通过收集至少 60 名参与者的治疗前和治疗后数据来测试 ACOM 是否表现出对治疗反应的可靠积极变化，并将获得其反应性和最小重要差异评分的估计。 ACOM 测量模型及其项目参数稳定性的验证性测试将在 300 名失语症参与者的样本中进行，以验证其内部结构是否适用于预期人群在缺乏评估的情况下的重测稳定性。第三，在 240 名失语症参与者的子样本中，还将评估 ACOM（基于表现的语言障碍测量）和同时进行的沟通、认知和身体功能 PRO 测量之间的相关性。到我们还将使用从该子样本收集的数据来评估 ACOM 在预测语言障碍测量和 PRO 测量之外的与沟通相关的幸福感方面的独特贡献。该提案的结果将包括 (1) ACOM 对治疗的反应性和解释基准的估计，(2) 支持 ACOM 内部结构有效性及其项目参数稳定性的证据，以及(2) 支持 ACOM 事实上衡量患者报告的沟通功能的基本结构这一主张的证据。