Shima Shahjouei1, Alireza Vafaei Sadr2, Soheila Khorasani3, Farideh Nejat4, Zohreh Habibi4, Ali Akbari Sari5. 1. Department of Neurosurgery, Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran; Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Universal Scientific Education and Research Network, Tehran, Iran. 2. Department of Physics, Shahid Beheshti University, Tehran, Iran; Department of Theoretical Physics and Center for Astroparticle Physics, University of Geneva, Geneva, Switzerland. 3. Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 4. Department of Neurosurgery, Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran. 5. Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: akbarisari@tums.ac.ir.
Abstract
BACKGROUND: Assessment of health-related quality of life (HRQOL or utility) is a complex issue especially in children with temporary health states. OBJECTIVES: To assess the utility of prone positioning as a prophylactic postsurgical approach with the aid of 5 frequently used general instruments. METHODS: Visual analogue scale (VAS), time trade-off (TTO), modified TTO (m-TTO), standard gamble (SG), and chain of gambles (ChGs) instruments and interview with the parent caregivers were used to measure the HRQOL (utility value) of patients who were admitted in the surgical wards of Children's Medical Center Hospital between July and November 2015. RESULTS: A total of 74 parent caregivers with a mean age of 30.48 ± 6.66 years were enrolled. On the basis of the Gaussian model of the repeated VAS measures, we classified the behavior of the participants into 4 clusters. Cumulative study of all these clusters demonstrated that TTO has the highest utility measure for prone positioning (0.682 ± 0.359), whereas the lowest utility value was measured by VAS2 (0.132 ± 0.569). In addition, all VAS measures underestimated the preferences. Overall, values of TTO, m-TTO, and ChGs remained consistent through each of these 4 clusters (intracluster consistency) and within each cluster (intercluster consistency). The adopted utility value of prone positioning based on these 3 instruments was estimated as 0.68 ± 0.21. CONCLUSIONS: We recommended a model for assessment of HRQOL in children with temporary health states to overcome the challenges of each isolated instrument and used this model to measure the utility value of prone positioning in pediatric patients.
BACKGROUND: Assessment of health-related quality of life (HRQOL or utility) is a complex issue especially in children with temporary health states. OBJECTIVES: To assess the utility of prone positioning as a prophylactic postsurgical approach with the aid of 5 frequently used general instruments. METHODS: Visual analogue scale (VAS), time trade-off (TTO), modified TTO (m-TTO), standard gamble (SG), and chain of gambles (ChGs) instruments and interview with the parent caregivers were used to measure the HRQOL (utility value) of patients who were admitted in the surgical wards of Children's Medical Center Hospital between July and November 2015. RESULTS: A total of 74 parent caregivers with a mean age of 30.48 ± 6.66 years were enrolled. On the basis of the Gaussian model of the repeated VAS measures, we classified the behavior of the participants into 4 clusters. Cumulative study of all these clusters demonstrated that TTO has the highest utility measure for prone positioning (0.682 ± 0.359), whereas the lowest utility value was measured by VAS2 (0.132 ± 0.569). In addition, all VAS measures underestimated the preferences. Overall, values of TTO, m-TTO, and ChGs remained consistent through each of these 4 clusters (intracluster consistency) and within each cluster (intercluster consistency). The adopted utility value of prone positioning based on these 3 instruments was estimated as 0.68 ± 0.21. CONCLUSIONS: We recommended a model for assessment of HRQOL in children with temporary health states to overcome the challenges of each isolated instrument and used this model to measure the utility value of prone positioning in pediatric patients.
Keywords:
chain of gambles; modified time trade-off; prone positioning; standard gamble (SG); temporary health state; time trade-off (TTO); visual analogue scale (VAS)