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Background The primary purpose of this study is to assess the existing evidence on the cost-effectiveness of surgical interventions for the management of knee and hip osteoarthritis by systematically reviewing published economic evaluation studies. Methods A systematic review was conducted for the period 2004 to 2016. Electronic databases were searched to identify both trial and model based economic evaluation studies that evaluated surgical interventions for knee and hip osteoarthritis. Results A total of 23 studies met the inclusion criteria and an assessment of these studies showed that total knee arthroplasty (TKA), and total hip arthroplasty (THA) showed evidence of cost-effectiveness and improvement in quality of life of the patients when compared to non-operative and non-surgical procedures. On the other hand, even though delaying TKA and THA may lead to some cost savings in the short-run, the results from the study showed that this was not a cost-effective option. Conclusions TKA and THA are cost-effective and should be recommended for the management of patients with end stage/severe knee and hip OA. However, there needs to be additional studies to assess the cost-effectiveness of other surgical interventions in order for definite conclusions to be reached.

Family and Group Conferencing (FGC) is a strengths-based approach to social work, originating from New Zealand and now used internationally. Previous research on FGC has focused largely on the context of children's services but, FGC also aligns with the principle of the Care Act in England to prevent, reduce or delay the need for long-term (and potentially costly) adult care services. Limited previous research has tended to explore potential cost savings associated with FGC, without accounting for the cost of the intervention itself, risking biased results. This paper aims to identify resource use and associated monetary costs associated with FGC services in English adult social care and mental health settings. Framework development was informed by previously published work establishing programme theory for FGC, extended by expert opinion and published sources of monetary costs. The framework used scenario-based analysis and a bottom-up costing approach, with sensitivity analysis. Estimated costs of conducting a standard full FGC (excluding referral) range from £1,455 to £2,043 (adjusted from 2022-2023-2025 prices) from a local authority and National Health Service (NHS) perspective. Costs can vary depending on the involvement of an advocate or interpreter, network size and the complexity of issues being addressed. We report overall costs with and without resource use specifically related to referral. Higher staff costs account for slightly higher intervention costs in an NHS mental health setting, compared to adult social care settings. Reallocating scarce public resources with the intention of preventing, reducing or delaying use of costly future care must be evidence-based as pressures build to meet acute needs. Accurate per-case costing of FGC is a necessary preliminary step towards exploring the cost-effectiveness of FGC. A full economic evaluation will account for costs, outcomes, and alternative options (uses of limited resources).

The ICECAP capability measures are increasingly being used to capture the impact of health and social care interventions on well-being. In cases where the recipient of an intervention is highly vulnerable, proxy completion may be necessary. This study adds to the limited existing evidence on proxy completion of ICECAP-A specifically and adopts the novel approach of investigating multiple proxy responses for the same four (hypothetical) individuals. 62 members of the public who were participating in a series of one day deliberative workshops on public health and social care completed ICECAP-A on behalf of four hypothetical individuals, described in vignettes. Quantitative analysis explored the range of proxy responses for each of the four hypothetical individuals, and any possible correlation between participants' own characteristics and their proxy responses. Participants discussed their proxy responses after completing the task; this discussion was audio recorded and analysed using Framework Analysis. Wide variation in ICECAP-A scores was observed across proxy respondents for each hypothetical individual. Participants' demographic characteristics and own well-being do not appear to have systematically influenced proxy responses. Qualitative analysis suggests two principal approaches (or perspectives) were adopted by participants: Empathetic (adopting the perspective of the 'subject') and factual (a factual assessment of the subject's well-being). Participants also drew on their own experiences to varying degrees. There were differing interpretations of the Independence attribute on ICECAP-A and some evidence that participants' ideas of what constituted achievement were context (including life-stage and condition/health) specific. The factual versus empathetic approaches identified from qualitative analysis in this study match to the concept of a proxy-proxy versus proxy-patient perspective, previously outlined in the literature. Researchers should consider specifying which perspective proxy raters should adopt. Findings also suggest proxy responses can be influenced by external points of reference and interpretation of measure attributes.

Sen's capability approach is underspecified; one decision left to those operationalising the approach is how to identify sets of relevant and important capabilities. Sen has suggested that lists be developed for specific policy or research objectives through a process of public reasoning and discussion. Robeyns offers further guidance in support of Sen's position, suggesting that lists should be explicit, discussed and defended; methods be openly scrutinised; lists be considered both in terms of what is ideal and what is practical ('generality'); and that lists be exhaustive. Here, the principles suggested by Robeyns are operationalised to facilitate external scrutiny of a list of capabilities identified for use in the evaluation of supportive end of life care. This work started with an existing list of seven capabilities (the ICECAP-SCM), identified as being necessary for a person to experience a good death. Semi-structured qualitative interviews were conducted with 20 experts in economics, psychology, ethics and palliative care, to facilitate external scrutiny of the developed list. Interviews were recorded, transcribed and analysed using constant comparison. The seven capabilities were found to encompass concepts identified as important by expert stakeholders (to be exhaustive) and the measure was considered feasible for use with patients receiving care at the end of life. The rigorous development of lists of capabilities using both initial participatory approaches with affected population groups, and subsequent assessment by experts, strengthens their democratic basis and may encourage their use in policy contexts.

Falls among older adults pose a significant public health challenge, as they lead to severe outcomes such as fractures and loss of independence. Research has shown that training cognitive function and balance simultaneously, termed Dual-Task (DT) training, improves mobility and reduces fall risks in older adults. This study aims to evaluate the feasibility and acceptability of a blended supervised and self-directed technology-based DT training programme for older adults who have high risk of falling. This is a single-arm, non-randomised feasibility study employing quantitative and qualitative methods. Fifty healthy adults aged 65 years or above will be recruited from the NHS primary and secondary care pathways and from the community. Participants will undergo supervised cognitive and balance DT training for 12 weeks, followed by self-directed DT training for an additional 12 weeks. The cognitive training will be delivered using a commercial mobile application (app) available from the AppStore or Google Play. The balance training will involve static (Marching on the spot, Tandem Stand, Hip Abduction & Extension, Squats, Tiptoe Stand, and Pendulum/Sideways Sway) and dynamic (Figure of Eight Walk, Walking Forwards and Backwards, Lunges, Functional Reach, Toe Tapping, Upper Limb Strength Exercises, and Side-Steps/Simple Grapevine) exercises focused on improving balance, postural stability and strength. Feasibility outcomes will be recruitment, adherence, usage of the app, and attrition. Outcomes measure data, that will be collected at baseline and at 24 weeks, includes the Timed- Up and Go (TUG) test (likely primary outcome in any future trial), along with self-reported questionnaires assessing cognition, fear of falling, quality of life, healthcare service usage, and the self-reported number of falls. Focus group interviews will be conducted with thirty participants and thirty healthcare professionals for in-depth exploration of the feasibility and acceptability of the DT training programme.

Plain English summary In the UK, more patients go to primary care than other parts of the health service. Therefore it is important for research into primary care to include the insights and views of people who receive these services. To explore the extent, quality and impact of patient and public involvement (PPI) in primary care research, we examined documents of 200 projects and surveyed 191 researchers. We found that about half of studies included PPI to develop research ideas and during the study itself. Common activities included designing study materials, advising on methods, and managing the research. Some studies did not undertake the PPI activities initially planned and funded for. PPI varied by study design, health condition and study population. We found pockets of good practice: having a PPI budget, supporting PPI contributors, and PPI informing recruitment issues. However, good practice was lacking in other areas. Few projects offered PPI contributors training, used PPI to develop information for participants about study progress and included PPI to advise on publishing findings. Researchers reported beneficial impacts of PPI. Most impact was reported when the approach to PPI included more indicators of good practice. The main cost of PPI for researchers was their time. Many reported difficulties providing information about PPI. In partnership with PPI contributors, we have used these findings to develop: a new Cost and Consequences Framework for PPI highlighting financial and non-financial costs, benefits and harms of PPI Fifteen co-produced recommendations to improve the practice and delivery of PPI. Background: To improve the lives of patients in primary care requires the involvement of service users in primary care research. We aimed to explore the extent, quality and impact of patient and public involvement (PPI) in primary care research. Methods: We extracted information about PPI from grant applications, reports and an electronic survey of researchers of studies funded by the NIHR School for Primary Care Research (SPCR). We applied recognised quality indicators to assess the quality of PPI and assessed its impact on research. Results: We examined 200 grant applications and reports of 181 projects. PPI was evident in the development of 47 (24%) grant applications. 113 (57%) grant applications included plans for PPI during the study, mostly in study design, oversight, and dissemination. PPI during projects was reported for 83 (46%) projects, including designing study materials and managing the research. We identified inconsistencies between planned and reported PPI. PPI varied by study design, health condition and study population. Of 46 (24%) of 191 questionnaires completed, 15 reported PPI activity. Several projects showed best practice according to guidelines, in terms of having a PPI budget, supporting PPI contributors, and PPI informing recruitment issues. However few projects offered PPI contributors training, used PPI to develop information for participants about study progress, and had PPI in advising on dissemination. Beneficial impacts of PPI in designing studies and writing participant information was frequently reported. Less impact was reported on developing funding applications, managing or carrying out the research. The main cost of PPI for researchers was their time. Many researchers found it difficult to provide information about PPI activities. Our findings informed: a new Cost and Consequences Framework for PPI in primary care research highlighting financial and non-financial costs, plus the benefits and harms of PPI Fifteen co-produced recommendations to improve PPI in research and within the SPCR. Conclusions: The extent, quality and impact of PPI in primary care research is inconsistent across research design and topics. Pockets of good practice were identified making a positive impact on research. The new Cost and Consequences Framework may help others assess the impact of PPI.

A bstract Background The UK Medical Research Council approach to evaluating complex interventions moves through development, feasibility, piloting, evaluation and implementation in an iterative manner. This approach might be useful as a conceptual process underlying complex valuation tasks. Objective The objective of the study was to explore the applicability of such a framework using a single case study (valuing the ICECAP-Supportive Care Measure) and considering three key uncertainties: the number of response categories for the measure; experimental design; and the potential for using slightly different variants of the measure with the same value set. Methods Three on-line pilot studies ( n  = 204, n  = 100, n  = 102) were undertaken during 2012 and 2013 with adults from the UK general population. Each used variants of discrete choice and best-worst scaling tasks; respondents were randomly allocated to different groups to allow exploration of the number of levels for the instrument (four or five), optimal experimental design and the values for alternative wording around prognosis. Conditional logit regression models were used in the analysis and variance scale factors were explored. Results The five-level version of the measure seemed to result in simplifying heuristics. Plotting the variance scale factors suggested that best-worst scaling answers were approximately four times more consistent than the discrete choice answers. The likelihood ratio test indicated there was virtually no difference in values between the differently worded versions. Conclusion Rigorous piloting can improve the design of valuation studies. Thinking in terms of a ‘complex valuation framework’ may emphasise the importance of conducting and funding such rigorous pilots.

Purpose A paper reporting the development of the ICECAP-O was published in 2006. Since then, there has been increasing interest in the use of capability-based measures within health economics and the ICECAP-O has been suggested for use in economic evaluation by decision-making bodies in the Netherlands and UK. Methods A systematic review of studies published between January 2006 and October 2018 which have assessed the psychometric properties of ICECAP-O or utilised the measure within economic evaluation. Results Twenty-four studies explored the psychometric properties of ICECAP-O and 21 have utilised the measure within economic evaluation; one study reported psychometric properties as well as utilising the measure within economic evaluation. The ICECAP-O has good construct validity and responsiveness, but there is evidence of some issues relating to content validity. In the context of economic evaluation, the ICECAP-O has, to date, mainly been included as a secondary economic measure and the reporting of results is brief with minimal detail and often no discussion. Five of the economic evaluation studies combined scores from ICECAP-O with time, but each used different terminology to describe this result. Conclusion Focus, in terms of publications, appears to have shifted now from assessment of psychometric properties to the utilisation of the ICECAP-O within economic evaluation. Further research is needed with respect to a decision-rule for the ICECAP measures. This additional research should also guide users in terms of appropriate analysis, terminology and presentation of results, which are in-keeping with the conceptual framework underpinning the ICECAP-O.

Background The evaluation of care strategies at the end of life is particularly important due to the globally increasing proportion of very old people in need of care. The ICECAP-Supportive Care Measure is a self-complete questionnaire developed in the UK to evaluate palliative and supportive care by measuring patient’s wellbeing in terms of ‘capability’. It is a new measure with high potential for broad and international use. The aims of this study were the translation of the ICECAP-Supportive Care Measure from English into German and the content validation of this version. Methods A multi-step and team-based translation process based on the TRAPD model was performed. An expert survey was carried out to assess content validity. The expert panel ( n  = 20) consisted of four expert groups: representative seniors aged 65+, patients aged 65+ living in residential care, patients aged 65+ receiving end-of-life care, and professionals in end-of-life care. Results The German version of the ICECAP-Supportive Care Measure showed an excellent content validity on both item- and scale-level. In addition, a high agreement regarding the length of the single items and the total length of the questionnaire as well as the number of answer categories was reached. Conclusions The German ICECAP-SCM is a valid tool to assess the quality of life at the end of life that is suitable for use in different settings. The questionnaire may be utilized in multinational clinical and economic evaluations of end-of-life care.

Objective: Patients' experiences are often treated as health care quality indicators. Our aim was to identify the range of experiences of health care delivery that matter to patients and to produce a conceptual map to facilitate consideration of why they matter. Methods: Broad-based review and critical interpretive synthesis of research literature on patients' perspectives of health care delivery. We recorded experiences reported by a diverse range of patients on 'concept cards', considered why they were important, and explored various ways of organizing them, including internationally recognized health care quality frameworks. We developed a conceptual map that we refined with feedback from stakeholders. Results: Patients identify many health care experiences as important. Existing health care quality frameworks do not cover them all. Our conceptual map presents a rich array of experiences, including health care relationships (beyond communication) and their implications for people's valued capabilities (e.g. to feel respected, contribute to their care, experience reciprocity). It is organized to reflect our synthesis argument, which links health care delivery to what people are enabled (or not) to feel, be and do. The map highlights the broad implications of the social dynamics of health care delivery. Experiences are labelled from a patient's perspective, rendering the importance of responsiveness to individuals axiomatic. Conclusions: Our conceptual map identifies and helps explain the importance of diverse experiences of health care delivery. It challenges and helps policy-makers, service providers and researchers to attend to the range of experiences that matter, and to take seriously the need for responsiveness to individuals.