ABSTRACT
Population confidence is essential to a well functioning health system. Using data from the People's Voice Survey-a novel population survey conducted in 15 low-income, middle-income, and high-income countries-we report health system confidence among the general population and analyse its associated factors. Across the 15 countries, fewer than half of respondents were health secure and reported being somewhat or very confident that they could get and afford good-quality care if very sick. Only a quarter of respondents endorsed their current health system, deeming it to work well with no need for major reform. The lowest support was in Peru, the UK, and Greece-countries experiencing substantial health system challenges. Wealthy, more educated, young, and female respondents were less likely to endorse the health system in many countries, portending future challenges for maintaining social solidarity for publicly financed health systems. In pooled analyses, the perceived quality of the public health system and government responsiveness to public input were strongly associated with all confidence measures. These results provide a post-COVID-19 pandemic baseline of public confidence in the health system. The survey should be repeated regularly to inform policy and improve health system accountability.
Subject(s)
COVID-19 , Pandemics , Humans , Female , Surveys and Questionnaires , COVID-19/epidemiology , PeruABSTRACT
Background: Arthritis leads to disabilities impacting patients' physical and mental health. Objective: To synthesize the evidence on measurement properties of the patient-reported outcome measures (PROMs) for people with upper extremity arthritis. Design: Overview of systematic reviews (SRs). Methods: We performed an electronic search of 6 databases to retrieve SRs looking at any measurement property related to PROMs for people with upper extremity arthritis. Two authors rated the risk of bias (ROB) of the included SRs using AMSTAR. We extracted data on measurement properties from each SR. Results: From 6 included SRs, 6 PROMs (Arthritis Impact Measurement Scale [AIMS], AIMS-2, AIMS-Short Form, Cedars-Sinai Health-Related Quality of Life for Rheumatoid Arthritis (CSHQ-RA), Revised CSHQ-RA, and Influence of Rheumatic Disease on General Health and Lifestyle) were evaluated in 2 or more SRs. The ROB of the included SRs ranged from moderate to high. Low- to moderate-quality evidence was found of good construct and criterion validity, acceptable content validity, and good responsiveness of the AIMS. We found low- to moderate-quality evidence of good internal consistency, test-retest reliability, and construct validity of the CSHQ-RA. Conclusion: We found a moderate to high ROB in the included SRs on the upper extremity PROMs for patients with arthritis. More evidence was specific to upper extremity arthritis in measures not in common use versus well-validated measures used in upper extremity conditions and recommended in current core sets. These factors suggest an urgent need for additional research to improve the scope and quality of evidence before recommendations can be made specific to patients with arthritis. Registration Number: on PROSPERO CRD 42019137491.
ABSTRACT
OBJECTIVE: The purpose of this study was to summarize and evaluate the research on the accuracy of provocative maneuvers to diagnose carpal tunnel syndrome (CTS). METHODS: The MEDLINE, CINAHL, Cochrane, and Embase databases were searched, and studies that assessed the diagnostic accuracy of at least 1 provocative test for CTS were selected. Study characteristics and data about the diagnostic accuracy of the provocative tests for CTS were extracted. A random-effects meta-analysis of the sensitivity (Sn) and specificity (Sp) of the Phalen test and Tinel sign was conducted. The risk of bias (ROB) was rated using the QUADAS-2 tool. RESULTS: Thirty-one studies that assessed 12 provocative maneuvers were included. The Phalen test and the Tinel sign were the 2 most assessed tests (in 22 and 20 studies, respectively). The ROB was unclear or low in 20 studies, and at least 1 item was rated as having high ROB in 11 studies. Based on a meta-analysis of 7 studies (604 patients), the Phalen test had a pooled Sn of 0.57 (95% CI = 0.44-0.68; range = 0.12-0.92) and a pooled Sp of 0.67 (95% CI = 0.52-0.79; range = 0.30-0.95). For the Tinel sign (7 studies, 748 patients), the pooled Sn was 0.45 (95% CI = 0.34-0.57; range = 0.17-0.97) and the pooled Sp was 0.78 (95% CI = 0.60-0.89; range = 0.40-0.92). Other provocative maneuvers were less frequently studied and had conflicting diagnostic accuracies. CONCLUSION: Meta-analyses are imprecise but suggest that the Phalen test has moderate Sn and Sp, whereas the Tinel test has low Sn and high Sp. Clinicians should combine provocative maneuvers with sensorimotor tests, hand diagrams, and diagnostic questionnaires to achieve better overall diagnostic accuracy rather than relying on individual clinical tests. IMPACT: Evidence of unclear and high ROB do not support the use of any single provocative maneuver for the diagnosis of CTS. Clinicians should consider a combination of noninvasive clinical diagnostic tests as the first choice for the diagnosis of CTS.
Subject(s)
Carpal Tunnel Syndrome , Humans , Carpal Tunnel Syndrome/diagnosis , Hand , Sensitivity and Specificity , Surveys and Questionnaires , Diagnostic Tests, RoutineABSTRACT
BACKGROUND: The Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Patient-Rated Wrist/Hand Evaluation (PRWHE) and the Thumb Disability Exam (TDX) are patient-reported outcome measures (PROM) designed to assess pain and hand function in patients with hand arthritis, hand pain and disability, or thumb pathology respectively. This study evaluated the content validity of AUSCAN, PRWHE and TDX in people with hand arthritis. METHODS: This study enrolled participants with hand arthritis to rate the items of all 3 PROM in terms of relevance and clarity. The Content Validity Index (CVI) was computed for each item in each scale (I-CVI) as well as for the overall scale (S-CVI). Kappa was used to determine the inter-rater agreement among the raters. RESULTS: Overall, 64 individuals with hand arthritis (27% with OA, 67% with rheumatoid arthritis and 6% with psoriatic arthritis) participated in the study. The I-CVI for all items and all scales were very high (I-CVI > 0.76) and the modified Kappa agreement among the raters demonstrated excellent agreement (k > 0.76). The S-CVI for all PROMs was very high for relevance (AUSCAN = 0.92, 95% CI 0.90 to 0.94; PRWHE = 0.85, 95% CI 0.82 to 0.88 and TDX = 0.87, 95% CI 0.85 to 0.89) and for clarity (AUSCAN = 0.99, 95% CI 0.98 to 1.00; PRWHE = 0.95, 95% CI 0.93 to 0.97 and TDX = 0.91, 95% CI 0.89 to 0.94), respectively. CONCLUSIONS: This study demonstrated very high content validity indices for the AUSCAN, PRWHE and TDX; with strong consensus across raters. This augments prior studies demonstrating appropriate statistical measurement properties, to provide confidence that all three measures assess important patient concepts of pain and disability.
