Doctors and patients don't agree: cross sectional study of patients' and doctors' perceptions and assessments of disability in multiple sclerosis

Abstract Objectives: To compare the judgments of clinicians on which domains of health in the short form questionnaire (SF-36) would be most important to patients with multiple sclerosis with the opinions of patients themselves; to compare assessment of physical disability in multiple sclerosis by a...

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Published in:BMJ 1997-05, Vol.314 (7094), p.1580-1583
Main Authors: Rothwell, P M, McDowell, Z, Wong, C K, Dorman, P J
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Disabilities
Disability
Disability Evaluation
Disabled Persons
Female
Humans
Judgment
Male
Medical research
Medical sciences
Mental health
Middle Aged
Multiple sclerosis
Multiple Sclerosis - physiopathology
Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis
Nervous system diseases
Neurology
Patients
Physical disabilities
Physician-Patient Relations
Quality of Life
Questionnaires
Scotland
Severity of Illness Index
Side effects
Vitality
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creator Rothwell, P M
McDowell, Z
Wong, C K
Dorman, P J
description Abstract Objectives: To compare the judgments of clinicians on which domains of health in the short form questionnaire (SF-36) would be most important to patients with multiple sclerosis with the opinions of patients themselves; to compare assessment of physical disability in multiple sclerosis by a clinician using Kurtzke's expanded disability status scale and a non-clinically qualified assistant using the Office of Population Census and Surveys' (OPCS) disability scale with self assessment of disability and other domains of health related quality of life by patients using the SF-36 and the EuroQol questionnaire; and to compare the scores of patients for each domain of the SF-36 with control data matched for age and sex. Design: Cross sectional study. Setting: Clinical department of neurology, Edinburgh. Subjects: 42 consecutive patients with multiple sclerosis attending a neurology outpatient clinic for review or a neurology ward for rehabilitation. Main outcome measures: Scores on the SF-36; EuroQol; Kurtzke's expanded disability status scale; the OPCS disability scale. Results: Patients and clinicians disagreed on which domains of health status were most important (χ2=21, df=7, P=0.003). Patients' assessment of their physical disability using the physical functioning domain of the SF-36 was highly correlated with the clinicians' assessment (r=-0.87, P
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Design: Cross sectional study. Setting: Clinical department of neurology, Edinburgh. Subjects: 42 consecutive patients with multiple sclerosis attending a neurology outpatient clinic for review or a neurology ward for rehabilitation. Main outcome measures: Scores on the SF-36; EuroQol; Kurtzke's expanded disability status scale; the OPCS disability scale. Results: Patients and clinicians disagreed on which domains of health status were most important (χ2=21, df=7, P=0.003). Patients' assessment of their physical disability using the physical functioning domain of the SF-36 was highly correlated with the clinicians' assessment (r=-0.87, P&lt;0.001) and the non-clinical assessment (r=-0.90, P&lt;0.001). However, none of the measures of physical disability correlated with overall health related quality of life measured with EuroQol. Quality of life correlated with vitality, general health, and mental health in the SF-36, each of which patients rated as more important than clinicians and for each of which patients scored lower than the controls. Conclusions: Patients with multiple sclerosis, and possibly those with other chronic diseases, are less concerned than their clinicians about physical disability in their illness. Clinical trials in multiple sclerosis should assess the effect of treatment on the other elements of health status that patients consider important, which are also affected by the disease process, are more closely related to overall health related quality of life, and may well be adversely affected by side effects of treatment. Key messages Patients can accurately assess their own physical disability Physical disability may not always be the main determinant of overall health related quality of life Patients and clinicians differ in their assessments of the relative importance of different elements of health related quality of life The opinions of patients should be taken into account in the selection of outcome measures for clinical trials</description><edition>International edition</edition><identifier>ISSN: 0959-8138</identifier><identifier>ISSN: 0959-8146</identifier><identifier>EISSN: 1468-5833</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.314.7094.1580</identifier><identifier>PMID: 9169401</identifier><identifier>CODEN: BMJOAE</identifier><language>eng</language><publisher>London: British Medical Journal Publishing Group</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Disabilities ; Disability ; Disability Evaluation ; Disabled Persons ; Female ; Humans ; Judgment ; Male ; Medical research ; Medical sciences ; Mental health ; Middle Aged ; Multiple sclerosis ; Multiple Sclerosis - physiopathology ; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis ; Nervous system diseases ; Neurology ; Patients ; Physical disabilities ; Physician-Patient Relations ; Quality of Life ; Questionnaires ; Scotland ; Severity of Illness Index ; Side effects ; Vitality</subject><ispartof>BMJ, 1997-05, Vol.314 (7094), p.1580-1583</ispartof><rights>1997 BMJ Publishing Group Ltd.</rights><rights>Copyright 1997 British Medical Journal</rights><rights>1997 INIST-CNRS</rights><rights>Copyright: 1997 (c) 1997 BMJ Publishing Group Ltd.</rights><rights>Copyright British Medical Association May 31, 1997</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b641t-3d4eb7cf8a6367691b96f9fd53f694ac777bcb0d9d3cd2b572dd62db6fdcefc93</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmj.com/content/314/7094/1580.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://bmj.com/content/314/7094/1580.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>112,113,230,314,776,780,881,3180,27903,27904,30978,58217,58450,77341,77342</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=2680254$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9169401$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rothwell, P M</creatorcontrib><creatorcontrib>McDowell, Z</creatorcontrib><creatorcontrib>Wong, C K</creatorcontrib><creatorcontrib>Dorman, P J</creatorcontrib><title>Doctors and patients don't agree: cross sectional study of patients' and doctors' perceptions and assessments of disability in multiple sclerosis</title><title>BMJ</title><addtitle>BMJ</addtitle><description>Abstract Objectives: To compare the judgments of clinicians on which domains of health in the short form questionnaire (SF-36) would be most important to patients with multiple sclerosis with the opinions of patients themselves; to compare assessment of physical disability in multiple sclerosis by a clinician using Kurtzke's expanded disability status scale and a non-clinically qualified assistant using the Office of Population Census and Surveys' (OPCS) disability scale with self assessment of disability and other domains of health related quality of life by patients using the SF-36 and the EuroQol questionnaire; and to compare the scores of patients for each domain of the SF-36 with control data matched for age and sex. Design: Cross sectional study. Setting: Clinical department of neurology, Edinburgh. Subjects: 42 consecutive patients with multiple sclerosis attending a neurology outpatient clinic for review or a neurology ward for rehabilitation. Main outcome measures: Scores on the SF-36; EuroQol; Kurtzke's expanded disability status scale; the OPCS disability scale. Results: Patients and clinicians disagreed on which domains of health status were most important (χ2=21, df=7, P=0.003). Patients' assessment of their physical disability using the physical functioning domain of the SF-36 was highly correlated with the clinicians' assessment (r=-0.87, P&lt;0.001) and the non-clinical assessment (r=-0.90, P&lt;0.001). However, none of the measures of physical disability correlated with overall health related quality of life measured with EuroQol. Quality of life correlated with vitality, general health, and mental health in the SF-36, each of which patients rated as more important than clinicians and for each of which patients scored lower than the controls. Conclusions: Patients with multiple sclerosis, and possibly those with other chronic diseases, are less concerned than their clinicians about physical disability in their illness. Clinical trials in multiple sclerosis should assess the effect of treatment on the other elements of health status that patients consider important, which are also affected by the disease process, are more closely related to overall health related quality of life, and may well be adversely affected by side effects of treatment. Key messages Patients can accurately assess their own physical disability Physical disability may not always be the main determinant of overall health related quality of life Patients and clinicians differ in their assessments of the relative importance of different elements of health related quality of life The opinions of patients should be taken into account in the selection of outcome measures for clinical trials</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Disabilities</subject><subject>Disability</subject><subject>Disability Evaluation</subject><subject>Disabled Persons</subject><subject>Female</subject><subject>Humans</subject><subject>Judgment</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Mental health</subject><subject>Middle Aged</subject><subject>Multiple sclerosis</subject><subject>Multiple Sclerosis - physiopathology</subject><subject>Multiple sclerosis and variants. 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Design: Cross sectional study. Setting: Clinical department of neurology, Edinburgh. Subjects: 42 consecutive patients with multiple sclerosis attending a neurology outpatient clinic for review or a neurology ward for rehabilitation. Main outcome measures: Scores on the SF-36; EuroQol; Kurtzke's expanded disability status scale; the OPCS disability scale. Results: Patients and clinicians disagreed on which domains of health status were most important (χ2=21, df=7, P=0.003). Patients' assessment of their physical disability using the physical functioning domain of the SF-36 was highly correlated with the clinicians' assessment (r=-0.87, P&lt;0.001) and the non-clinical assessment (r=-0.90, P&lt;0.001). However, none of the measures of physical disability correlated with overall health related quality of life measured with EuroQol. Quality of life correlated with vitality, general health, and mental health in the SF-36, each of which patients rated as more important than clinicians and for each of which patients scored lower than the controls. Conclusions: Patients with multiple sclerosis, and possibly those with other chronic diseases, are less concerned than their clinicians about physical disability in their illness. Clinical trials in multiple sclerosis should assess the effect of treatment on the other elements of health status that patients consider important, which are also affected by the disease process, are more closely related to overall health related quality of life, and may well be adversely affected by side effects of treatment. Key messages Patients can accurately assess their own physical disability Physical disability may not always be the main determinant of overall health related quality of life Patients and clinicians differ in their assessments of the relative importance of different elements of health related quality of life The opinions of patients should be taken into account in the selection of outcome measures for clinical trials</abstract><cop>London</cop><pub>British Medical Journal Publishing Group</pub><pmid>9169401</pmid><doi>10.1136/bmj.314.7094.1580</doi><tpages>4</tpages><edition>International edition</edition><oa>free_for_read</oa></addata></record>
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source Applied Social Sciences Index & Abstracts (ASSIA); BMJ Publishing; JSTOR Journals and Primary Sources
subjects Adult
Aged
Biological and medical sciences
Disabilities
Disability
Disability Evaluation
Disabled Persons
Female
Humans
Judgment
Male
Medical research
Medical sciences
Mental health
Middle Aged
Multiple sclerosis
Multiple Sclerosis - physiopathology
Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis
Nervous system diseases
Neurology
Patients
Physical disabilities
Physician-Patient Relations
Quality of Life
Questionnaires
Scotland
Severity of Illness Index
Side effects
Vitality
title Doctors and patients don't agree: cross sectional study of patients' and doctors' perceptions and assessments of disability in multiple sclerosis
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