Browsing by Person "Tan, Chee-Wee"

Now showing 1 - 20 of 27

25. Upper limb morbidity after treatment for breast cancer: A cross-sectional study of lymphedema and function
(2012-11) Bulley, Catherine; Coutts, Fiona; Blyth, Christine; Jack, Wilma; Chetty, Udi; Tan, Chee-Wee; Barber, Matthew; Breast Cancer Institute
Introduction: This study explored the prevalence of impaired upper limb function (ULF) and lymphoedema (LO) after breast cancer treatment, their relationships with each other, quality of life, and with patient/treatment characteristics.
A Morbidity Screening Tool for identifying fatigue, pain, upper limb dysfunction and lymphedema after breast cancer treatment: A validity study
(Elsevier, 2013-11-15) Bulley, Catherine; Coutts, Fiona; Blyth, Christine; Jack, Wilma; Chetty, Udi; Barber, Matthew; Tan, Chee-Wee
Purpose: This study aimed to investigate validity of a newly developed Morbidity Screening Tool (MST) to screen for fatigue, pain, swelling (lymphedema) and arm function after breast cancer treatment. Methods: A cross-sectional study included women attending reviews after completing treatment (surgery, chemotherapy and radiotherapy), without recurrence, who could read English. They completed the MST and comparator questionnaires: Disability of the Arm, Shoulder and Hand questionnaire (DASH), Chronic Pain Grade Questionnaire (CPGQ), Lymphedema and Breast Cancer Questionnaire (LBCQ) and Functional Assessment of Cancer Therapy questionnaire with subscales for fatigue (FACT F) and breast cancer (FACT B + 4). Bilateral combined shoulder ranges of motion were compared (upward reach; hand behind back) and percentage upper limb volume difference (%LVD =/>10% diagnosed as lymphedema) measured with the vertical perometer (400T). Results: 613 of 617 participants completed questionnaires (mean age 62.3 years, SD 10.0; mean time since treatment 63.0 months, SD 46.6) and 417 completed objective testing. Morbidity prevalence was estimated as 35.8%, 21.9%, 19.8% and 34.4% for fatigue, impaired upper limb function, lymphedema and pain respectively. Comparing those self-reporting the presence or absence of each type of morbidity, statistically significant differences in comparator variables supported validity of the MST. Statistically significant correlations resulted between MST scores focussing on impact of morbidity, and comparator variables that reflect function and quality of life. Conclusion: Analysis supports the validity of all four short-forms of the MST as providing indications of both presence of morbidity and impacts on participants' lives. This may facilitate early and appropriate referral for intervention. 2013 Elsevier Ltd. All rights reserved.
Comparison of breast cancer-related lymphedema (Upper Limb Swelling) prevalence estimated using objective and subjective criteria and relationship with quality of life
(Hindawi, 2013-05) Bulley, Catherine; Gaal, S.; Coutts, Fiona; Blyth, Christine; Jack, W.; Chetty, U.; Barber, M.; Tan, Chee-Wee
This study aimed to investigate lymphedema prevalence using three different measurement/diagnostic criterion combinations and explore the relationship between lymphedema and quality of life for each, to provide evaluation of rehabilitation. Cross-sectional data from 617 women attending review appointments after completing surgery, chemotherapy, and radiotherapy included the Morbidity Screening Tool (MST; criterion: yes to lymphedema); Lymphedema and Breast Cancer Questionnaire (LBCQ; criterion: yes to heaviness and/or swelling); percentage limb volume difference (perometer: %LVD; criterion: 10%+ difference); and the Functional Assessment of Cancer Therapy breast cancer-specific quality of life tool (FACT B+4). Perometry measurements were conducted in a clinic room. Between 341 and 577 participants provided sufficient data for each analysis, with mean age varying from 60 to 62 (SD 9.95-10.03) and median months after treatment from 49 to 51. Lymphedema prevalence varied from 26.2% for perometry %LVD to 20.5% for the MST and 23.9% for the LBCQ; differences were not significant. Limits of agreement analysis between %LVD and the subjective measures showed little consistency, while moderate consistency resulted between the subjective measures. Quality of life differed significantly for women with and without lymphedema only when subjective measurements were used. Results suggest that subjective and objective tools investigate different aspects of lymphedema. 2013 Catherine Bulley et al.
Constructing a measure of balance recovery confidence for older persons: Content themes from different stakeholders
(Foundation of Nursing Studies, 2021-05-19) Soh, Shawn Leng-Hsien; Gilmour, Fiona; Lane, Judith; Asokan, Shalini; Ling Woan, Kang; Tan, Chee-Wee
Background: The absence of patient-reported outcome measures (PROMs) for a specific construct or target population suggests a need for such measures to be developed. A case in point is the domain of falls efficacy; a PROM for balance recovery confidence was proposed to improve older persons ’agency to arrest a fall. Appropriate participation in its development by relevant stakeholders was identified as essential to maximise the utility of the PROM and its potential to enhance patient care. There is a gap in the practice development literature in terms of PROMs for older persons. This article aims to encourage researchers to use the principles of practice development to address this gap by involving relevant stakeholders to gain greater insight.
Contribution of vision, touch, and hearing to the use of sham devices in acupuncture-related studies
(Elsevier, 2019-12-23) Tan, Chee-Wee; Santos, Derek
This study investigates whether visual deprivation influences participants' accuracy in differentiating between real and sham acupuncture needles. It also evaluates the relative contributions of tactile, visual, and auditory cues that participants use in their decision-making processes. In addition, a simple sensory decision-making model for research using acupuncture sham devices as comparative controls is proposed. Forty healthy individuals underwent two conditions (blindfolded and sighted) in random sequence. Four sham and four real needles were randomly applied to the participants' lower limb acupoints (ST32 to ST39). Participants responded which needle type was applied. Participants then verbally answered a questionnaire on which sensory cues influenced their decision-making. The proportion of correct judgments, P(C), was calculated to indicate the participants' accuracy in distinguishing between the needle types. Visual deprivation did not significantly influence the participants' discrimination accuracy. Tactile cues were the dominant sensory modality used in decision-making, followed by visual and auditory cues. Sharp and blunt sensations were associated with the real and sham needles, respectively, for both conditions. This study confirmed that tactile cues were the main sensory modalities used in participant decision-making during acupuncture administration. Also, short-term blindfolding of participants during procedures will unlikely influence blinding effectiveness.
Detection theory analysis of scaling and discrimination tasks: Responses to noxious thermal stimuli
(Psychonomic Society, 2007-08) Tan, Chee-Wee; Palmer, S.; Martin, D. J.; Roche, Patricia
This study's main purpose was to examine the sensitivity estimates obtained from scaling and discrimination approaches for nociception assessment in healthy individuals. This investigation may inform future applications in diagnostic procedures for painful conditions. Models of psychophysical judgment based on those of Durlach and Braida (1969), Laming (1984), and Irwin and Whitehead (1991) were used as the common analytical framework. Noxious thermal contact stimuli were used. The results show that the scaling approach produced lower detection theory sensitivity estimates than did the discrimination approach. The additional judgment variance in scaling tasks could explain this lowered sensitivity. The relative judgmental variance value of 2.18 obtained in this study is lower than variance values found in previous investigations. This discrepancy is probably due to the relatively smaller stimulus range employed in this study. The authors propose that the theoretical framework used in this study may be used in future studies to investigate the different dimensions of pain perception. Perception & Psychophysics,
Discrimination accuracy between real and sham needles using the Park sham device in the upper and lower limbs.
(2011-09-07) Tan, Chee-Wee; Sheehan, P.; Santos, Derek
Objective To evaluate the blinding effectiveness of the Park sham acupuncture device using participants' ability to discriminate between the real and sham acupuncture needles in the (1) upper limb (TE points) compared with pure guessing and (2) lower limb (BL points) compared with pure guessing. Methods 20 healthy acupuncture-naïve university students and staff were recruited through convenience sampling. Participants made Yes-No judgements on whether the real or sham needle was administered to four TE acupoints on the dominant upper limb, and four acupoints along the BL meridian on the dominant lower limb. The proportion of correct judgements, P(C), for each participant was calculated to indicate the discrimination accuracy of participants in distinguishing between the real and sham needles. Separate P(C) were computed for the upper limb acupoints and lower limb acupoints. The data were also pooled to calculate a P(C) for a combination of both body regions. Results The participants' discrimination accuracy between the real and sham needles was not statistically signifi cant from P(C)=0.5 (chance level) for the lower limb alone and combined body regions' acupoint comparisons (lower limb: t 19=0.00, unadjusted p=1.00; combined: t19=1.75, unadjusted p=0.10). However, the participants' discrimination accuracy was statistically signifi cant from P(C)=0.5 for the upper limb acupoints alone comparison (t 19=2.36, unadjusted p=0.03). Conclusions This study showed that the Park sham device is more likely to blind participants in differentiating between the real and sham needles in the lower limb (BL meridian) acupoints than in the upper limb (TE meridian). However, the participants' ability to differentiate between the needle types for the upper limb acupoints was signifi cantly different from chance levels
Discrimination of Real and Sham Acupuncture Needles Using the Park Sham Device: A Preliminary Study
(Elsevier, 2009-12) Tan, Chee-Wee
Objective: To evaluate the blinding effectiveness of the Park sham acupuncture device using participants’ ability to discriminate between the real and sham acupuncture needles. Design: The design was a yes-no experiment. Judgments were made on whether the real or sham acupuncture needle was administered. Setting: University laboratory. Participants: Healthy, acupuncture-naive university students and staff (N20; median age, 22y; range, 18 – 48y) recruited through convenience sampling. Interventions: Participants made yes-no judgments on whether the real or sham needle was administered to 8 acupoints (4 traditional and 4 nontraditional) along the Pericardium meridian(Pericardium 3 to Pericardium 6) on the dominant forearm. Main Outcome Measures: The accuracy index, d=, of participants’ ability to discriminate between the real and sham needles(discriminability) was computed for the traditional alone, the nontraditional alone, and a combination of both types of acupoints. Results: The participants’ d= between the real and sham needles was not statistically significant from d' = equal to 0 for the combined traditional and nontraditional acupoints comparison and the nontraditional acupoints alone comparison (combined, t(19)=1.20, P=.25; nontraditional, t(19)=.16, P=.87). However, the participants’ d' = was statistically significant from d' = equal to 0 for the traditional acupoints comparison (t(19)=2.096, P=.049). Conclusions: The Park sham acupuncture device appears to be effective in blinding participants to real acupuncture intervention when it is applied to the nontraditional acupoints and when traditional and nontraditional acupoints are combined on the forearm along the pericardium meridian. However, the sham device does not appear to blind participants effectively when traditional acupoints alone are used for the same context. Key Words: Acupuncture; Placebos; Rehabilitation; Signal detection, psychological; Validation studies at topic.
Effectiveness of the Alfredson Protocol Compared With a Lower Repetition-Volume Protocol for Midportion Achilles Tendinopathy: A Randomized Controlled Trial
(2014) Stevens, Marc; Tan, Chee-Wee
Study Design Randomized clinical trial. Objectives To compare the effectiveness of the Alfredson eccentric heel-drop protocol with a do-as-tolerated- protocol for nonathletic individuals with midportion Achilles tendinopathy. Background The Alfredson protocol recommends the completion of 180 eccentric heel drops a day. However, completing this large number of repetitions is time consuming and potentially uncomfortable. There is a need to investigate varying exercise dosages that minimize the discomfort yet retain the clinical benefits. Methods Twenty-eight individuals from outpatient physiotherapy departments were randomized to either the standard (n = 15) or the do-as-tolerated (n = 13) 6-week intervention protocol. Apart from repetition volume, all other aspects of management were standardized between groups. Tendinopathy clinical severity was assessed with the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire. Pain intensity was assessed using a visual analog scale (VAS). Both were assessed at baseline, 3 weeks, and 6 weeks. Treatment satisfaction was assessed at week 6. Adverse effects were also monitored. Results There was a statistically significant within-group improvement in VISA-A score for both groups (standard, P = .03; do as tolerated, P<.001) and VAS pain for the do-as-tolerated group (P = .001) at week 6, based on the intention-to-treat analysis. There was a statistically significant between-group difference in VISA-A scores at week 3, based on both the intention-to-treat (P = .004) and per-protocol analyses (P = .007), partly due to a within-group deterioration at week 3 in the standard group. There were no statistically significant between-group differences for VISA-A and VAS pain scores at week 6, the completion of the intervention. There was no significant association between satisfaction and treatment groups at week 6. No adverse effects were reported. Conclusion Performing a 6-week do-as-tolerated program of eccentric heel-drop exercises, compared to the recommended 180 repetitions per day, did not lead to lesser improvement for individuals with midportion Achilles tendinopathy, based on VISA-A and VAS scores.
Falls efficacy instruments for community-dwelling older adults: A COSMIN-based systematic review
(BMC, 2021-01-07) Soh, Shawn Leng-Hsien; Lane, Judith; Xu, Tianma; Gleeson, Nigel; Tan, Chee-Wee
Background: Falls efficacy is a widely-studied latent construct in community-dwelling older adults. Various self-reported instruments have been used to measure falls efficacy. In order to be informed of the choice of the best measurement instrument for a specific purpose, empirical evidence of the development and measurement properties of falls efficacy related instruments is needed. Methods: The Consensus-based Standards for the Selection of Health Measurement Intruments (COSMIN) checklist was used to summarise evidence on the development, content validity, and structural validity of instruments measuring falls efficacy in community-dwelling older adults. Databases including MEDLINE, Web of Science, PsychINFO, SCOPUS, CINAHL were searched (May 2019). Records on the development of instruments and studies assessing content validity or structural validity of falls efficacy related scales were included. COSMIN methodology was used to guide the review of eligible studies and in the assessment of their methodological quality. Evidence of content validity: relevance, comprehensiveness and comprehensibility and unidimensionality for structural validity were synthesised. A modified GRADE approach was applied to evidence synthesis. Results: Thirty-five studies, of which 18 instruments had been identified, were included in the review. High-quality evidence showed that the Modified Falls Efficacy Scale (FES)-13 items (MFES-13) has sufficient relevance, yet insufficient comprehensiveness for measuring falls efficacy. Moderate quality evidence supported that the FES-10 has sufficient relevance, and MFES-14 has sufficient comprehensibility. Activities-specific Balance Confidence (ABC) Scale–Simplified (ABC-15) has sufficient relevance in measuring balance confidence supported by moderate-quality evidence. Low to very low-quality evidence underpinned the content validity of other instruments. High-quality evidence supported sufficient unidimensionality for eight instruments (FES-10, MFES-14, ABC-6, ABC-15, ABC-16, Iconographical FES (Icon-FES), FES–International (FES-I) and Perceived Ability to Prevent and Manage Fall Risks (PAPMFR)). Conclusion: Content validity of instruments to measure falls efficacy is understudied. Structural validity is sufficient for a number of widely-used instruments. Measuring balance confidence is a subset of falls efficacy. Further work is needed to investigate a broader construct for falls efficacy.
Falls efficacy: Extending the understanding of self-efficacy in older adults towards managing falls
(Hylonome Publications, 2021-09) Soh, Shawn Leng-Hsien; Tan, Chee-Wee; Thomas, Janet I.; Tan, Gideon; Xu, Tianma; Ng, Yoke Leng; Lane, Judith; Lyritis, George
Falls efficacy is a widely studied construct. The understanding of falls efficacy has evolved over time. Falls efficacy was initially perceived to be suitably used as a measure of fear of falling. However, further research suggested that falls efficacy and fear of falling are distinct constructs, and therefore, would be inappropriate to be used as a proxy. Instead, some researchers posited that falls efficacy is synonymous with balance confidence. Falls efficacy has been conventionally understood as the perceived ability of individuals to perform activities without losing balance or falling. A recently conducted systematic review by the authors on existing falls efficacy related measures had revealed a fresh perspective of recognising falls efficacy as a perceived ability to manage a threat of a fall. Falls efficacy, with a broadened interpreted construct, relates to the individual’s perceived self-efficacy of performing necessary actions needed in different scenarios, including pre-fall, near-fall, fall-landing and completed fall. The conventional interpretation of falls efficacy needs a rethinking of perspective. An extended understanding of falls efficacy would provide an integral approach towards improving the agency of individual to deal with falls and would enhance person-centred care.
Interventions and measurement instruments used for falls efficacy in community-dwelling older adults: A systematic review.
(2022-09-01) Soh, Shawn Leng-Hsien; Lane, Judith; Lim, Ashleigh Yoke-Hwee; Mujtaba, Mariana Shariq; Tan, Chee-Wee
Falls efficacy has been defined as perceived self-belief in the prevention and management of falls. In the case of community-dwelling older adults, it is essential that interventions should address the different aspects of falls efficacy in terms of balance confidence, balance recovery confidence, safe landing confidence and post-fall recovery confidence to improve their agency to deal with falls. This review aims to provide the current landscape of falls efficacy interventions and measurement instruments. A literature search of five electronic databases was conducted to extract relevant trials from January 2010 to September 2021, and the CASP tool for critical appraisal was applied to assess the quality and applicability of the studies. Eligibility criteria included randomised controlled trials evaluating falls efficacy as a primary or secondary outcome for community-dwelling older adults. A total of 302 full texts were reviewed, with 47 selected for inclusion involving 7,259 participants across 14 countries. A total of 63 interventions were identified, using exercise and other components to target different aspects of falls efficacy. The novel contribution of this article is to highlight that those interventions were applied to address the different fall-related self-efficacies across pre-fall, near-fall, fall landing and completed fall stages. Appropriate measurement instruments need to be used to support empirical evidence of clinical effectiveness. [Abstract copyright: Copyright: © 2022 Hylonome Publications.]
Measurement of lower limb volume: Agreement between the vertically oriented perometer and a tape measure method
(Elsevier Science B.V. Amsterdam, 2013-09) Tan, Chee-Wee; Coutts, Fiona; Bulley, Catherine
Objective: To investigate the agreement between lower limb volume measurements for the vertically oriented perometer and a tape measure method. Design: Between-methods agreement and test-retest reliability study. Setting: University setting. Participants: Thirty university staff and students were recruited using convenience sampling with no participant drop-outs. Interventions: All participants' dominant lower limb volumes were measured using the vertically oriented perometer and a tape measure method. Main outcome measures: The Bland-Altman difference plot was reported for determining the bias between the two methods and its 95% confidence interval. Test-retest reliability and the measurement error for the perometer method were determined using the ICC(2,1) model and within-subject standard deviation (sw) respectively. Results: There was a lack of agreement between the tape measure and perometer method. The Bland-Altman difference plot showed that the tape measure method overestimated limb volume by 157 ml compared to the perometer method. A 95% confidence interval of -834 ml to 519 ml was observed. The test-retest reliability of the perometer method was ICC(2,1) = 0.99. The measurement error of the perometer method was clinically acceptable (sw = 121 ml). Conclusions: There was a lack of agreement between the two methods investigated. Therefore the perometer and tape measure methods are not interchangeable. It is recommended that future validity and reliability studies for the vertically oriented perometer are conducted on clinical populations. 2012 Chartered Society of Physiotherapy.
Modification of experimental lower limb ischaemic pain with transcutaneous electrical nerve stimulation.
(Lippincott Williams & Wilkins, 2012-10) Seenan, Christopher; Roche, Patricia; Tan, Chee-Wee; Mercer, Tom
Introduction: Transcutaneous electrical nerve stimulation (TENS)has been shown to be effective for the reduction of experimentally induced ischemic pain in the upper limb. No studies have been published on the effects of TENS for lower limb ischemic pain. Objectives: To investigate the pain-modifying effect of TENS on experimentally induced ischemic pain in the lower limb. Methods: A modified Submaximal Effort Tourniquet Test-induced ischemic pain in the nondominant lower limb of 27 healthy volunteers. Each of the participants completed a baseline modified Submaximal Effort Tourniquet Test (No TENS) and 1 of the experimental conditions: either high-frequency TENS (HF-TENS) or placebo TENS(P-TENS). The outcome measures were the time taken (in seconds) for the participants to report pain threshold and pain tolerance. Pain endurance was calculated as the difference between these points. Pain intensity during ischemia was assessed using a numerical rating scale. The McGill Pain Questionnaire recorded participants' retrospective description of 'intolerable' induced pain. The differences in scores between these measures at the baseline and TENS intervention was calculated and used for the analysis. Results: Paired Student t-tests found significant increases in time to pain tolerance and pain endurance in both the TENS groups(P<0.001 HF-TENS and P<0.05 for P-TENS, respectively). When compared with baseline, time to pain threshold increased significantly only with HF-TENS (P<0.01). The independent Student t-tests detected greater increases in pain threshold, tolerance, and endurance in the HF-TENS group compared with the PTENS group (P<0.05, 0.002, and 0.003, respectively). Compared with P-TENS, HF-TENS significantly reduced the pain intensity between the fifth and eigth minutes. Both HF-TENS and P-TENS significantly reduced the mean McGill Pain Questionnaire Pain Rating Index scores, but did not show a between-group difference. Conclusions: HF-TENS had stronger modifying effects on several aspects of laboratory-induced ischemic pain than did P-TENS. HFTENS delayed the onset of pain, reduced pain levels, and delayed the onset of extreme pain over a period of several mi
Near-falls in Singapore community-dwelling older adults: A feasibility study
(BMC, 2021-01-12) Soh, Shawn Leng-Hsien; Tan, Chee-Wee; Lane, Judith; Yeh, Ting-Ting; Soon, Benjamin
Background: A near-fall is defined as a loss of balance that would result in a fall if sufficient balance recovery manoeuvres are not executed. Compared to falls, near-falls and its associated balance recovery manoeuvres have been understudied. Older adults may not recognise a near-fall or identify the use of their balance recovery manoeuvres to prevent a fall. The consensus on the methods to collect near-fall data is lacking. The primary objective of this study was to determine the feasibility of recruitment and retention. Secondary objectives were to establish evidence that Singapore community-dwelling older adults can identify near-falls and associated balance recovery manoeuvres. Texting and calling methods were explored as reporting methods. Methods: This study took place in Singapore (September to October 2019). Participants were healthy, community-dwelling adults aged 65 or older. Recruitment was done through poster advertisement, and all participants gave informed consent. Participants attended a briefing session and reported their near-fall or fall incidence over 21 days using either daily texting or calling. The primary outcome measures were the recruitment rate, retention rate, preferred modes for data reporting and ability to report near-falls or falls. Secondary outcomes included the self-reported incidence of falls and near-falls. Results: Thirty older adults were recruited in 5 weeks. All participants completed the study. They understood near-fall concepts and were able to report the occurrence and relevant balance recovery manoeuvres used to prevent a fall. 87% (26/30) chose to text while 13% (4/30) selected calling as their reporting method. One actual fall (0.16%) out of 630 responses was reported. Thirty-six incidents (5.7%) of near-falls were recorded. Sixteen participants (53.3%) experienced near-falls and half of this group experienced two or more near-falls. The use of reach-to-grasp strategy (36%), compensatory stepping (52.8%), and other body regions (11.2%) were used to prevent the fall. Conclusions: The study provided evidence that studying near-falls in Singapore community-dwelling older adults is feasible and can be applied to a large-scale study. Recruitment and retention rates were good. Older adults were able to identify near-falls and balance recovery manoeuvres. Both texting and calling were feasible reporting methods, but texting was preferred. Trial registration: ClinicalTrials identifier: NCT04087551. Registered on September 12, 2019
Noxious heat discrimination ability in persons with chronic pain: A psychophysical study.
(2007-06-02) Tan, Chee-Wee; Martin, D.; Roche, Patricia; Palmer, Shea
Perometry limb volume measurement: Protocol development and reliability
(2013-12) Bulley, Catherine; Coutts, Fiona; Tan, Chee-Wee
Aims: Perometry measurement of limb volume involves non-invasive optoelectronic scanning and is increasingly used due to its practicality and increasing evidence for its validity. This study aimed to develop a standardized protocol for the measurement of upper and lower limb volume using a vertical perometer (400T) and test its reliability. Methodology: Multiple pilot studies were conducted in a laboratory-based setting to investigate specific procedural questions and develop the final standardized protocol. This included elements such as standardization of the proportion of limb being measured, and of limb positioning within the perometer frame. The standardized protocol was tested for inter-and intra-rater reliability in two raters, on two separate test occasions, 24-48 h apart. The study included 30 volunteers with no known clinical conditions (n = 23 women, seven men; mean age 23). Major findings: High intra-class correlation coefficient (ICC) values resulted for intra-rater and inter-rater reliability in the upper and lower limbs (0.953-0.989). Limits of agreement analysis demonstrated less positive results, however. Principal conclusion: The results provide support for the use of this protocol to increase standardization and comparability of measurement in clinical and research contexts. Further investigation in different clinical populations is required. 2013 Informa Healthcare.
Prevalence and impacts of upper limb morbidity after treatment for breast cancer: a cross-sectional study of lymphedema and function.
(2013) Bulley, Catherine; Coutts, Fiona; Blyth, Christine; Jack, W.; Chetty, U.; Barber, M.; Tan, Chee-Wee; Breast Cancer Institute
A cross-sectional study screened lymphedema, impaired upper limb function (ULF) and quality of life (QOL) in women post-breast cancer. Women attending review appointments who had completed surgery, chemotherapy and radiotherapy, were without recurrence, and could complete questionnaires in English were invited. Medical records were reviewed and questionnaires completed: the Morbidity Screening Tool (MST), Disability of the Arm, Shoulder and Hand questionnaire (DASH), and Functional Assessment of Cancer Therapy for breast cancer QOL questionnaire (FACTB+4). The vertical perometer (400T) measured percentage upper limb volume difference (%LVD), with 10% or greater difference diagnosed as lymphedema. Of 617 participants (mean age 62.3y, SD 10.0; mean time since treatment 63.0 months, SD 46.6), sufficient questionnaire data were available for 613 and perometry data for 417. Using the MST, 21.9% self-reported impaired ULF, 19.8% lymphedema, and 9.2% both. Based on %LVD, 26.5% had lymphedema. Histogram analysis for individuals in the first eight twelve-month intervals after treatment found impaired ULF prevalence peaked at three to five years and lymphedema at three years. Significantly worse function (DASH) and QOL (FACT B+4) resulted for those with morbidity (p<0.000). This provides evidence that impaired ULF and lymphedema negatively affect QOL years after treatment and are not necessarily linked.
Researcher as instrument: A critical reflection using nominal group technique for content development of a new patient-reported outcome measure
(Foundation of Nursing Studies, 2020-11-18) Soh, Shawn Leng-Hsien; Lane, Judith; Tan, Chee-Wee
Background: This article presents a critical reflection on the application of the ‘researcher as instrument’ concept within a study employing the nominal group technique. Twelve community-dwelling older adults were recruited to generate a list of items for a new patient-reported outcome measure on perceived ability to recover balance. The ontological position and epistemological stance of the first author are presented to provide a philosophical context of his lens and biases of his reflection.
Screening for morbidity following breast cancer
(Wounds UK, 2012-12) Bulley, Catherine; Coutts, Fiona; Blyth, Christine; Tan, Chee-Wee; Hamilton, L.; Jack, W.; Chetty, U.
Background: A screening tool was developed to identify morbidity emerging in the years after breast cancer treatment. Aims: This project aimed to investigate patient responses to a newly developed screening tool for lymphoedema, reduced arm function, fatigue and pain. Methods: Interviews were conducted following completion of the screening tool by 40 women attending review appointments post-treatment for breast cancer (86% response rate). Questions addressed ease of completion and administration. Results: On average, participants were 5.8 years post-treatment (1-28) and 64 years of age (38-79). It took eight to 20 minutes to complete the screening tool, with five participants needing assistance. Ninety-eight per cent of participants generally understood the instructions and 76% were able to answer all questions. There was some confusion about unfamiliar terminology (i.e. 'the axilla') and a question was raised relating to experiences of pain (people had difficulty differentiating pain relating to breast cancer and other conditions). Twenty per cent of respondents would prefer to receive the questionnaire by post, with 41% preferring paper to electronic completion. Conclusions: With minor modifications and further pilot testing of validity and reliability, this screening tool has the potential to enable rapid identification of morbidity, enabling appropriate action to be taken as well as facilitating service planning. Declaration of interest: None.