3. Physical function: home palliative care versus usual care.
| Study | Measure | Analysis | Follow‐up | Significance and direction | Details |
|
Higginson 2009 UK (high quality) |
MS Impact Scale (MSIS) Physical subscale score: range not stated; higher scores equal greater physical impact; patient report |
Forwards from enrolment | 6 weeks |
n.s.a ES 0.2 F = 0.15 P value = 0.70 |
M change from baseline Intervention (n = 16): M 1.3 (SD 17.0; 95% CI ‐7.7 to 10.4) Control (n = 7): M ‐1.7 (SD 17.5; 95% CI ‐17.9 to 10.4) |
| 12 weeks | n.s.a ES 0.4 F = 0.37 P value = 0.55 |
M change from baseline Intervention (n = 16): M ‐0.3 (SD 17.5; 95% CI ‐9.7 to 9.0) Control (n = 7): M ‐7.1 (SD 21.3; 95% CI ‐26.8 to 12.5) |
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|
Jordhøy 2000 Norway (high quality) |
EORTC‐QLQ‐C30 Physical functioning scale (5 items) transformed score: from 0 to 100; higher scores equal better functioning; patient report |
Forwards from enrolment | 1 month |
n.s.b SAUC intervention ‐8.9 vs. SAUC control ‐6.4 P value = 0.42 |
Intervention: M 47 Control: M 49 |
| 2 months |
Intervention: M 51 Control: M 52 |
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| 4 months |
Intervention: M 49 Control: M 54 |
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| 6 months | Differences and statistically significance not stated | Intervention: M 53 Control: M 56 |
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|
McKegney 1981 US (high quality) |
Karnofsky Performance Status (KPS) score: from 0 to 100; higher scores equal better performance status; patient report |
Backwards from death |
180 to 150 days | Authors stated there were no differences but statistical significance was not stated |
"It should be briefly noted that the intensive and non‐intensive patients did not differ in (...) overall health status as defined by the KPS" (McKegney 1981); no data provided to support this statement |
| 150 to 120 days | |||||
| 120 to 90 days | |||||
| 90 to 60 days | |||||
| 60 to 30 days | |||||
| 30 to 0 days | |||||
|
Aiken 2006 US |
SF‐36 2 subscales: physical functioning and role‐physical transformed score: from 0 to 100; lower scores equal lower physical functioning; negative slope equal reduction; patient report |
Forwards from enrolment | 3 months |
Physical functioning Favours intervention slope: z 2.50; P value < 0.05 Intercept at 9 months: z 2.16; P value < 0.05; g 0.41 Role‐physical n.s. |
Growth modelling analysis (separate for COPD and CHF patients) Physical functioning COPD slope: intervention: 1.00 vs. control: ‐0.95 CHF slope: intervention: 0.18 vs. control: ‐1.39 Control slope declined while intervention slope rose Role‐physical COPD slope: intervention: 0.57 vs. control: ‐0.14 CHF slope: intervention: ‐0.51 vs. control: 1.60 |
| 6 months | |||||
| 9 months | |||||
|
Hughes 1992 US |
Barthels Self Care Index score: range not stated; higher scores equal greater dependency; patient report |
Forwards from enrolment | 1 month |
n.s. Beta ‐0.58 t ‐0.11 P value = 0.92 |
ANCOVA (age, education, race, marital status, retirement due to health, prior private sector hospital use, living arrangement, and baseline care satisfaction scores – none of these factors were predictive of outcomes); descriptive data not provided |
| 6 months | n.s. t < 1 |
Intervention (n = 18): M 72.00 Control (n = 16): M 69.31 Data were analysed using t‐tests because the sample did not support regression models |
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|
McCorkle 1989 US |
Enforced Social Dependency Scale (10 items) score: from 10 to 54; higher scores equal greater functional dependency on others; patient report |
Forwards from enrolment |
6 weeks | Favours interventionc F = 5.72; P value = 0.02 Graphs showed that social dependency worsens in the control2 group (i.e. those receiving usual outpatient care) 6 weeks earlier than in the 2 treatment groups |
Adjusted estimates Intervention: M 22.33 Control1 (home cancer care): M 21.68 Control2 (usual outpatient care): M 21.74 |
| 12 weeks | Adjusted estimates Intervention: M 22.67 Control1 (home cancer care): M 20.97 Control2 (usual outpatient care): M 24.85 |
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| 18 weeks | Adjusted estimates Intervention: M 24.57 Control1 (home cancer care): M 24.90 Control2 (usual outpatient care): M 25.17 |
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|
Greer 1986 (CBA) |
Karnofsky Performance Status (KPS) score: from 0 to 100; higher scores equal better performance status; caregiver report |
Backwards from death | 3 weeks | Authors stated there were no differences but statistical significance was not stated "the three samples exhibited similar decreases in functional performance as measured by the Karnofsky Performance Status" (Greer 1986) |
Adjusted estimates Community‐based intervention: M 29.52 (SE 0.64) Hospital‐based intervention: M 31.05 (SE 0.79), Control (conventional care): M 28.84 (SE 1.06) |
| 1 week | Adjusted estimates Community‐based intervention: M 23.72 (SE 0.54) Hospital‐based intervention: M 25.39 (SE 0.57) Control (conventional care): M 23.83 (SE 0.84) |
ANCOVA: analysis of covariance; CHF: congestive heart failure; CI: confidence interval; COPD: chronic obstructive pulmonary disease; ES: estimated effect size; M: mean; n.s.: not significant; SAUC: standardised area under the curve; SD: standard deviation; SE: standard error.
aResults from F‐tests of non‐imputed data; authors stated that imputed data gave similar results bThe authors calculated mean changes from baseline at one to four months after enrolment by dividing the area under the curve scores by time; differences between groups were tested by bootstrap estimation to fit regression models allowing for clustering and predictive factors. cThe authors used repeated measures analysis and analysis of variance; analysis included 78 patients who completed the three follow‐up interviews (i.e. up to 18 weeks after enrolment); adjusted means were used due to baseline differences despite randomisation.