Patient-reported treatment burdens of repeated IVI Three items with loading below 0.4 or cross loading over 0.4 were individually reviewed and ultimately retained in the 20-item construct due to their clinical significance. The threshold value for loading and cross loading was 0.4. To evaluate the internal consistency of these 20 question items, Cronbach’s alpha analyses were performed. ![]() Given the use of multiple measurement levels (nominal and ordinal) across question items, we performed CATPCA with Varimax rotation with Kaiser normalisation (IBM Statistics SPSS V.24). These items (hereafter referred to as 20 ‘major’ items) assessed aspects of the patient experience that were hypothesised to influence perceived patient burden, including discomfort, anxiety, the frequency and cumulative number of treatments, and satisfaction with treatment. Measurements such as the TBS could inform approaches to optimise patient experiences and adherence for a broad range of retinopathies and/or for comparative analysis of retinal therapeutics.įrom the original 50-item questionnaire, psychometric analysis was performed on a subset of 20 items, estimated to address the most salient aspects of burden ( online supplemental appendix 2A). We establish a single score of treatment burden, the IVI Treatment Burden Score (TBS) from this survey. Herein, we describe the development and psychometric analysis of the Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections (QUALITII). The current study uses a patient survey to characterise burdensome aspects of repeated IVI and to develop a quantitative measure of patient burden. 4 5 11–13 18 19 23 24 To facilitate this effort, it would be useful for practitioners who manage exudative retinal diseases to understand the magnitude of patient treatment burden associated with repeated IVI. In an effort to balance vision benefits against associated burdens of repeated IVI for exudative retinal diseases, the exact frequency of injections needed to maintain optimal clinical outcomes has been the subject of several investigations. While multiple authors have highlighted the challenging aspects of patient experiences with IVI, 17–22 no single quantitative model of patient treatment burden has emerged. 16 Thus, careful examination of the factors underlying patient burden could yield further insight into areas of improvement in the management of exudative retinal disease. 14 In one single-centre retrospective study, the most frequent reason patients discontinued treatment was fear of injection. Interestingly, others have reported that patients with high levels of satisfaction measured by MacTSQ continued to identify several burdensome aspects of treatment. Studies of the experiences of patients undergoing repeated IVI 14 have used long-standing tools such as the macular disease Treatment Satisfaction Questionnaire (MacTSQ), 15 designed to examine satisfaction with IVI in the treatment of nAMD. There is, therefore, great interest in optimising patient experiences, towards the goal of maximising adherence. ![]() Outcomes can thereby depend greatly on patient adherence, which can in turn be influenced by patient experiences and perceptions of satisfaction versus treatment burden. 13 To manage pathological neovascularisation and exudation in these disorders, treatment typically involves repeated anti-VEGF injections over an indefinite time course. Several randomised studies have demonstrated the efficacy of anti-VEGF agents for nAMD, 7 8 DME, 4 DR 9–12 and RVO. 3 5 6 Accordingly, it is estimated that over 20 million IVIs are administered on an annual basis. 6 Worldwide, the prevalence of each of these conditions ranges in the tens of millions. Injection of these anti-VEGF drugs has become the cornerstone of therapy for a number of exudative retinal disorders, including neovascular age-related macular degeneration (nAMD), 3 diabetic macular oedema (DME), 4 diabetic retinopathy (DR) 5 and retinal venous occlusive disease (RVO). 1 2 This is in large part due to the advent of antivascular endothelial growth factor (VEGF) agents and the large number of exudative retinal pathophysiologies now recognised to be driven by upregulation of VEGF. Over the last two decades, intravitreal injections (IVIs) have become one of the most common procedures performed in medicine.
0 Comments
Leave a Reply. |