Use this URL to cite or link to this record in EThOS:
Title: Patient reported outcome measures in endodontics using a mixed methodology
Author: Jacobs, Robert Peter
ISNI:       0000 0004 7659 1409
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2018
Availability of Full Text:
Access from EThOS:
Access from Institution:
Introduction and Aims: Historically, endodontic treatment outcomes have been measured via clinical outcomes, rather than patients' perspectives. The aim of this thesis was to design a user-friendly and reliable tool for reporting patient reported outcomes in endodontics. This was achieved by piloting the tool, followed by a prospective longitudinal study on a sample of endodontic patients in secondary care treated by postgraduates. Thematic analysis of semi-structured interviews explored the concerns and the impact of endodontics on quality of life, on a sample of patients' who participated in the longitudinal study. Methods: A PROMs tool was developed using Oral Health Impact Profile (OHIP-14), which consisted of 14 questions over 7 domains, answered on a Likert scale ranging from 0 (never) to 4 (very often) In addition, 4 visual analogue scales assessed patients' levels of pain, anxiety, concern and oral health state from 0 (no problem) to 100 (maximum problem). Ethical approval was granted, and data was collected from patients treated by postgraduates at LUDH. Eligibility criteria were adults (age =18) requiring: RCT, ReRCT or Surgery. Questionnaires were completed pre-treatment (T0), 2 months post-treatment (T1), and 6 months post-treatment (T2). Twenty-one patients participated in a qualitative study, with telephone interviews recorded and transcribed, followed by coding and thematic analysis. Results: 53 patients provided PROMs at T0 and T2, analysed with Paired Samples t Test. OHIP-14 mean values revealed a non-statistically significant reduction of 2.6 ± 10.3 (P=0.067). The VAS scale means showed statistically significant reductions in anxiety 12.9 ± 32.1 (P=0.005), and concerns 15.5 ± 32.3 (P=0.001), and non-statistically significant reductions in mean levels of pain 3.0 ± 21.1 (P=0.305) and oral health state -1.6 ± 35.8 (P=0.752). Qualitative analysis highlighted patient awareness of treatment complexity and subsequent referral to specialist services. Patients were concerned about pain levels in relation to endodontics. Trust and resultant reduced anxiety were key themes in terms of expertise and equipment encountered at LUDH, as well as dentist qualifications and supervision by consultants. Patients valued endodontics to avoid the consequences of tooth loss and resultant functional and cosmetic concerns. Conclusions: Patient reported outcomes indicated an improvement in oral health-related quality of life (OHRQoL) following endodontics, although OHIP-14 mean reduction was not statistically significant, and the OH-VAS scale did not adequately capture the OHRQoL improvement. Key points raised from the telephone interviews were as follows: the important and meaningful impact of tooth loss regarding function and aesthetics, the recognition that OHIP-14 was imperfect but still captured key issues regarding function for some participants, and the complexities surrounding referral to secondary care.
Supervisor: Jarad, Fadi ; Desmons, Sophie ; Harris, Rebecca Sponsor: Not available
Qualification Name: Thesis (D.D.Sc.) Qualification Level: Doctoral