EFFECT OF VARYING THE TIME FRAME FOR COOP-WONCA FUNCTIONAL HEALTH-STATUS CHARTS - A NESTED RANDOMIZED CONTROLLED TRIAL IN BRISTOL, UK

Study objective-To investigate whether changing the stated time frame for COOP-WONCA charts has any effect on responses. Specifically, to as sess the effect of attempting to avoid the situation where the time fr ame crosses the onset of an acute episode. Design-A randomised control led trial of two time frames, nested within a main trial comparing ear ly discharge with a hospital at home scheme against routine discharge policy. The time frames compared were the standard two weeks (four for the pain chart) and a shorter period of 48 hours for all seven charts . Setting-Acute hospital wards in Frenchay Healthcare Trust and the Av on Orthopaedic Centre in Bristol. Participants-Patients entered into t he main trial, who were medically stable, in need of continued rehabil itative care but suitable for discharge to hospital at home. Main resu lts-A total of 200 patients were randomised, 106 to the shorter time f rame, 94 to the standard charts. No clear differences were observed be tween the two groups for the proportion failing to self complete the c harts. For the (seven) chart scores, only pain was statistically signi ficantly different between the time frames (Mann-Whitney p=0.0085; pro portion reporting moderate or severe pain 19% higher in the standard g roup, 95% confidence intervals 5% to 33%). For both this chart and tha t for change in health, however, there was evidence of greater differe nces between the versions of the chart among those admitted more recen tly (p values for relevant interactions 0.004 and <0.001 respectively) . Conclusions while the present findings give some support for the wid e applicability of the standard version, there is sufficient evidence here to indicate that the time frame may influence the results, partic ularly for patients with a recent acute episode. In the absence of fur ther data, then, it would seem prudent to consider a shorter time fram e for such patients, especially if the aim is to assess current health status or to measure changes over a comparatively short period of tim e, or both.