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RCT
ACE Report #3426

Comparable outcomes in quality of life with/(out) partner violence screening intervention


Study Type:Therapy
OE Level Evidence:1
Journal Level of Evidence:N/A

Effect of Screening for Partner Violence on Women's Quality of Life: a randomized controlled trial

JAMA. 2012 Aug 15;308(7):681-9

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OE EXCLUSIVE

Dr. Klevens speaks on screening for intimate partner violence.

Synopsis

2708 English- or Spanish-speaking women were randomised to undergo an intervention involving a computerized partner violence screening with a partner violence resource list, an intervention with just a partner violence resource list, or a control group with neither. The primary outcome was health-related quality of life. The results indicated that no significant differences were seen between the three groups on the outcome of quality of life at the one-year follow-up.

Publication Funding Details +
Funding:
Non-Industry funded
Sponsor:
Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control, Division of Violence Prevention
Conflicts:
Consultant

Risk of Bias

8/10

Reporting Criteria

18/20

Fragility Index

N/A

Was the allocation sequence adequately generated?

Was allocation adequately concealed?

Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?

Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?

Blinding Patients: Was knowledge of the allocated interventions adequately prevented?

Was loss to follow-up (missing outcome data) infrequent?

Are reports of the study free of suggestion of selective outcome reporting?

Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?

Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?

Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?

Yes = 1

Uncertain = 0.5

Not Relevant = 0

No = 0

The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.

4/4

Randomization

3/4

Outcome Measurements

4/4

Inclusion / Exclusion

4/4

Therapy Description

3/4

Statistics

Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65

The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.

Why was this study needed now?

Partner violence is considered a health and public health problem. Screening for partner violence has been recommended by a number of health organizations. However, there is a lack of evidence that supports that this intervention results in improvement in health-related outcomes. This study examines the effect of screening for partner violence on the quality of life of women.

What was the principal research question?

What are the outcomes in quality of life for women participating in an intervention involving a computerized screening for partner violence with a partner violence resource list, an intervention with only a violence resource list, or no intervention at all over a one-year follow-up period?

Study Characteristics -
Population:
2708 English- or Spanish-speaking women seeking care in outpatient clinical settings. (Age: >18 years; Mean age: 38.7 (SD 14.9) years)
Intervention:
Group 1: Computerized partner violence screening. The Partner Violence Screen instrument was used and a partner violence resource list was provided if screening was positive. (Mean age: 39.0 (SD 15.0) years) (n=909) Group 2: Local partner violence resource list was provided to each participant. No screening. (Mean age: 38.3 (SD 14.8) years) (n=893)
Comparison:
Group 3 (Control): No screening and no resource list provided. (Mean age: 38.7 (SD 15.1) years) (n=898)
Outcomes:
Primary outcome: Quality of Life (QOL, physical and mental health components using the Short Form (SF-12) version 2); Secondary outcomes: Number of days unable to work/complete housework, recurrence of partner violence, and use of health care and partner violence services.
Methods:
RCT: Multiple centres (10); Single-blinded.
Time:
1 year (Range: 48-56 weeks)

What were the important findings?

  • No significant differences were observed in the QOL physical health component between Group 1 (Screen and resource list) (n=801; mean score, 46.8; 95% CI, 46.1-47.4), Group 2 (Resource list only) (n=772; mean score, 46.4; 95% CI, 45.8-47.1), and Group 3 (Control) (n=791; mean score, 47.2; 95% CI, 46.5-47.8) at the 1-year follow-up.
  • No significant differences were observed between the three groups on the mental health component (Group 1: Mean score, 48.3; 95% CI, 47.5-49.1; Group 2: Mean score, 48.0; 95% CI, 47.2-48.9; Group 3: Mean score, 47.8; 95% CI, 47.0-48.6).
  • No significant differences were seen between the three groups on the the outcomes of: number of days unable to work (p=0.96) or complete housework (p=0.66), hospitalizations (p=0.40), visits from ambulatory care (p=0.12) or the emergency department (p=0.40), recurrence of partner violence (Screened group compared to control: p=0.16; Resource list group compared to control: p=0.12), or patients who contacted a partner violence agency (Screened group compared to control: p=0.60; Resource list group compared to control: p=0.21).

What should I remember most?

No significant improvement of health-related quality of life was observed when women seeking care in outpatient clinical settings were provided a partner violence resource list with or without a screening intervention compared to controls.

How will this affect the care of my patients?

Computerized partner violence screening and the provision of a partner violence resource list to those who screened positive did not provide any significant improvements in health-related quality of life. It is unclear if the population studied (all outpatients) is representative of an orthopaedic practice (i.e. fracture clinic), and thus difficult to generalize results. Other forms of intervention need to be developed to provide better care for those suffering from partner violence.

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