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Leidy NK, Bushnell DM, Thach C, Hache C, Gutzwiller FS. Interpreting Evaluating Respiratory Symptoms TM in COPD Diary Scores in Clinical Trials: Terminology, Methods, and Recommendations. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:576-590. [PMID: 36130315 PMCID: PMC9718578 DOI: 10.15326/jcopdf.2022.0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Accurately interpreting scores on patient-reported outcome (PRO) measures is essential to understanding and communicating treatment benefit. Over the years, terminology and methods for developing recommendations for PRO score interpretation in clinical trials have evolved, leading to some confusion in the field. The phrase "minimal clinically important difference (MCID)" has been simplified to "minimal important difference (MID)" and use of responder thresholds to interpret statistically significant treatment effects has increased. Anchor-based derivation methods continue to be the standard, with specific variations preferred by regulatory authorities for drug development programs. In the midst of these changes, the Evaluating Respiratory Symptoms™ in COPD (E-RS:COPD) was developed and qualified for use as an endpoint in chronic obstructive pulmonary disease (COPD) drug development programs. This paper summarizes the evolution of terminology and method preferences for the development of recommendations for interpreting scores from PRO measures used in clinical trials, and how these changes are reflected in the E-RS:COPD recommendations. The intent is to add clarity to discussions around PRO endpoints and facilitate use of the E-RS:COPD as a key efficacy endpoint in clinical trials of COPD.
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Dao A, Dunivan G. Patient-Centered Goals for Treatment of Pelvic Floor Disorders. CURRENT BLADDER DYSFUNCTION REPORTS 2022; 17:210-218. [PMID: 36258780 PMCID: PMC9562075 DOI: 10.1007/s11884-022-00668-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/28/2022]
Abstract
Purpose of review To review the current literature on patient centered goals for the treatment of pelvic floor disorders (PFDs). Recent findings Patients have a poor understanding of their PFDs, regardless if they had prior PFD treatments or received counseling, emphasizing the need for improved education from healthcare providers. Understanding the patient perspective provides insights into identifying patient goals, which facilitates communication and allows for tailored counseling, management of expectations, and assessment of treatment response. Functional outcomes are consistently important to patients, often listed as their main treatment goals. The achievement of these goals is fundamental to satisfaction. IMPACT and PROMIS are examples of PCO measures that can be utilized in both research and clinical settings. Finally, telemedicine has emerged as a viable alternative to clinic visits that offers improved access to care with no increase in adverse events or dissatisfaction, in order to aid in monitoring and meeting patient treatment goals. Summary Patient involvement is fundamental to providing value-based care. Provider understanding of the patient perspective is necessary to guide counseling and treatment. Patient-centered goals offer a way to engage patients, facilitate communication, and improve patient satisfaction. Although there are multiple validated PCO tools, further development and research involving patient input is needed.
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Affiliation(s)
- Angela Dao
- Division of Urogynecology, Department of OBGYN, University of New Mexico, MSC 10-5580, Albuquerque, NM 87131-0001 USA
| | - Gena Dunivan
- Division of Urogynecology, Department of OBGYN, University of Alabama at Birmingham, Birmingham, AL USA
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Abstract
BACKGROUND Pilot studies test the feasibility of methods and procedures to be used in larger-scale studies. Although numerous articles describe guidelines for the conduct of pilot studies, few have included specific feasibility indicators or strategies for evaluating multiple aspects of feasibility. In addition, using pilot studies to estimate effect sizes to plan sample sizes for subsequent randomized controlled trials has been challenged; however, there has been little consensus on alternative strategies. METHODS In Section 1, specific indicators (recruitment, retention, intervention fidelity, acceptability, adherence, and engagement) are presented for feasibility assessment of data collection methods and intervention implementation. Section 1 also highlights the importance of examining feasibility when adapting an intervention tested in mainstream populations to a new more diverse group. In Section 2, statistical and design issues are presented, including sample sizes for pilot studies, estimates of minimally important differences, design effects, confidence intervals (CI) and nonparametric statistics. An in-depth treatment of the limits of effect size estimation as well as process variables is presented. Tables showing CI around parameters are provided. With small samples, effect size, completion and adherence rate estimates will have large CI. CONCLUSION This commentary offers examples of indicators for evaluating feasibility, and of the limits of effect size estimation in pilot studies. As demonstrated, most pilot studies should not be used to estimate effect sizes, provide power calculations for statistical tests or perform exploratory analyses of efficacy. It is hoped that these guidelines will be useful to those planning pilot/feasibility studies before a larger-scale study.
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Affiliation(s)
- Jeanne A. Teresi
- Columbia University Stroud Center at New York State
Psychiatric Institute, 1051 Riverside Drive, Box 42, Room 2714, New York, New York,
10032-3702, USA
- Research Division, Hebrew Home at Riverdale, 5901 Palisade
Avenue, Riverdale New York 10471
| | - Xiaoying Yu
- Office of Biostatistics, Department of Preventive Medicine
and Population Health, University of Texas Medical Branch at Galveston, 301
University Boulevard, Galveston, Texas, 77555-1147
| | - Anita L. Stewart
- University of California, San Francisco, Institute for
Health & Aging, 490 Illinois St., 12 floor, Box 0646, San
Francisco, CA 94143
| | - Ron D. Hays
- University of California, Los Angeles; Division of General
Internal Medicine and Health Services Research, 1100 Glendon Avenue, Suite 850, Los
Angeles, California 90024
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54
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Kirsten N, Rustenbach S, von Kiedrowski R, Sorbe C, Reich K, Augustin M. Which PASI Outcome Is Most Relevant to the Patients in Real-World Care? Life (Basel) 2021; 11:life11111151. [PMID: 34833027 PMCID: PMC8618980 DOI: 10.3390/life11111151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 12/19/2022] Open
Abstract
In psoriasis treatment, there is a high need to define meaningful endpoints and differences from the patient perspective to analyze patient-relevant differences of frequently used outcome methods for psoriasis under real-world conditions. A sample of 3116 patients from the German Psoriasis-Registry PsoBest was analyzed for clinical as well as patient-reported outcomes (PRO) after 3- and 6-month treatment. The parameters PASI, DLQI, and PBI were intercorrelated and related to two anchoring variables: (1) patient satisfaction with treatment and (2) perceived complete clearance. Baseline data were as follows: PASI 10.5 ± 9.1, DLQI 12.4 ± 3.4, and PBI 2.7 ± 0.3. There was an almost linear relationship between "complete patient satisfaction" and the relative differences in PASI in the range from PASI 25 to PASI 90. However, there was no additional benefit between PASI 90 and PASI 100. The same finding resulted from the anchoring variable "perception of complete healing". When related to DLQI outcomes, relative PASI changes as well as absolute changes and PASI at 3 and 6 months showed relevant differences between the PASI classes 25 to 90 but not between PASI 90 and PASI 100. Under real-world conditions, changes in PASI and DLQI reflect patient-relevant benefits.
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Affiliation(s)
- Natalia Kirsten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; (S.R.); (C.S.); (K.R.); (M.A.)
- Correspondence: ; Tel.: +49-40-7410-55428; Fax: +49-40-7410-55348
| | - Stephan Rustenbach
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; (S.R.); (C.S.); (K.R.); (M.A.)
| | - Ralph von Kiedrowski
- Dermatology Office and Dermatology Study Center (CMSS) Dr. Ralph von Kiedrowski, Selters/Westerwald, Kirchstraße 1, 56242 Selters, Germany;
| | - Christina Sorbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; (S.R.); (C.S.); (K.R.); (M.A.)
| | - Kristian Reich
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; (S.R.); (C.S.); (K.R.); (M.A.)
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; (S.R.); (C.S.); (K.R.); (M.A.)
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Silverberg JI, DeLozier A, Sun L, Thyssen JP, Kim B, Yosipovitch G, Nunes FP, Gugiu PC, Doll HA, Eichenfield LF. Psychometric properties of the itch numeric rating scale, skin pain numeric rating scale, and atopic dermatitis sleep scale in adult patients with moderate-to-severe atopic dermatitis. Health Qual Life Outcomes 2021; 19:247. [PMID: 34688290 PMCID: PMC8542315 DOI: 10.1186/s12955-021-01877-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background The Itch Numeric Rating Scale (NRS), Skin Pain NRS, and Atopic Dermatitis Sleep Scale (ADSS) are self-administered patient-reported outcome (PRO) instruments developed to assess symptoms in patients with atopic dermatitis (AD). The objective of this study was to evaluate the psychometric properties (reliability, validity, and responsiveness) and interpretability thresholds of these PROs using data from three pivotal Phase 3 studies in adults. Methods BREEZE-AD1, BREEZE-AD2, and BREEZE-AD5 evaluated the safety and efficacy of baricitinib in adults with moderate-to-severe AD. Clinician-reported outcomes and other PROs commonly assessed in patients with AD were used to estimate meaningful changes and evaluate test–retest reliability, convergent and divergent validity, known-groups validity, responsiveness, and meaningful change thresholds (MCTs) of the Itch NRS, Skin Pain NRS, and ADSS. Results The test–retest reliability of the Itch NRS, Skin Pain NRS, and ADSS was evidenced by generally large intraclass correlation coefficients (> 0.7) in stable groups of patients between baseline and Week 1 and Weeks 4 and 8. Moderate-to-large correlations (r > 0.4) at baseline and Week 16 were generally observed between each measure and other PROs measuring the same concept, supporting convergent validity. Small-to-moderate correlations with clinician-reported outcomes demonstrated divergent validity. Each instrument was able to distinguish between known groups of disease severity as assessed using other indicators of AD severity. The responsiveness of the Itch NRS, Skin Pain NRS, and ADSS scales was demonstrated through significant differences in their change scores from baseline to Week 16 between categories of change in another PRO also from baseline to Week 16. Thresholds for interpreting meaningful change were estimated as − 4.0 for the 0–10 Itch and Skin Pain NRS items; − 1.25 for the 0–4 ADSS Items 1 and 3 and; − 1.50 for the 0–29 ADSS Item 2, these equivalent to moderate degrees of change. Conclusions Results of this study demonstrate that the psychometric properties of the Itch NRS, Skin Pain NRS, and ADSS are good to excellent. These findings support the use of these instruments in daily assessment of AD symptoms in adults with moderate-to-severe AD. Trial registration ClinicalTrials.gov numbers: NCT03334396, NCT03334422, and NCT03435081.
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Affiliation(s)
| | - Amy DeLozier
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, 46285, USA.
| | - Luna Sun
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, 46285, USA
| | - Jacob P Thyssen
- Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Brian Kim
- Pied Piper Consulting, LLC, St. Louis, MO, USA
| | - Gil Yosipovitch
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Fabio P Nunes
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, 46285, USA
| | | | - Helen A Doll
- Clinical Outcomes Solutions, Folkestone, Kent, UK
| | - Lawrence F Eichenfield
- University of California San Diego, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
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Gilligan C, Volschenk W, Russo M, Green M, Gilmore C, Mehta V, Deckers K, De Smedt K, Latif U, Georgius P, Gentile J, Mitchell B, Langhorst M, Huygen F, Baranidharan G, Patel V, Mironer E, Ross E, Carayannopoulos A, Hayek S, Gulve A, Van Buyten JP, Tohmeh A, Fischgrund J, Lad S, Ahadian F, Deer T, Klemme W, Rauck R, Rathmell J, Levy R, Heemels JP, Eldabe S. An implantable restorative-neurostimulator for refractory mechanical chronic low back pain: a randomized sham-controlled clinical trial. Pain 2021; 162:2486-2498. [PMID: 34534176 PMCID: PMC8442741 DOI: 10.1097/j.pain.0000000000002258] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/19/2022]
Abstract
ABSTRACT Chronic low back pain can be caused by impaired control and degeneration of the multifidus muscles and consequent functional instability of the lumbar spine. Available treatment options have limited effectiveness and prognosis is unfavorable. We conducted an international randomized, double-blind, sham-controlled trial at 26 multidisciplinary centers to determine safety and efficacy of an implantable, restorative neurostimulator designed to restore multifidus neuromuscular control and facilitate relief of symptoms (clinicaltrials.gov identifier: NCT02577354). Two hundred four eligible participants with refractory mechanical (musculoskeletal) chronic LBP and a positive prone instability test indicating impaired multifidus control were implanted and randomized to therapeutic (N = 102) or low-level sham (N = 102) stimulation of the medial branch of the dorsal ramus nerve (multifidus nerve supply) for 30 minutes twice daily. The primary endpoint was the comparison of responder proportions (≥30% relief on the LBP visual analogue scale without analgesics increase) at 120 days. After the primary endpoint assessment, participants in the sham-control group switched to therapeutic stimulation and the combined cohort was assessed through 1 year for long-term outcomes and adverse events. The primary endpoint was inconclusive in terms of treatment superiority (57.1% vs 46.6%; difference: 10.4%; 95% confidence interval, -3.3% to 24.1%, P = 0.138). Prespecified secondary outcomes and analyses were consistent with a modest but clinically meaningful treatment benefit at 120 days. Improvements from baseline, which continued to accrue in all outcome measures after conclusion of the double-blind phase, were clinically important at 1 year. The incidence of serious procedure- or device-related adverse events (3.9%) compared favorably with other neuromodulation therapies for chronic pain.
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Affiliation(s)
- Christopher Gilligan
- Division of Pain Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA, United States
| | | | - Marc Russo
- Hunter Pain Specialists, Newcastle, Australia
| | | | - Christopher Gilmore
- Center for Clinical Research, Carolinas Pain Institute, Winston-Salem, NC, United States
| | - Vivek Mehta
- Barts Neuromodulation Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Kristiaan Deckers
- Department of Physical Medicine and Rehabilitation, GZA - Sint Augustinus Hospital, Wilrijk, Belgium
| | - Kris De Smedt
- Department of Neurosurgery, GZA - Sint Augustinus Hospital, Wilrijk, Belgium
| | - Usman Latif
- Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, KS, United States
| | - Peter Georgius
- Sunshine Coast Clinical Research, Noosa Heads, Australia
| | | | | | | | - Frank Huygen
- Department of Anaesthesiology Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ganesan Baranidharan
- Leeds Pain and Neuromodulation Centre,Leeds Teaching Hopsitals NHS Trust, Leeds, United Kingdom
| | - Vikas Patel
- Department of Orthopedic Surgery, University of Colorado, Denver, CO, United States
| | - Eugene Mironer
- Carolinas Center for the Advanced Management of Pain, Spartanburg, NC, United States
| | - Edgar Ross
- Division of Pain Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA, United States
| | - Alexios Carayannopoulos
- Departments of Physical Medicine and Rehabilitation, Rhode Island Hospital, Brown University Medical School, Providence, RI, United States
| | - Salim Hayek
- Division of Pain Medicine, University Hospitals, Cleveland Medical Center, Cleveland, OH, United States
| | - Ashish Gulve
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, United Kingdom
| | | | - Antoine Tohmeh
- Multicare Neuroscience Institute, Spokane, WA, United States
| | - Jeffrey Fischgrund
- Department of Orthopedic Surgery, Oakland University, Beaumont Hospital, Royal Oak, MI, United States
| | - Shivanand Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States
| | - Farshad Ahadian
- Center for Pain Medicine, University of California, San Diego, CA, United States
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, United States
| | - William Klemme
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Richard Rauck
- Carolinas Pain Institute, Wake Forest University, Winston-Salem, NC, United States
| | - James Rathmell
- Division of Pain Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA, United States
| | - Robert Levy
- Anesthesia Pain Care Consultant, Tamarac, FL, United States
| | | | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, United Kingdom
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Triangulation of multiple meaningful change thresholds for patient-reported outcome scores. Qual Life Res 2021; 30:2755-2764. [PMID: 34319532 DOI: 10.1007/s11136-021-02957-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The notion of what constitutes meaningful differences or changes in patient-reported outcome scores is represented by meaningful change thresholds (MCTs). Applying multiple methods to estimate MCTs inevitably results in a range of estimates; however, a single estimate or small range is sought in practice to enable consistent interpretation of scores. While current recommendations for triangulation are appropriate in principle, the vital step of moving from all estimates to a value or small range lacks clarity and is subjective in nature. This article aims to review current triangulation approaches and provide more robust recommendations than what is currently available. METHODS Current approaches to perform triangulation are described and discussed. Anchor-based estimates are focussed upon due to their recognition as the most valid and developed approach. Recommendations for triangulation are provided. RESULTS A correlation-weighted average of MCT estimates is recommended to triangulate multiple MCT estimates derived from a single study into a single value, where increased weighting is given to stronger anchor measures. The choice of method to triangulate estimates from several published studies is highly dependent on the availability of information within the publications. MCTs designed for between-group differences, within-group changes, and within-individual changes should be considered separately. CONCLUSION The recommendations within this article provide a reliable and transparent approach to triangulation when a single value is sought, based on meta-analytic approaches. This approach is preferable to a simple mean of estimates where all are weighted equally, or through 'eyeballing' plotted estimates which is unreliable. We encourage researchers to adopt these methods, but to remain aware of the limitations within each method and further nuances in study design that result in heterogeneity. Sensitivity analyses with a range of plausible values are encouraged; however, the recommendations provide a suitable starting value for inferences. Unresolved issues in triangulation, requiring further exploration, are highlighted.
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58
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Parker C, Wei A, Liew D, Zomer E, Ayton D. It doesn't stop at validation: patient reported outcome measures require ongoing and iterative development. Support Care Cancer 2021; 30:995-998. [PMID: 34529139 DOI: 10.1007/s00520-021-06553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
Patient reported outcomes (PROs) are a pillar of modern-day patient-centered care and clinical trials. PROs complement clinical information with the patient's own report about their experiences of health, without influence or interpretation by other people. However, choosing an appropriate PRO measure from the many available remains challenging for clinicians and researchers. One of the common pitfalls in instrument selection is that the instrument is often developed with a different patient population than the group being cared for or researched. This difference can result in salient items of importance to the patients, being under-reported or missed altogether. We highlight, through the reporting of some of our own data, that PRO instrument development does not stop with a validation study and we provide suggestions for future research for further improvement in this space.
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Affiliation(s)
- Catriona Parker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,Department of Haematology, The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Andrew Wei
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of General Medicine, The Alfred Hospital, Melbourne, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Darshini Ayton
- Health and Social Care Unit, Monash University, Melbourne, Australia
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Cappelleri JC, Chambers R. Addressing Bias in Responder Analysis of Patient-Reported Outcomes. Ther Innov Regul Sci 2021; 55:989-1000. [PMID: 34046875 PMCID: PMC8332587 DOI: 10.1007/s43441-021-00298-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 04/20/2021] [Indexed: 10/29/2022]
Abstract
INTRODUCTION Quantitative patient-reported outcome (PRO) measures ideally are analyzed on their original scales and responder analyses are used to aid the interpretation of those primary analyses. As stated in the FDA PRO Guidance for Medical Product Development (2009), one way to lend meaning and interpretation to such a PRO measure is to dichotomize between values where within-patient changes are considered clinically important and those that are not. But even a PRO scale with a cutoff score that discriminates well between responder and non-responders is fraught with some misclassification. METHODS Using estimates of sensitivity and specificity on classification of responder status from a PRO instrument, formulas are provided to correct for such responder misclassification under the assumption of no treatment misclassification. Two case studies from sexual medicine illustrate the methodology. RESULTS Adjustment formulas on cell counts for responder misclassification are a direct extension of correction formulas for misclassification on disease from a two-way cross-classification table of disease (yes, no) and exposure (yes, no). Unadjusted and adjusted estimates of treatment effect are compared in terms of odds ratio, response ratio, and response difference. In the two case studies, there was considerable underestimation of treatment effect. DISCUSSION AND CONCLUSIONS The methodology can be applied to different therapeutic areas. Limitations of the methodology, such as when adjusted cell estimates become negative, are highlighted. The role of anchor-based methodology is discussed for obtaining estimates of sensitivity and specificity on responder classification. Correction for treatment effect bias from misclassification of responder status on PRO measures can lead to more trustworthy interpretation and effective decision-making. Clinicaltrials.gov: NCT00343200.
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Affiliation(s)
- Joseph C Cappelleri
- Global Biometrics and Data Management, Pfizer Inc., Groton, 445 Eastern Point Road, MS 8260-2502, Groton, CT, 06340, USA.
| | - Richard Chambers
- Global Biometrics and Data Management, Pfizer Inc., Collegeville, PA, USA
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Grant A, Lerer T, Griffiths AM, Hyams JS, Otley A. Assessing disease activity using the pediatric Crohn’s disease activity index: Can we use subjective or objective parameters alone? World J Gastroenterol 2021; 27:5100-5111. [PMID: 34497438 PMCID: PMC8384732 DOI: 10.3748/wjg.v27.i30.5100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/22/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The pediatric Crohn’s disease activity index (PCDAI) is used as a standard tool to assess disease activity in clinical trials for pediatric Crohn’s disease.
AIM To examine which items on the PCDAI drive assessment of disease activity, and how subgroups of subjective and objective items reflect change in disease state over time.
METHODS Selective raw data from three prospectively collected datasets were combined, including 703 children with full PCDAI data at baseline, at 3-mo (Q1, n = 670), and 1-year (Q4, n = 474). Change in individual PCDAI scores from baseline to Q1 and to Q4 were examined using the non-weighted PCDAI.
RESULTS Abdominal pain, well-being, weight, and stooling had the highest change scores over time. Objective indicators including albumin, abdominal exam, and height velocity followed. Change scores for well-being and abdominal exam did not explain significant variance at Q1 but were significant predictors at Q4 (P < 0.001 and P < 0.05). Subjective and objective subgroups of items predicted less variance (18% and 22%) on total PCDAI scores at Q1 and Q4 compared to the full PCDAI, or a composite scale (both 32%) containing significant predictors.
CONCLUSION Although subjective items on the PCDAI change the most over time, the full PCDAI or a smaller composite of items including a combination of subjective and objective components classifies disease activity better than a subgroup of either subjective or objective items alone. Reliance on subjective or objective items as stand-alone proxies for disease activity measurement could result in misclassification of disease state.
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Affiliation(s)
- Amy Grant
- Division of Pediatrics, IWK Health, Halifax, NS B3K6R8, Canada
| | - Trudy Lerer
- Division of Research, Connecticut Children's Medical Center, Hartford, CT 06106, United States
| | - Anne M Griffiths
- Division of Gastroenterology Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - JS Hyams
- Division of Gastroenterology, Connecticut Children's Medical Center, Hartford, CT 06106, United States
| | - Anthony Otley
- Division of Pediatrics, IWK Health, Halifax, NS B3K6R8, Canada
- Division of Pediatrics, Dalhousie University, Halifax, NS B3H4C3, Canada
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Benhissen Z, Konzelmann M, Vuistiner P, Leger B, Luthi F, Devilliers H, Hilfiker R, Benaim C. Development and validation of a short version of the French Hand Function Sort questionnaire in vocational rehabilitation. Ann Phys Rehabil Med 2021; 64:101533. [PMID: 33933688 DOI: 10.1016/j.rehab.2021.101533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 02/27/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Hand Function Sort (HFS) is a pictorial self-administered questionnaire with 62 items. It is a valid and reliable scale focused on the physical function of the upper limbs. It is used to predict the return to work. OBJECTIVES We aimed to develop and validate a short version of the French version of the HFS (HFS-F) to simplify its use in clinical practice. METHODS We included patients with upper-limb chronic pain hospitalised for vocational rehabilitation from 2012 to 2019. Vocational rehabilitation aims to improve the autonomy of patients to regain their previous working capacity. The 62 items of the HFS-F were analysed in terms of patient and expert assessments, floor/ceiling effect, item-to-total correlation, principal component analysis, and Rasch analysis. A short HFS-F was developed. Thereafter, we assessed its internal consistency, test-retest reliability, criterion validity with the full-length HFS-F, construct validity with different scales (Disabilities of the Arm, Shoulder, and Hand [DASH]; Brief Pain Inventory [BPI]; Hospital Anxiety and Depression [HAD]), standard error of measurement (SEM), and minimal detectable change (MDC). RESULTS Six experts were consulted, 34 patients were interviewed, and 629 questionnaires were analysed. Among the items, 25 were selected after the final round with the six experts. The internal consistency and test-retest reliability were excellent (Cronbach α=0.95, intraclass correlation coefficient=0.92, 95% confidence interval [95% CI] 0.87 to 0.95). The correlation coefficient between scores of the short and full-length HFS-F was 0.841 (95% CI: 0.752 to 0.897, P<10-4), and those between the short HFS-F score and the DASH, BPI, HAD-Anxiety, and HAD-Depression scores were -0.816 (95% CI: -0.714 to -0.881, P<10-4), -0.529 (95% CI: -0.338 to -0.674, P<10-4), -0.451 (95% CI: -0.244 to 0.614, P=0.0001), and -0.360 (95% CI: -0.140 to -0.542, P=0.0018), respectively. The SEM and MDC values were estimated at 6/100 and 17/100, respectively. CONCLUSIONS A short version of the HFS-F was developed and validated. We named this questionnaire the 25 HFS-F.
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Affiliation(s)
- Zineb Benhissen
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland.
| | - Michel Konzelmann
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland; Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Philippe Vuistiner
- Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Bertrand Leger
- Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - François Luthi
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland; Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland; Division of Physical Medicine and Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland Valais, Sion, Switzerland
| | - Charles Benaim
- Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland; Division of Physical Medicine and Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
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de Bruijn TM, de Groot IB, Miedema HS, Haumann J, Ostelo RW. Clinical Relevance of Epidural Steroid Injections on Lumbosacral Radicular Syndrome-related Synptoms: Systematic Review and Meta-Analysis. Clin J Pain 2021; 37:524-537. [PMID: 33859113 PMCID: PMC8162229 DOI: 10.1097/ajp.0000000000000943] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Epidural steroid injections (ESIs) can be used to reduce lumbosacral radicular syndrome (LRS) related pain. The clinical relevance of ESIs are currently unknown. This systematic review and meta-analyses aims to assess whether ESIs are clinically relevant for patients with LRS. MATERIALS AND METHODS Comprehensive literature searches for randomized controlled trials regarding steroid injections for LRS were conducted in PudMed, EMBASE, CINAHL, and CENTRAL from their inception to September 2018 (December 2019 for PubMed). For each homogenous comparison, the outcomes function, pain intensity and health-related quality of life at different follow-up intervals were pooled separately. The GRADE approach was used to determine the overall certainty of the evidence. RESULTS Seventeen studies were included. Two different homogenous comparisons were identified for which the randomized controlled trials could be pooled. In 36 of the 40 analyses no clinically relevant effect was found. The certainty of evidence varied between very low to high. Four analyses found a clinically relevant effect, all on pain intensity and health-related quality of life, but the certainty of the evidence was either low or very low. Two of the 33 subgroup analyses showed a clinically relevant effect. However, according to the GRADE approach the certainty of these findings are low to very low. DISCUSSION On the basis of the analyses we conclude there is insufficient evidence that ESIs for patients with LRS are clinically relevant at any follow-up moment. High-quality studies utilizing a predefined clinical success are necessary to identify potential clinically relevant effects of ESIs. Until the results of these studies are available, there is reason to consider whether the current daily practice of ESIs for patients with LRS should continue.
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Affiliation(s)
- Thomas M. de Bruijn
- Department Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam
- National Health Care Institute, Diemen
| | | | - Harald S. Miedema
- National Health Care Institute, Diemen
- Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | | | - Raymond W.J.G. Ostelo
- Department Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam
- Department of Epidemiology and Biostatistics, Amsterdam UMC (Location VUmc) and Amsterdam Movement Sciences, Amsterdam
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Gnanasakthy A, Barrett A, Norcross L, D'Alessio D, Romano CD. Use of Patient and Investigator Global Impression Scales: A Review of Food and Drug Administration-Approved Labeling, 2009 to 2019. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1016-1023. [PMID: 34243825 DOI: 10.1016/j.jval.2021.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/25/2021] [Accepted: 01/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Identify disease categories in which single-item global impression (GI) scales were included in product labeling of new drugs approved by the US Food and Drug Administration (FDA) in January 2009-December 2019 and review the characteristics of GIs included in product labeling of new FDA-approved drugs (January 2017-December 2019). METHODS FDA Clinical Outcome Assessment (COA) Compendium was reviewed for drug labels that included GIs for drugs approved in 2009-2016. The indication, year of approval, ICD-10 code, and GI respondent were noted. A manual review of labels of FDA-approved drugs (2017-2019) was undertaken to identify GIs included in the labels. Corresponding drug approval packages were reviewed to identify details of any regulatory reviewer comments related to GIs. GI characteristics were noted from the drug label or the review documents, including the respondent, type of measure (static or dynamic), item wording, concept assessed, and response options. RESULTS Product labeling containing GIs was most common in diseases related to the skin, nervous system, behavioral disorders, and the musculoskeletal system. GIs were included in 30/77 (39.0%) drug labels in the four disease categories. CONCLUSION In the past 10 years, GIs have been included as endpoint measures in confirmatory clinical trials and have generated evidence of treatment benefit in diseases related to the skin, nervous system, behavioral disorders, and the musculoskeletal system. GIs frequently provide important insights into the patient experience. Before GIs are included in clinical trials to assess treatment benefit, it is important to ensure that they are valid, reliable, and responsive.
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Affiliation(s)
| | - Amy Barrett
- RTI Health Solutions, Research Triangle Park, NC, USA
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Chang DW, Neville TH, Parrish J, Ewing L, Rico C, Jara L, Sim D, Tseng CH, van Zyl C, Storms AD, Kamangar N, Liebler JM, Lee MM, Yee HF. Evaluation of Time-Limited Trials Among Critically Ill Patients With Advanced Medical Illnesses and Reduction of Nonbeneficial ICU Treatments. JAMA Intern Med 2021; 181:786-794. [PMID: 33843946 PMCID: PMC8042568 DOI: 10.1001/jamainternmed.2021.1000] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/19/2021] [Indexed: 11/14/2022]
Abstract
Importance For critically ill patients with advanced medical illnesses and poor prognoses, overuse of invasive intensive care unit (ICU) treatments may prolong suffering without benefit. Objective To examine whether use of time-limited trials (TLTs) as the default care-planning approach for critically ill patients with advanced medical illnesses was associated with decreased duration and intensity of nonbeneficial ICU care. Design, Setting, and Participants This prospective quality improvement study was conducted from June 1, 2017, to December 31, 2019, at the medical ICUs of 3 academic public hospitals in California. Patients at risk for nonbeneficial ICU treatments due to advanced medical illnesses were identified using categories from the Society of Critical Care Medicine guidelines for admission and triage. Interventions Clinicians were trained to use TLTs as the default communication and care-planning approach in meetings with family and surrogate decision makers. Main Outcomes and Measures Quality of family meetings (process measure) and ICU length of stay (clinical outcome measure). Results A total of 209 patients were included (mean [SD] age, 63.6 [16.3] years; 127 men [60.8%]; 101 Hispanic patients [48.3%]), with 113 patients (54.1%) in the preintervention period and 96 patients (45.9%) in the postintervention period. Formal family meetings increased from 68 of 113 (60.2%) to 92 of 96 (95.8%) patients between the preintervention and postintervention periods (P < .01). Key components of family meetings, such as discussions of risks and benefits of ICU treatments (preintervention, 15 [34.9%] vs postintervention, 56 [94.9%]; P < .01), eliciting values and preferences of patients (20 [46.5%] vs 58 [98.3%]; P < .01), and identifying clinical markers of improvement (9 [20.9%] vs 52 [88.1%]; P < .01), were discussed more frequently after intervention. Median ICU length of stay was significantly reduced between preintervention and postintervention periods (8.7 [interquartile range (IQR), 5.7-18.3] days vs 7.4 [IQR, 5.2-11.5] days; P = .02). Hospital mortality was similar between the preintervention and postintervention periods (66 of 113 [58.4%] vs 56 of 96 [58.3%], respectively; P = .99). Invasive ICU procedures were used less frequently in the postintervention period (eg, mechanical ventilation preintervention, 97 [85.8%] vs postintervention, 70 [72.9%]; P = .02). Conclusions and Relevance In this study, a quality improvement intervention that trained physicians to communicate and plan ICU care with family members of critically ill patients in the ICU using TLTs was associated with improved quality of family meetings and a reduced intensity and duration of ICU treatments. This study highlights a patient-centered approach for treating critically ill patients that may reduce nonbeneficial ICU care. Trial Registration ClinicalTrials.gov Identifier: NCT04181294.
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Affiliation(s)
- Dong W. Chang
- Division of Pulmonary and Critical Care Medicine, Lundquist Institute at Harbor-University of California, Los Angeles Medical Center, David Geffen School of Medicine at UCLA, Torrance, California
- Los Angeles County Department of Health Services, Los Angeles, California
| | - Thanh H. Neville
- Division of Pulmonary and Critical Care Medicine, Ronald Reagan University of California, Los Angeles Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jennifer Parrish
- Division of Pulmonary and Critical Care Medicine, Lundquist Institute at Harbor-University of California, Los Angeles Medical Center, David Geffen School of Medicine at UCLA, Torrance, California
| | - Lian Ewing
- Los Angeles County Department of Health Services, Los Angeles, California
- Division of Pulmonary and Critical Care Medicine, Olive View Medical Center, David Geffen School of Medicine at UCLA, Sylmar, California
| | - Christy Rico
- Division of Pulmonary and Critical Care Medicine, Los Angeles County-University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles
| | - Liliacna Jara
- Division of Pulmonary and Critical Care Medicine, Los Angeles County-University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles
| | - Danielle Sim
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Chi-hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Carin van Zyl
- Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Los Angeles County-University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles
| | - Aaron D. Storms
- Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Los Angeles County-University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles
| | - Nader Kamangar
- Los Angeles County Department of Health Services, Los Angeles, California
- Division of Pulmonary and Critical Care Medicine, Olive View Medical Center, David Geffen School of Medicine at UCLA, Sylmar, California
| | - Janice M. Liebler
- Division of Pulmonary and Critical Care Medicine, Los Angeles County-University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles
| | - May M. Lee
- Division of Pulmonary and Critical Care Medicine, Los Angeles County-University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles
| | - Hal F. Yee
- Los Angeles County Department of Health Services, Los Angeles, California
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Bogduk N, Stojanovic M. Group Data or Categorical Data for Outcomes of Pain Treatment? PAIN MEDICINE 2021; 21:2046-2052. [PMID: 33118600 DOI: 10.1093/pm/pnaa286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nikolai Bogduk
- The University of Newcastle, Faculty of Medicine and Health Sciences, New South Wales Australia
| | - Milan Stojanovic
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.,VA Boston Health Care System Jamaica Plain Campus, Boston, Massachusetts.,Harvard Medical School, Anesthesiology, Critical Care and Pain Medicine Service, Boston, Massachusetts, USA
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Nagpal A, Clements N, Duszynski B, Boies B. The Effectiveness of Dorsal Root Ganglion Neurostimulation for the Treatment of Chronic Pelvic Pain and Chronic Neuropathic Pain of the Lower Extremity: A Comprehensive Review of the Published Data. PAIN MEDICINE 2021; 22:49-59. [PMID: 33260203 DOI: 10.1093/pm/pnaa369] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of dorsal root ganglion neurostimulation for the treatment of refractory, focal pain in the pelvis and lower extremities. DESIGN Systematic review. OUTCOME MEASURES The primary outcome was ≥50% pain relief. Secondary outcomes were physical function, mood, quality of life, opioid usage, and complications. RESULTS One pragmatic randomized controlled trial, four prospective cohort studies, and eight case series met the inclusion criteria. A worst-case scenario analysis from the randomized controlled trial reported ≥50% pain relief in 74% of patients with dorsal root ganglion neurostimulation vs. 51% of patients who experienced at least 50% relief with spinal cord stimulation at 3 months. Cohort data success rates ranged from 43% to 83% at ≤6 months and 27% to 100% at >6 months. Significant improvements were also reported in the secondary outcomes assessed, including mood, quality of life, opioid usage, and health care utilization, though a lack of available quantitative data limits further statistical analysis. Complication rates vary, though the only randomized controlled trial reported a higher rate of adverse events than that seen with traditional neurostimulation. CONCLUSIONS In accordance with the Grades of Recommendation, Assessment, Development, and Evaluation system, low-quality evidence supports dorsal root ganglion neurostimulation as a more effective treatment than traditional neurostimulation for pain and dysfunction associated with complex regional pain syndrome or causalgia. Very low-quality evidence supports dorsal root ganglion neurostimulation for the treatment of chronic pelvic pain, chronic neuropathic groin pain, phantom limb pain, chronic neuropathic pain of the trunk and/or limbs, and diabetic neuropathy.
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Affiliation(s)
- Ameet Nagpal
- Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Nathan Clements
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | - Brian Boies
- Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Efficacy and safety of propranolol for treatment of temporomandibular disorder pain: a randomized, placebo-controlled clinical trial. Pain 2021; 161:1755-1767. [PMID: 32701836 DOI: 10.1097/j.pain.0000000000001882] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Propranolol is a nonselective beta-adrenergic receptor antagonist. A multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 2b trial enrolled participants aged 18 to 65 years with temporomandibular disorder myalgia to evaluate efficacy and safety of propranolol compared with placebo in reducing facial pain. Participants were randomized 1:1 to either extended-release propranolol hydrochloride (60 mg, BID) or placebo. The primary endpoint was change in facial pain index (FPI = facial pain intensity multiplied by facial pain duration, divided by 100). Efficacy was analyzed as a mean change in FPI from randomization to week 9 and as the proportion of participants with ≥30% or ≥50% reductions in FPI at week 9. Regression models tested for treatment-group differences adjusting for study site, sex, race, and FPI at randomization. Of 299 participants screened, 200 were randomized; 199 had at least one postrandomization FPI measurement and were included in intention-to-treat analysis. At week 9, model-adjusted reductions in mean FPI did not differ significantly between treatment groups (-1.8, 95% CL: -6.2, 2.6; P = 0.41). However, the proportion with a ≥30% reduction in FPI was significantly greater for propranolol (69.0%) than placebo (52.6%), and the associated number-needed-to-treat was 6.1 (P = 0.03). Propranolol was likewise efficacious for a ≥50% reduction in FPI (number-needed-to-treat = 6.1, P = 0.03). Adverse event rates were similar between treatment groups, except for more frequent fatigue, dizziness, and sleep disorder in the propranolol group. Propranolol was not different from placebo in reducing mean FPI but was efficacious in achieving ≥30% and ≥50% FPI reductions after 9 weeks of treatment among temporomandibular disorder participants.
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Ogdie A, de Vlam K, McInnes IB, Mease PJ, Baer P, Lukic T, Gruben D, Kwok K, Wang C, Hsu MA, Maniccia A. Efficacy of tofacitinib in reducing pain in patients with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis. RMD Open 2021; 6:rmdopen-2019-001042. [PMID: 32396519 PMCID: PMC6999680 DOI: 10.1136/rmdopen-2019-001042] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 01/21/2023] Open
Abstract
Objective To describe the efficacy of tofacitinib in reducing pain in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) in a post-hoc analysis of randomised controlled trials. Methods Data were collected from patients in seven tofacitinib studies: six phase III (four RA, two PsA) and one phase II study (AS), and grouped into five analysis populations based on rheumatic disease diagnosis and category of prior inadequate response (IR) to treatment: conventional synthetic disease-modifying antirheumatic drugs-IR (RA and PsA), tumour necrosis factor inhibitors-IR (RA and PsA), or non-steroidal anti-inflammatory drugs-IR (AS). Only patients who received tofacitinib 5 or 10 mg twice daily or placebo were included. Pain assessments included: Patient’s Assessment of Arthritis Pain, Short-Form Health Survey 36v2 Question (Q)7 and Bodily Pain domain, Ankylosing Spondylitis Quality of Life Q9 and Q14, EuroQol Five Dimensions Pain/Discomfort dimension and Bath Ankylosing Spondylitis Disease Activity Index Q2 and Q3. Data were reported to month 6 (placebo to month 3) in the RA and PsA populations, and week 12 (tofacitinib and placebo) in the AS population. Results Overall, 3330 patients were included in this analysis. In the RA and PsA populations, pain improvements in tofacitinib-treated patients compared with placebo were observed at the earliest time point assessed and at month 3 (maintained to month 6). In the AS population, pain improvements compared with placebo were observed at week 12. Conclusion Tofacitinib was associated with rapid and sustained improvements across multiple pain measures in patients with inflammatory rheumatic musculoskeletal diseases.
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Affiliation(s)
- Alexis Ogdie
- Division of Rheumatology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kurt de Vlam
- Department of Rheumatology, UZ Leuven, Leuven, Belgium
| | - Iain B McInnes
- Glasgow Biomedical Research Centre, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Philip J Mease
- Swedish Rheumatology Research Group, Swedish Medical Center and University of Washington, Seattle, Washington, USA
| | - Philip Baer
- Baer Weinberg MPC, Scarborough, Ontario, Canada
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Gladman D, Nash P, Goto H, Birt JA, Lin CY, Orbai AM, Kvien TK. Fatigue numeric rating scale validity, discrimination and responder definition in patients with psoriatic arthritis. RMD Open 2021; 6:rmdopen-2019-000928. [PMID: 31958274 PMCID: PMC7046948 DOI: 10.1136/rmdopen-2019-000928] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 09/27/2019] [Accepted: 10/22/2019] [Indexed: 01/21/2023] Open
Abstract
Objectives This study assessed the psychometric properties of the fatigue numeric rating scale (NRS) and sought to establish values for clinically meaningful change (responder definition). Methods Using disease-specific clinician-reported and patient-reported data from two randomised clinical trials of patients with psoriatic arthritis (PsA), the fatigue NRS was evaluated for test–retest reliability, construct validity and responsiveness. A responder definition was also explored using anchor-based and distribution-based methods. Results Test–retest reliability analyses supported the reproducibility of the fatigue NRS in patients with PsA (intraclass correlation coefficient=0.829). Mean (SD) values at baseline and week 2 were 5.7 (2.2) and 5.7 (2.4), respectively. Supporting construct validity of the fatigue NRS, moderate-to-large correlations with other assessments measuring similar concepts as measured by Sackett’s conventions were demonstrated. Fatigue severity was reduced when the underlying disease activity was improved and reductions remained consistent at week 12 and 24. A 3-point improvement was identified as being optimal for demonstrating a level of clinically meaningful improvement in fatigue NRS after 12–24 weeks of treatment. Conclusions Fatigue NRS is a valid and responsive patient-reported outcome instrument for use in patients with PsA. The established psychometric properties from this study support the use of fatigue NRS in clinical trials and in routine clinical practice. Robust validation of reliability for use in routine clinical practice in treating patients with active PsA in less active disease states and other more diverse ethnic groups is needed.
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Affiliation(s)
- Dafna Gladman
- Medicine/Rheumatology, Krembil Research Institute, Toronto, Ontario, Canada
| | - Peter Nash
- Department of Medicine, Griffith University, Brisbane, Queensland, Australia
| | | | - Julie A Birt
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Chen-Yen Lin
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Ana-Maria Orbai
- Medicine Rheumatology, Johns Hopkisn University, Baltimore, Maryland, USA
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Heavy menstrual bleeding and its detection in clinical practice. Med Clin (Barc) 2021; 157:332-338. [PMID: 33840528 DOI: 10.1016/j.medcli.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/22/2022]
Abstract
Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that interferes with quality of life. It is an under-diagnosed and under-treated disorder due to the poor correlation between patient perception and objective menstrual blood loss, as well as the scarcity of validated diagnostic tools. Anaemia caused by HMB is a common problem, underestimated on many occasions and with consequences that go beyond the scope of gynaecology. Despite the condition's negative effect on quality of life, most of the tools validated to detect HBM do not take this into account. The aim of this paper is to review the main instruments available to detect HMB, their advantages and disadvantages, their applicability in routine clinical practice, and to recommend those with the best characteristics.
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Thiery-Vuillemin A, Fizazi K, Sartor O, Oudard S, Bury D, Thangavelu K, Ozatilgan A, Poole EM, Eisenberger M, de Bono J. An analysis of health-related quality of life in the phase III PROSELICA and FIRSTANA studies assessing cabazitaxel in patients with metastatic castration-resistant prostate cancer. ESMO Open 2021; 6:100089. [PMID: 33740734 PMCID: PMC7980065 DOI: 10.1016/j.esmoop.2021.100089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/28/2021] [Accepted: 02/21/2021] [Indexed: 12/29/2022] Open
Abstract
Background Men with metastatic castration-resistant prostate cancer (mCRPC) are living longer, therefore optimizing health-related quality of life (HRQL), as well as survival outcomes, is important for optimal patient care. The aim of this study was to assess the HRQL in patients with mCRPC receiving docetaxel or cabazitaxel. Patients and methods PROSELICA (NCT01308580) assessed the non-inferiority of cabazitaxel 20 mg/m2 (C20) versus 25 mg/m2 (C25) in patients with mCRPC after docetaxel. FIRSTANA (NCT01308567) assessed the superiority of C25 or C20 versus docetaxel 75 mg/m2 (D75) in patients with chemotherapy-naive mCRPC. HRQL and pain were analyzed using protocol-defined, prospectively collected, Functional Assessment of Cancer Therapy—Prostate (FACT-P) and McGill-Melzack questionnaires. Analyses included definitive improvements in HRQL, maintained or improved HRQL, and HRQL over time. Results In total, 2131 patients were evaluable for HRQL across the two studies. In PROSELICA, 38.8% and 40.5% of patients receiving C20 and C25, respectively, had definitive FACT-P total score (TS) improvements. In FIRSTANA, 43.4%, 49.7%, and 44.9% of patients receiving D75, C20, and C25, respectively, had definitive FACT-P TS improvements. In both trials, definitive improvements started after cycle 1 and were maintained for the majority of subsequent treatment cycles. More than two-thirds of patients maintained or improved their FACT-P TS. Conclusions In PROSELICA and FIRSTANA, >40% of the 2131 evaluable patients with mCRPC had definitive FACT-P TS improvements; improvements occurred early and were maintained. More than 75% of patients maintained or improved their FACT-P TS. Patients with metastatic castration-resistant prostate cancer (mCRPC) are living longer. Optimizing health-related quality of life (HRQL), as well as survival outcomes, is important for optimal patient care. This study analyzed the HRQL data from patients treated by cabazitaxel or docetaxel within the trials PROSELICA and FIRSTANA. HRQL is often maintained or improved in patients with mCRPC who receive docetaxel or cabazitaxel. This is the largest prospective clinical dataset assessing HRQL among patients with mCRPC treated with taxane chemotherapy.
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Affiliation(s)
| | - K Fizazi
- Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - O Sartor
- Tulane University School of Medicine, New Orleans, USA
| | - S Oudard
- George Pompidou European Hospital, René Descartes University, Paris, France
| | - D Bury
- Sanofi US, Cambridge, USA
| | | | | | | | - M Eisenberger
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, USA
| | - J de Bono
- Royal Marsden and The Institute of Cancer Research, Sutton, UK
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Frech TM, VanBuren JM, Startup E, Assassi S, Bernstein EJ, Castelino FV, Chung L, Correia C, Gordon JK, Hant FN, Hummers L, Khanna D, Sandorfi N, Shah AA, Shanmugam VK, Steen V, Evnin L. Does hand involvement in systemic sclerosis limit completion of patient-reported outcome measures? Clin Rheumatol 2021; 40:965-971. [PMID: 33094395 PMCID: PMC7897231 DOI: 10.1007/s10067-020-05467-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 01/08/2023]
Abstract
The objective of this analysis is to examine whether the severity of systemic sclerosis (SSc)-hand involvement influences patient-reported outcome measure (PROM) completion rate in a US cohort of early disease. Participants included SSc patients with less than 5 years disease duration consented and enrolled in the Collaborative, National, Quality, and Efficacy Registry (CONQUER) between June 2018 and December 2019. Participants' socio-demographics, hand clinical features (severe modified Rodnan skin score, presence of small joint contractures, acro-osteolysis, calcinosis, and digital ulcers), and completion rates of seven PROMs including a Resource Use Questionnaire were analyzed. Cohort characteristics and baseline PROM completion were evaluated. Multivariable logistic regression assessed the relationship between hand limitations and PROM incompletion at several time points using generalized estimating equations. At the time of data lock, 339 CONQUER subjects had a total of 600 visits available for analysis. Calcinosis (odds ratio [OR] 6.35, confidence interval [CI] 2.41-16.73 and acro-osteolysis OR 3.88 (1.57-9.55) were significantly associated with incomplete PROM. The Resource Use Questionnaire was the PROM most commonly not completed. Increasing age was correlated with resource use questionnaire incompletion rate. Acro-osteolysis and calcinosis were associated with lower PROM completion rates in a US SSc cohort, independent of the length of the questionnaires or the modality of administration (electronic or paper). Resource Use Questionnaires are important for understanding the economic impact and burden of chronic disease; however, in this study, it had lower completion rates than PROMs devoted to clinical variables. Key points •Multiple strategies are needed to ensure optimal completion of PROM in longitudinal cohort studies. Even if patients request electronic surveys, we have found it is important to follow up incomplete surveys with paper forms provided at the time of a clinical visit. •The Resource Utilization Questionnaire was lengthy and prone to non-completion in the younger population. •Acro-osteolysis and calcinosis were associated with reduced PROM completion rates.
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Affiliation(s)
- Tracy M Frech
- Department of Internal Medicine, Division of Rheumatology, University of Utah and Salt Lake Veterans Affair Medical Center, 1900 E 30 N, SOM 4b200, Salt Lake City, UT, 84132, USA.
| | - John M VanBuren
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Emily Startup
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Shervin Assassi
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Elana J Bernstein
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Flavia V Castelino
- Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Lorinda Chung
- Department of Medicine and Dermatology, Division of Rheumatology, Stanford University and Palo Alto Veterans Affairs Health Care System, Stanford, CA, USA
| | - Chase Correia
- Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Faye N Hant
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - Laura Hummers
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, MI, USA
| | - Nora Sandorfi
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ami A Shah
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Victoria K Shanmugam
- Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Virginia Steen
- Georgetown University School of Medicine, Washington, DC, USA
| | - Luke Evnin
- Scleroderma Research Foundation, San Francisco, CA, USA
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73
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Absolom K, Warrington L, Hudson E, Hewison J, Morris C, Holch P, Carter R, Gibson A, Holmes M, Clayton B, Rogers Z, McParland L, Conner M, Glidewell L, Woroncow B, Dawkins B, Dickinson S, Hulme C, Brown J, Velikova G. Phase III Randomized Controlled Trial of eRAPID: eHealth Intervention During Chemotherapy. J Clin Oncol 2021; 39:734-747. [DOI: 10.1200/jco.20.02015] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Electronic patient self-Reporting of Adverse-events: Patient Information and aDvice (eRAPID) is an online eHealth system for patients to self-report symptoms during cancer treatment. It provides automated severity-dependent patient advice guiding self-management or medical contact and displays the reports in electronic patient records. This trial evaluated the impact of eRAPID on symptom control, healthcare use, patient self-efficacy, and quality of life (QOL) in a patient population treated predominantly with curative intent. METHODS Patients with colorectal, breast, or gynecological cancers commencing chemotherapy were randomly assigned to usual care (UC) or the addition of eRAPID (weekly online symptom reporting for 18 weeks). Primary outcome was symptom control (Functional Assessment of Cancer Therapy-General, Physical Well-Being subscale [FACT-PWB]) assessed at 6, 12, and 18 weeks. Secondary outcomes were processes of care (admissions or chemotherapy delivery), patient self-efficacy, and global quality of life (Functional Assessment of Cancer Therapy–General, EQ5D-VAS, and EORTC QLQ-C30 summary score). Multivariable mixed-effects repeated-measures models were used for analyses. Trial registration: ISRCTN88520246. RESULTS Participants were 508 consenting patients (73.6% of 690 eligible) and 55 health professionals. eRAPID compared to UC showed improved physical well-being at 6 ( P = .028) and 12 ( P = .039) weeks and no difference at 18 weeks (primary end point) ( P = .69). Fewer eRAPID patients (47%) had clinically meaningful physical well-being deterioration than UC (56%) at 12 weeks. Subgroup analysis found benefit in the nonmetastatic group at 6 weeks ( P = .0426), but not in metastatic disease. There were no differences for admissions or chemotherapy delivery. At 18 weeks, patients using eRAPID reported better self-efficacy ( P = .007) and better health on EQ5D-VAS ( P = .009). Average patient compliance with weekly symptom reporting was 64.7%. Patient adherence was associated with clinician's data use and improved FACT-PWB at 12 weeks. CONCLUSION Real-time monitoring with electronic patient-reported outcomes improved physical well-being (6 and 12 weeks) and self-efficacy (18 weeks) in a patient population predominantly treated with curative intent, without increasing hospital workload.
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Affiliation(s)
- Kate Absolom
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Lorraine Warrington
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Eleanor Hudson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Carolyn Morris
- Patient Representative, Independent Cancer Patients Voices, Brighton, United Kingdom
| | - Patricia Holch
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
- Psychology Group, School of Social Sciences, Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Robert Carter
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Andrea Gibson
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, United Kingdom
| | - Marie Holmes
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Beverly Clayton
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Zoe Rogers
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Lucy McParland
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Liz Glidewell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Barbara Woroncow
- Patient Representative, Research Advisory Group to Patient-Centred Outcomes Research at Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Bryony Dawkins
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sarah Dickinson
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Claire Hulme
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
- University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Julia Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, United Kingdom
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Beaton DE, Maxwell LJ. Commentary: Online Platform of Minimal Important Difference estimates for patient reported outcomes: potential and challenges. J Clin Epidemiol 2021; 133:172-174. [PMID: 33600950 DOI: 10.1016/j.jclinepi.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022]
Affiliation(s)
- D E Beaton
- 400 University Avenue, Suite 1800, Toronto, Ontario, Canada M5G 1S5.
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75
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Hunt CW, Cavallaro PM, Bordeianou LG. Metrics Used to Quantify Fecal Incontinence and Constipation. Clin Colon Rectal Surg 2021; 34:5-14. [PMID: 33536844 PMCID: PMC7843947 DOI: 10.1055/s-0040-1714245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
While fecal incontinence and constipation can be measured through physiological testing, the subjective experience of severity and impact on health-related quality of life lead to both being most effectively captured through patient-reported measures. Patient-reported measures of severity and impact help to determine baseline symptoms, guide clinical decision making, and compare various treatments. Here, we take pause to review the psychometric qualities that make effective instruments, and discuss some of the most commonly used instruments along with the reasons behind their use. In addition, we highlight the benefits of a standardized instrument designed to evaluate the major symptoms of patients presenting with pelvic floor disorders (including fecal incontinence and constipation). Ultimately, we aim to provide guidance in choosing appropriate instruments for clinical and research use.
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Affiliation(s)
- Cameron W. Hunt
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Paul M. Cavallaro
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Liliana G. Bordeianou
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Mitchell GL, Richdale K, Lam D, Wagner H, Kinoshita BT, Zimmerman AB, Sorbara L, Rosner B. Development of a contact Lens risk survey. Cont Lens Anterior Eye 2020; 44:101383. [PMID: 33281075 DOI: 10.1016/j.clae.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/29/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe the development and report psychometric properties of the Contact Lens Risk Survey (CLRS) to identify patients at risk for soft contact lens-related complications. METHODS Psychometric properties of the CLRS, a web-based survey with branching logic, were determined using data from 5 multi-site fieldings (n = 1059), including re-fielding to sub groups. Responses from participants with and without an active red eye were used to identify risk factors of a red eye event and calculate an overall risk score. A 6th fielding of the CLRS (n = 171) was used to assess discriminate validity. RESULTS Participants needed 11-12 min to complete the survey with a negligible difference by age. Internal consistency was excellent (Cronbach's α ≥ 0.70) for 3 of the 5 constructs identified by factor analysis. Twelve of the 17 survey items exhibited excellent within-subject repeatability (Kappa ≥ 0.61). Between-subject agreement, assessed in 18-25 year olds, was high for the majority of items, suggesting good generalizability across different populations of SCL wearers. The ability of the model using individual items of the CLRS to discriminate Controls and participants with a red eye was good with an area under the curve of 0.779. CONCLUSION The CLRS tool is a repeatable and valid instrument to standardize documentation of demographic, behavior, and exposure factors which appear to drive the greatest risk of a contact lens related red eye event.
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Affiliation(s)
- G Lynn Mitchell
- Ohio State University, College of Optometry, Columbus, OH, United States.
| | - Kathryn Richdale
- University of Houston, College of Optometry, Houston, TX, United States
| | - Dawn Lam
- Marshall B. Ketchum University, College of Optometry, Fullerton, CA, United States
| | - Heidi Wagner
- Ohio State University, College of Optometry, Columbus, OH, United States
| | - Beth T Kinoshita
- Pacific University, College of Optometry, Forest Grove, OR, United States
| | - Aaron B Zimmerman
- Ohio State University, College of Optometry, Columbus, OH, United States
| | - Luigina Sorbara
- University of Waterloo, School of Optometry, Waterloo, ON, Canada
| | - Bernard Rosner
- Harvard University, T. H Chan School of Public Health, Boston, MA, United States
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Abstract
OBJECTIVE To evaluate the effects of elagolix on clinically meaningful improvements in health-related quality of life (HRQOL) measured by the EHP-30 (Endometriosis Health Profile-30). METHODS Data from two phase III trials of elagolix for moderate to severe pain associated with endometriosis were pooled and analyzed as three groups: placebo, elagolix 150 mg once daily, or elagolix 200 mg twice daily. Patients were administered the EHP-30 questionnaire at baseline, and at months 1, 3, and 6 of treatment. Previously established responder definitions were applied to determine percentages of patients with clinically meaningful EHP-30 improvements. The probability of meeting EHP-30 responder definitions with elagolix compared with placebo at months 3 and 6 was determined by Poisson regression analysis, controlling for baseline scores. RESULTS At month 6, the probabilities of meeting EHP-30 subscale responder definitions for pain, control and powerlessness, self-image, social support, emotional well-being, and sexual intercourse were 169% (adjusted relative risk [aRR]: 2.69, 95% CI 2.26-3.21), 129% (aRR 2.29, 95% CI 1.96-2.67), 80% (aRR 1.80, 95% CI 1.54-2.11), 70% (aRR 1.70, 95% CI 1.47-1.97), 67% (aRR 1.67, 95% CI 1.45-1.92), and 62% (aRR 1.62, 95% CI 1.36-1.92) greater, respectively (all P<.001), in the 200-mg group than in the placebo group. Although lower in magnitude than the 200-mg group, the 150-mg group also had greater probabilities of meeting responder definitions than the placebo group for all subscales except sexual intercourse. The probabilities of meeting responder definitions for pain, control and powerlessness, self-image, social support, and emotional well-being were 75% (aRR 1.75, 95% CI 1.44-2.14), 50% (aRR 1.50, 95% CI 1.25-1.80), 22% (aRR 1.22, 95% CI 1.01-1.47), 30% (aRR 1.30, 95% CI 1.09-1.53), and 35% (aRR 1.35, 95% CI 1.16-1.57) greater, respectively (all P<.05), in the 150-mg group than in the placebo group. CONCLUSION Patients with moderate to severe pain associated with endometriosis and were treated with elagolix experienced clinically meaningful HRQOL improvements. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01620528 and NCT01931670. FUNDING SOURCE AbbVie Inc.
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78
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Tran TXM, Park J, Lee J, Jung YS, Chang Y, Cho H. Utility of the Patient-Reported Outcomes Measurement Information System (PROMIS) to measure primary health outcomes in cancer patients: a systematic review. Support Care Cancer 2020; 29:1723-1739. [PMID: 33058000 DOI: 10.1007/s00520-020-05801-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To systematically review the literature on how the Patient-Reported Outcomes Measurement Information System (PROMIS) measure system is used to assess patient-reported outcomes (PROs) in cancer patients. METHODS We conducted a systematic review following the PRISMA guidelines. Articles were identified through searches of PubMed, EMBASE, and additional manual review of the publications listed on the PROMIS website. We included studies measuring outcomes, including physical function, fatigue, pain, anxiety, and depression in cancer patients. Eligible articles included interventional and observational studies published in English between 2009 and 2019. RESULTS A total of 1789 records were identified and screened by three reviewers, 118 articles were reviewed in full text, and 42 articles met the inclusion criteria. The majority of studies used the PROMIS measure system to prospectively assess longitudinal changes in PROs; the number of measurements ranges from 2 to 4 with the time points of follow-up set at 3, 6, and 12 months after the baseline assessment. Depression and fatigue were the most frequently measured outcomes. Fixed-length short forms with four items were the most common measure types. A transition toward utilizing a web- or smartphone-based electronic tool was observed to limit the burden of the conventional paper-based survey to collect and store PROs. CONCLUSION The PROMIS measure system is increasingly popular to measure PROs in cancer patients with acceptance of its various short forms and electronic-based systems to administer data electronically. Findings from this review highlight various aspects of PROMIS and may help health professionals in their choice of PRO tools for optimizing care and support for cancer patients.
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Affiliation(s)
- Thi Xuan Mai Tran
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Jungeun Park
- Division of Healthcare Technology Assessment Research, National Evidence-based healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Joonki Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yuh-Seog Jung
- Cancer Knowledge and Information Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
- Division of Tumor Immunology, Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Yoonjung Chang
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
- National Cancer Survivorship Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Hyunsoon Cho
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
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Linguistic and Cultural Adaptation to Spanish of the Screening Tool Psoriatic arthritis UnclutteRed Screening Evaluation (PURE4). ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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80
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Kennedy DJ, Schneider B. Lies, Damn Lies, and Statistic: A Commentary. PAIN MEDICINE 2020; 21:2052-2054. [PMID: 32918475 DOI: 10.1093/pm/pnaa287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- David J Kennedy
- Vanderbilt University Medical Center, Physical Medicine and Rehabilitation, Nashville, Tennessee, USA
| | - Byron Schneider
- Vanderbilt University Medical Center, Physical Medicine and Rehabilitation, Nashville, Tennessee, USA
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81
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Reveille JD, Hwang MC, Danve A, Kafka S, Peterson S, Lo KH, Kim L, Hsia EC, Chan EKH, Deodhar A. The effect of intravenous golimumab on health-related quality of life and work productivity in adult patients with active ankylosing spondylitis: results of the phase 3 GO-ALIVE trial. Clin Rheumatol 2020; 40:1331-1341. [PMID: 32926247 DOI: 10.1007/s10067-020-05342-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION/OBJECTIVES The effect of intravenous (IV) golimumab on health-related quality of life (HRQoL) and productivity in patients with ankylosing spondylitis (AS) was evaluated. METHOD Patients were randomized to IV golimumab 2 mg/kg (n = 105) at weeks 0, 4, then every 8 weeks (q8w) through week 52 or placebo (n = 103) at weeks 0, 4, 12, with crossover to golimumab 2 mg/kg at weeks 16, 20, then q8w through week 52. Changes from baseline in EuroQol-5 dimension-5 level (EQ-5D-5L) index and visual analog scale (EQ-VAS), daily productivity VAS, Work Limitations Questionnaire (WLQ), and Ankylosing Spondylitis Quality of Life (ASQoL) were assessed. Correlations between these outcomes and disease activity and patient functioning outcomes were evaluated post hoc. RESULTS At week 16, changes from baseline (mean ± standard deviation) in EQ-5D-5L index (0.17 ± 0.16 vs 0.05 ± 0.14), EQ-VAS (20.3 ± 24.6 vs 4.8 ± 23.5), daily productivity VAS (- 2.9 ± - 2.9 vs - 1.1 ± - 2.5), WLQ productivity loss score (- 3.5 ± - 5.3 vs - 1.9 ± - 4.0), and ASQoL (- 5.4 ± - 5.0 vs - 1.8 ± - 4.5) were greater in the IV golimumab versus placebo group, respectively. At week 28, changes from baseline were similar between the IV golimumab and placebo-crossover groups (EQ-5D-5L index: 0.18 ± 0.17 and 0.16 ± 0.16, EQ-VAS: 20.5 ± 27.9 and 22.5 ± 23.1, daily productivity VAS: - 3.1 ± - 3.0 and - 3.1 ± - 2.8, WLQ productivity loss: - 3.9 ± - 5.5 and - 4.5 ± - 4.5, and ASQoL: - 5.3 ± - 5.2 and - 5.3 ± - 4.8, respectively); improvements were maintained through week 52. HRQoL and productivity outcomes were generally moderately correlated with disease activity and functioning outcomes. CONCLUSIONS In patients with AS, IV golimumab produced sustained improvements in HRQoL and productivity through 1 year, which correlated with improvements in disease activity and functioning. ClinicalTrials.gov registry number is NCT02186873. Key Points • Intravenous (IV) golimumab resulted in clinically important improvement in general and ankylosing spondylitis-specific health-related quality of life (HRQoL) and productivity outcomes in patients with ankylosing spondylitis (AS) as early as week 8 and maintained improvement through 1 year • Improvements in HRQoL and productivity outcomes in these patients with AS were correlated with improvements in measures of disease activity and patient functional capability • IV golimumab is an effective treatment option for AS that can help mitigate the negative effects of the disease on HRQoL and productivity.
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Affiliation(s)
- John D Reveille
- Department of Internal Medicine, Division of Rheumatology, The University of Texas McGovern Medical School, 6431 Fannin, MSB 5.270, Houston, TX, USA.
| | - Mark C Hwang
- Department of Internal Medicine, Division of Rheumatology, The University of Texas McGovern Medical School, 6431 Fannin, MSB 5.270, Houston, TX, USA
| | - Abhijeet Danve
- Section of Rheumatology, Yale School of Medicine, New Haven, CT, USA
| | - Shelly Kafka
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | | | - Kim Hung Lo
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Lilianne Kim
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Elizabeth C Hsia
- Janssen Research & Development, LLC, Spring House, PA, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | - Eric K H Chan
- Patient Reported Outcomes, Janssen Global Services, LLC, Raritan, NJ, USA
| | - Atul Deodhar
- Oregon Health & Science University, Portland, OR, USA
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Mjåset C, Zwart JA, Goedmakers CMW, Smith TR, Solberg TK, Grotle M. Criteria for success after surgery for cervical radiculopathy-estimates for a substantial amount of improvement in core outcome measures. Spine J 2020; 20:1413-1421. [PMID: 32502657 DOI: 10.1016/j.spinee.2020.05.549] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Defining clinically meaningful success criteria from patient-reported outcome measures (PROMs) is crucial for clinical audits, research and decision-making. PURPOSE We aimed to define criteria for a successful outcome 3 and 12 months after surgery for cervical degenerative radiculopathy on recommended PROMs. STUDY DESIGN Prospective cohort study with 12 months follow-up. PATIENT SAMPLE Patients operated at one or two levels for cervical radiculopathy included in the Norwegian Registry for Spine Surgery (NORspine) from 2011 to 2016. OUTCOME MEASURES Neck disability index (NDI), Numeric Rating Scale for neck pain (NRS-NP) and arm pain (NRS-AP), health-related quality-of-life EuroQol 3L (EQ-5D), general health status (EQ-VAS). METHODS We included 2,868 consecutive cervical degenerative radiculopathy patients operated for cervical radiculopathy in one or two levels and included in the Norwegian Registry for Spine Surgery (NORspine). External criterion to determine accuracy and optimal cut-off values for success in the PROMs was the global perceived effect scale. Success was defined as "much better" or "completely recovered." Cut-off values were assessed by analyzing the area under the receiver operating curves for follow-up scores, mean change scores, and percentage change scores. RESULTS All PROMs showed high accuracy in defining success and nonsuccess and only minor differences were found between 3- and 12-month scores. At 12 months, the area under the receiver operating curves for follow-up scores were 0.86 to 0.91, change scores were 0.74 to 0.87, and percentage change scores were 0.74 to 0.91. Percentage scores of NDI and NRS-AP showed the best accuracy. The optimal cut-off values for each PROM showed considerable overlap across those operated due to disc herniation and spondylotic foraminal stenosis. CONCLUSIONS All PROMs, especially NDI and NRS-AP, showed good to excellent discriminative ability in distinguishing between a successful and nonsuccessful outcome after surgery due to cervical radiculopathy. Percentage change scores are recommended for use in research and clinical practice.
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Affiliation(s)
- Christer Mjåset
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
| | - John-Anker Zwart
- Faculty of Medicine, University of Oslo, Oslo, Norway; Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Caroline M W Goedmakers
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands; Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, School of Medicine, Harvard University, Boston, MA, USA
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, School of Medicine, Harvard University, Boston, MA, USA
| | - Tore K Solberg
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Institute of Clinical Medicine, The Arctic University of Norway (UiT), Tromsø, Norway
| | - Margreth Grotle
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway; Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
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Salah S, Colomb L, Benize AM, Cornillon C, Shaiek A, Charbit J, Schritz A. Prediction of treatment effect perception in cosmetics using machine learning. J Biopharm Stat 2020; 31:55-62. [PMID: 32715937 DOI: 10.1080/10543406.2020.1792479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Perception of treatment effect (TE) in cosmetics is multifaceted and influenced by multiple parameters that need to be considered simultaneously when evaluating TE. Here we provide a global approach to predicting TE perception using Random Forest (RF) classifier. Data from three randomized double-blind clinical studies with a total of 50 subjects were used. Different products were applied to each facial cheek of subjects at each visit, and post-application photographs were taken. Nine primary endpoints relating to skin pores were assessed by a specific image analysis algorithm. Twenty judges evaluated the relative pore visibility in all possible pairs of cheek photographs. RF was used to construct a prediction model for TE perception based on the primary endpoints and judge's evaluation. Intra-study product ranking was done using the Bradley-Terry model on mean judges' predicted preference. RF demonstrated overall good accuracy in predicting TE perception. Applying RF technique not only addresses issues of multiplicity, nonlinearity and interactions between multiple criteria but also focuses decision-making on one discrete parameter thereby simplifying interpretability and allowing for more consumer-centered claim substantiation in clinical trials.Abbreviations: RF: Random Forest classifier; FDA: The US Food and Drug Agency; ID: Identifier; MCID: Minimal clinical important difference; Param: Parameter; PGIC: Patients' Global Impression of Change; TE: Treatment effect; TRT: Treatment.
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Affiliation(s)
| | | | | | | | | | | | - Anna Schritz
- Competence Center of Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
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84
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Rogers RG, Bann CM, Barber MD, Fairchild P, Lukacz ES, Arya L, Markland AD, Siddiqui NY, Sung VW. The responsiveness and minimally important difference for the Accidental Bowel Leakage Evaluation questionnaire. Int Urogynecol J 2020; 31:2499-2505. [PMID: 32613557 PMCID: PMC7680270 DOI: 10.1007/s00192-020-04367-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/25/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We describe the responsiveness and minimally important difference (MID) of the Accidental Bowel Leakage Evaluation (ABLE) questionnaire. METHODS Women with bowel leakage completed ABLE, Patient Global Impression of Improvement, Colo-Rectal Anal Distress Inventory, and Vaizey questionnaires pretreatment and again at 24 weeks post-treatment. Change scores were correlated between questionnaires. Student's t tests compared ABLE change scores for improved versus not improved based on other measures. The MID was determined by anchor- and distribution-based approaches. RESULTS In 266 women, the mean age was 63.75 (SD = 11.14) and 79% were white. Mean baseline ABLE scores were 2.32 ± 0.56 (possible range 1-5) with a reduction of 0.62 (SD = 0.79) by 24 weeks. ABLE change scores correlated with related measures change scores (r = 0.24 to 0.53) and differed between women who improved and did not improve (all p < 0.001). Standardized response means for participants who improved were large ranging from -0.89 to -1.12. Distribution-based methods suggest a MID of -0.19 based on the criterion of one SEM and -0.28 based on half a standard deviation. Anchor-based MIDs ranged from -0.10 to -0.45. We recommend a MID of -0.20. CONCLUSIONS The ABLE questionnaire is responsive to change, with a suggested MID of -0.20.
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Affiliation(s)
- Rebecca G Rogers
- Department of Women's Health, Dell Medical School, 1501 Red River Street, Austin, TX, 78712, USA.
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | - Carla M Bann
- Division of Statistical and Data Sciences, RTI International, Research Triangle Park, NC, USA
| | - Matthew D Barber
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
- Obstetrics Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Pamela Fairchild
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Magee-Women's Research Institute, Pittsburgh, PA, USA
| | - Emily S Lukacz
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Diego, San Diego, CA, USA
| | - Lily Arya
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Alayne D Markland
- Department of Medicine, University of Alabama at Birmingham; Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL, USA
| | - Nazema Y Siddiqui
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Vivian W Sung
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
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85
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Lapin BR. Considerations for Reporting and Reviewing Studies Including Health-Related Quality of Life. Chest 2020; 158:S49-S56. [DOI: 10.1016/j.chest.2020.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/20/2019] [Accepted: 03/09/2020] [Indexed: 11/26/2022] Open
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86
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Woaye-Hune P, Hardouin JB, Lehur PA, Meurette G, Vanier A. Practical issues encountered while determining Minimal Clinically Important Difference in Patient-Reported Outcomes. Health Qual Life Outcomes 2020; 18:156. [PMID: 32460882 PMCID: PMC7251729 DOI: 10.1186/s12955-020-01398-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/07/2020] [Indexed: 11/24/2022] Open
Abstract
Background Using a real dataset, we highlighted several major methodological issues raised by the estimation of the Minimal Clinically Important Difference (MCID) of a Patient-Reported Outcomes instrument. We especially considered the management of missing data and the use of more than two times of measurement. While inappropriate missing data management and inappropriate use of multiple time points can lead to loss of precision and/or bias in MCID estimation, these issues are almost never dealt with and require cautious considerations in the context of MCID estimation. Methods We used the LIGALONGO study (French Randomized Controlled Trial). We estimated MCID on the SF-36 General Health score by comparing many methods (distribution or anchor-based). Different techniques for imputation of missing data were performed (simple and multiple imputations). We also consider all measurement occasions by longitudinal modeling, and the dependence of the score difference on baseline. Results Three hundred ninety-three patients were studied. With distribution-based methods, a great variability in MCID was observed (from 3 to 26 points for improvement). Only 0.2 SD and 1/3 SD distribution methods gave MCID values consistent with anchor-based methods (from 4 to 7 points for improvement). The choice of missing data imputation technique clearly had an impact on MCID estimates. Simple imputation by mean score seemed to lead to out-of-range estimate, but as missing not at random mechanism can be hypothesized, even multiple imputations techniques can have led to an slight underestimation of MCID. Using 3 measurement occasions for improvement led to an increase in precision but lowered estimates. Conclusion This practical example illustrates the substantial impact of some methodological issues that are usually never dealt with for MCID estimation. Simulation studies are needed to investigate those issues. Trial registration NCT01240772 (ClinicalTrials.gov) registered on November 15, 2010.
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Affiliation(s)
- Pascal Woaye-Hune
- Inserm, Université Bretagne-Loire - Université de Nantes - Université de Tours, UMR U1246 SPHERE "Methods in patient-centered outcomes and health research", Nantes, France.,Internal Medicine Department, University Hospital of Nantes, Nantes, France
| | - Jean-Benoit Hardouin
- Inserm, Université Bretagne-Loire - Université de Nantes - Université de Tours, UMR U1246 SPHERE "Methods in patient-centered outcomes and health research", Nantes, France.,Unit of Methodology and Biostatistics, University Hospital of Nantes, Nantes, France
| | - Paul-Antoine Lehur
- Digestive Surgery Department, University Hospital of Nantes, Nantes, France
| | - Guillaume Meurette
- Digestive Surgery Department, University Hospital of Nantes, Nantes, France
| | - Antoine Vanier
- Inserm, Université Bretagne-Loire - Université de Nantes - Université de Tours, UMR U1246 SPHERE "Methods in patient-centered outcomes and health research", Nantes, France.
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87
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Belinchón I, Queiro R, Salgado-Boquete L, López-Ferrer A, Ferran M, Coto-Segura P, Rivera R, Vidal D, Rodríguez L, de la Cueva P, Guinea G, Martin Vazquez V. Linguistic and Cultural Adaptation to Spanish of the Screening Tool Psoriatic Arthritis UnclutteRed Screening Evaluation (PURE4). ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:655-664. [PMID: 32401721 DOI: 10.1016/j.ad.2020.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The 4-item Psoriatic arthritis UnclutteRed screening Evaluation (PURE-4) questionnaire is a useful tool for identifying patients with suspected psoriatic arthritis before referring them to a rheumatology department for confirmation. The original English version has good discriminant validity (sensitivity, 85.7%; specificity, 83.6%). We aimed to produce an adapted Spanish version of the PURE-4 for validation and use in Spain. MATERIAL AND METHOD We applied the method recommended by the International Society for Pharmacoeconomic and Outcome Research for the cultural adaptation of patient-centered measurement tools. The phases in the processes involved forward translation, reconciliation, back translation review, harmonization, cognitive debriefing and review, and proofreading. RESULTS We obtained the permission of the author of the original questionnaire. Two native-speaking translators translated the questionnaire into Spanish. Small changes, mainly in the way the items were expressed, were then made in order to reconcile the 2 translations. The questionnaire was then back translated to English and revised to achieve a version equivalent to the original. A Spanish translation derived from the revision was tested for understandability in 7 patients, and the final Spanish version was then produced. During the translation phases, the project manager and a scientific committee made up of a dermatologist and a rheumatologist reviewed the different versions. Team members exchanged information throughout the process, providing for harmonization and the quality control that guaranteed conceptual equivalence. CONCLUSIONS This adaptation of the PURE-4 questionnaire for use in Spain has been the first step toward using it in routine clinical practice. The standardized method we used ensures that the Spanish and the original versions are equivalent.
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Affiliation(s)
- I Belinchón
- Servicio de Dermatología, Hospital General Universitario de Alicante-ISABIAL, Universidad Miguel Hernández, Alicante, España.
| | - R Queiro
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - L Salgado-Boquete
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - A López-Ferrer
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Ferran
- Servicio de Dermatología, Hospital del Mar, Barcelona, España
| | - P Coto-Segura
- Servicio de Dermatología, Hospital Álvarez-Buylla, Asturias, España
| | - R Rivera
- Servicio de Dermatología, Hospital 12 de Octubre, Madrid, España
| | - D Vidal
- Servicio de Dermatología, Hospital de Sant Joan Despí Moisés Broggi, Barcelona, España
| | - L Rodríguez
- Servicio de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - G Guinea
- Novartis pharmaceuticals Spain, Barcelona, España
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88
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Byrom B, Breedon P, Tulkki-Wilke R, Platko JV. Meaningful change: Defining the interpretability of changes in endpoints derived from interactive and mHealth technologies in healthcare and clinical research. J Rehabil Assist Technol Eng 2020; 7:2055668319892778. [PMID: 32206336 PMCID: PMC7079306 DOI: 10.1177/2055668319892778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 11/01/2019] [Indexed: 12/28/2022] Open
Abstract
Immersive, interactive and mHealth technologies are increasingly being used in clinical research, healthcare and rehabilitation solutions. Leveraging technology solutions to derive new and novel clinical outcome measures is important to the ongoing assessment of clinical interventions. While demonstrating statistically significant changes is an important element of intervention assessment, understanding whether changes detected reflect changes of a magnitude that are considered meaningful to patients is equally important. We describe methodologies used to determine meaningful change and recommend that these techniques are routinely included in the development and testing of clinical assessment and rehabilitation technology solutions.
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Affiliation(s)
- B Byrom
- Product Management, Signant Health, London, UK
| | - P Breedon
- Medical Design Research Group, Nottingham Trent University, Nottingham, UK
| | | | - J V Platko
- ECOA Science, Signant Health, Plymouth Meeting, USA
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89
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Tan J, Frey MP, Thiboutot D, Layton A, Eady A. Identifying the Impacts of Acne: A Delphi Survey of Patients and Clinicians. J Cutan Med Surg 2020; 24:259-266. [PMID: 32096429 DOI: 10.1177/1203475420907088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Acne can adversely impact those affected in multiple dimensions. The purpose of this study was to determine the most prominent impacts identified by acne patients and by clinicians. METHODS Independent Delphi surveys for acne patients and clinicians were conducted to achieve consensus regarding acne impacts within each group. Acne patients were recruited from outpatient clinics of authors (AL, JT, and DT). The first phase involved qualitative responses, where emergent themes were identified and used to generate items for 2 subsequent phases. RESULTS The qualitative phase generated 64 items in 3 themes: psychological, sociological, and treatment related. These items were independently ranked in importance by patients and by clinicians. Consensus for importance was achieved for 34 items by patients and 43 by clinicians. Patient-identified highest ranked items were being self-conscious, feeling unattractive, feeling uncomfortable in own skin, unattractive to others, would not want pictures taken, envious of people with clear skin, and time/effort spent concealing scarring; while clinicians identified feeling unattractive. CONCLUSIONS We identify acne impacts within psychological, sociological, and treatment-related domains by acne patients and clinicians. Further, we establish discrepancies between patients and clinicians regarding the impact of acne. This provides evidence for the importance of establishing patient-reported outcomes.
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Affiliation(s)
- Jerry Tan
- Department of Psychology, University of Windsor, ON, Canada.,70384 Windsor Clinical Research Inc., ON, Canada.,8637 Department of Medicine, University of Western Ontario, London, Canada
| | - Marc P Frey
- Department of Psychology, University of Windsor, ON, Canada
| | | | | | - Anne Eady
- 3746 Harrogate & District NHS Foundation Trust, UK
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90
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Walton MK, Cappelleri JC, Byrom B, Goldsack JC, Eremenco S, Harris D, Potero E, Patel N, Flood E, Daumer M. Considerations for development of an evidence dossier to support the use of mobile sensor technology for clinical outcome assessments in clinical trials. Contemp Clin Trials 2020; 91:105962. [PMID: 32087341 DOI: 10.1016/j.cct.2020.105962] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/05/2020] [Accepted: 02/17/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mobile sensors offer enormous potential for the collection of informative clinical endpoints in clinical trials to support regulatory decision making and product labelling. There are currently no specific guidelines on the information needed to enable regulators to review and accept proposed endpoints derived from mobile sensors for use in drug development trials. OBJECTIVE The purpose of this working group report is to recommend the structure and content of an evidence dossier intended to support whether a clinical endpoint derived from mobile sensor data is fit-for-purpose for use in regulatory submissions for drug approvals. EVIDENCE DOSSIER The structure and content of a dossier to provide evidence supporting the use of a sensor-derived clinical endpoint is described. Sections include clinical endpoint definition and positioning, the concept of interest, the context of use, clinical validation and interpretation, study implementation, and analytical validity with sensor performance verification in support of the selected sensor. CONCLUSIONS In the absence of definitive regulatory guidance, this report provides a considered approach to compiling a comprehensive body of evidence to justify acceptance of mobile sensors for support of new drug applications.
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Affiliation(s)
- M K Walton
- Janssen Research and Development, Titusville, NJ, USA
| | | | | | - J C Goldsack
- Digital Medicine Society (DiMe), Sarasota, FL, USA
| | - S Eremenco
- Critical Path Institute, Tucson, AZ, USA
| | | | | | - N Patel
- AstraZeneca, Gaithersburg, MD, USA
| | - E Flood
- AstraZeneca, Gaithersburg, MD, USA
| | - M Daumer
- Sylvia Lawry Centre for Multiple Sclerosis Research, Munich, Germany
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91
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Werner DAT, Grotle M, Gulati S, Austevoll IM, Madsbu MA, Lønne G, Solberg TK. Can a Successful Outcome After Surgery for Lumbar Disc Herniation Be Defined by the Oswestry Disability Index Raw Score? Global Spine J 2020; 10:47-54. [PMID: 32002349 PMCID: PMC6963355 DOI: 10.1177/2192568219851480] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
STUDY DESIGN Prospective multicenter cohort study. OBJECTIVE To investigate (1) the discriminative ability and cutoff estimates for success 12 months after surgery for lumbar disc herniation on the Oswestry Disability Index (ODI) raw score compared with a change and a percentage change score and (2) to what extent these clinical outcomes depend on the baseline disability. METHODS A total of 6840 patients operated for lumbar disc herniation from the Norwegian Registry for Spine Surgery (NORspine) were included. In receiver operating characteristic (ROC) curve analyses, a global perceived effect (GPE) scale (1-7) was used an external anchor. Success was defined as categories 1-2, "completely recovered" and "much better." Cutoffs for success for subgroups with different preoperative disability were also estimated. RESULTS When defining success after surgery for lumbar disc herniation, the accuracy (sensitivity, specificity, area under the curve, 95% CI) for the ODI raw score (0.83, 0.87, 0.930, 0.924-0.937) was comparable to the ODI percentage change score (0.85, 0.85, 0.925, 0.918-0.931), and higher than the ODI change score (0.79, 0.73, 0.838, 0.830-0.852). The cutoff for success was highly dependent on the amount of baseline disability (low-high), with cutoffs ranging from 13 to 28 for the ODI raw score and 39% to 66% for ODI percentage change. The ODI change score (points) was not as accurate. CONCLUSION The 12-month ODI raw score, like the ODI percentage change score, can define a successful outcome with excellent accuracy. Adjustment for the baseline ODI score should be performed when comparing outcomes across groups, and one should consider using cutoffs according to preoperative disability (low, medium, high ODI scores).
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Affiliation(s)
- David A. T. Werner
- University Hospital of Northern Norway, Tromsø, Norway,University of Tromsø, Institute of Clinical Medicine, Tromsø, Norway,David Werner, Department of Neurosurgery, University Hospital of Northern Norway, Sykehusveien 38, 9019 Tromsø, Norway.
| | - Margreth Grotle
- Oslo Metropolitan University, Oslo, Norway,Oslo University Hospital, Oslo, Norway
| | - Sasha Gulati
- St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway,Norwegian University of Science and Technology, Trondheim, Norway
| | - Ivar M. Austevoll
- Kysthospitalet in Hagevik, Haukeland University Hospital, Bergen, Norway
| | - Mattis A. Madsbu
- St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Greger Lønne
- Norwegian University of Science and Technology, Trondheim, Norway,Innlandet Hospital Trust, Lillehammer, Norway,Norwegian Registry for Spine Surgery, Northern Norway Regional Health Authority, Bodø, Norway
| | - Tore K. Solberg
- University Hospital of Northern Norway, Tromsø, Norway,University of Tromsø, Institute of Clinical Medicine, Tromsø, Norway,Norwegian Registry for Spine Surgery, Northern Norway Regional Health Authority, Bodø, Norway
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92
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Higuchi S, Moriguchi Y, Tan KHX. Psychometric validation of the Japanese version of Alcohol Quality of Life Scale (AQoLS-Japan) in the treatment of patients with alcohol use disorder. Qual Life Res 2020; 29:223-235. [PMID: 31586271 PMCID: PMC6962253 DOI: 10.1007/s11136-019-02310-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 11/02/2022]
Abstract
Abstract
Purpose
The Alcohol Quality of Life Scale (AQoLS) is accepted as a useful measure in assessing impact of alcohol use disorders (AUD) on health-related quality of life (HR-QoL) in Western cultures. We aimed to assess the psychometric properties of the Japanese version of the AQoLS (AQoLS-Japan).
Methods
This was a 3-month, observational cohort study in patients undergoing routine treatment for AUD in Japan. HR-QoL was assessed using the AQoLS-Japan (34 items, 7 dimensions). Scale psychometrics were analyzed using correlative techniques.
Results
Data from 132 patients were analyzed. Inter-item and item-scale correlations for the AQoLS-Japan scale were moderate to strong. Confirmatory factor analysis results supported the AQoLS-Japan structure but there was evidence of interdependency among some items and factors. Cronbach’s alpha coefficients for internal consistency ranged from 0.73 to 0.97, and intraclass correlation coefficients for scores between test (baseline) and retest (2 weeks) ranged from 0.65 to 0.82. Convergent and divergent validity and known-groups validity were supported. Evaluation of within-group change demonstrated that the AQoLS-Japan total and domains consistently demonstrated statistically significant improvement (p < 0.001 in all cases) in HR-QoL over time. Estimates for minimal clinically important difference on the AQoLS-Japan total score ranged from 13.2 to 18.2 for group-level change and from 2.4 to 15.7 for a group-level difference.
Conclusions
The AQoLS-Japan is a reliable and valid measure of HR-QoL that is able to demonstrate benefits associated with the routine treatment of AUD in Japan.
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93
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Measuring Pelvic Floor Disorder Symptoms Using Patient-Reported Instruments: Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the International Continence Society, the American Urogynecologic Society, and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. Dis Colon Rectum 2020; 63:6-23. [PMID: 31804265 DOI: 10.1097/dcr.0000000000001529] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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94
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Liu J, Legg JC, Mo M, Zhang X. Considerations in testing treatment effects on transient event driven health status changes measured by patient reported outcomes. Stat Med 2019; 38:5497-5511. [PMID: 31631355 DOI: 10.1002/sim.8376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/28/2019] [Indexed: 11/10/2022]
Abstract
Many treatments and drugs are intended to reduce the occurrence of negative events of interest, control the severity of the events, accelerate recovery from the events, or a combination of these effects. While assessing the clinical effect is typically the primary objective of a trial, testing the treatment effect on the health status of patients based on patient reported outcome (PRO) can be a useful component in determining the value of a treatment. Analysis of PROs in this setting, however, face the following challenges: the PRO value immediately after the event occurrence is often not captured, and the effect of the event on health status measured by the PRO is transient as subjects recover over time. Therefore, traditional statistical methods used to assess treatment effects suffer from low power for PROs. In this manuscript, we apply a kernel smoothing technique to estimate before- and after-event PRO values. We also propose new test outcomes based on observed and estimated PRO values and evaluate tests that focus on the tail distributions. We demonstrate that the tail distribution tests using the new outcomes can achieve high power under certain conditions.
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Affiliation(s)
- Jingyuan Liu
- MOE Key Laboratory of Econometrics, Department of Statistics, School of Economics, Wang Yanan Institute for Studies in Economics and Fujian Key Laboratory of Statistical Science, Xiamen University, Xiamen, China
| | - Jason C Legg
- Global Biostatistical Science, Amgen, Newbury Park, California
| | - May Mo
- Global Biostatistical Science, Amgen, Newbury Park, California
| | - Xuwen Zhang
- MOE Key Laboratory of Econometrics, Department of Statistics, School of Economics, Wang Yanan Institute for Studies in Economics and Fujian Key Laboratory of Statistical Science, Xiamen University, Xiamen, China
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95
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Measuring Pelvic Floor Disorder Symptoms Using Patient-Reported Instruments: Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the International Continence Society, the American Urogynecologic Society, and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. Female Pelvic Med Reconstr Surg 2019; 26:1-15. [PMID: 31833996 DOI: 10.1097/spv.0000000000000817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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96
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Bordeianou LG, Anger J, Boutros M, Birnbaum E, Carmichael JC, Connell K, De EJB, Mellgren A, Staller K, Vogler SA, Weinstein MM, Yafi FA, Hull T. Measuring pelvic floor disorder symptoms using patient-reported instruments: proceedings of the consensus meeting of the pelvic floor consortium of the American Society of Colon and Rectal Surgeons, the International Continence Society, the American Urogynecologic Society, and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. Tech Coloproctol 2019; 24:5-22. [DOI: 10.1007/s10151-019-02125-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 12/17/2022]
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97
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Devillier P, Brüning H, Bergmann K. Determination of the minimally important difference in a nasal symptom score in house dust mite allergy. Allergy 2019; 74:2191-2198. [PMID: 31124151 DOI: 10.1111/all.13925] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND House dust mite (HDM) allergens are responsible for the most prevalent persistent respiratory allergies. Clinical trials in this field often use a four-component nasal symptom score (T4NSS) as a measure of efficacy. METHODS The present observational, prospective, multinational, multicenter study determined the minimal important difference (MID) for a T4NSS in children, adolescents, and adults with physician-diagnosed HDM-induced allergic rhinoconjunctivitis (AR). Patients rated the T4NSS daily, a 15-point global rating of change scale (GRCS) and the Rhinoconjunctivitis Quality of Life Questionnaire weekly. The MID was determined primarily by using a regression method with a GRCS threshold of 2. RESULTS A total of 546 patients (210 adults, 133 adolescents, and 203 children) were included; 92.6% of the patients had moderate-to-severe AR, and 30.1% had concomitant mild asthma. During the first week, the mean ± standard deviation T4NSS was 5.68 ± 2.76 in adults, 5.34 ± 2.66 in adolescents, and 5.07 ± 2.48 in children. In a GRCS regression analysis, the MID [95% confidence interval] for the T4NSS was -0.90 [-1.06;-0.75] overall (n = 509), -0.94 [-1.19;-0.69] in children (n = 187), -0.74 [-1.07;-0.41] in adolescents (n = 125), and -1.04 [-1.29;-0.79] in adults (n = 197). The MID did not differ greatly from one disease severity tertile to another. Confirmatory distribution-based analyses yielded overall MID values of -0.87 for the first week of the study and -0.93 for the week 2-week 1 difference. CONCLUSION The MID for improvement in the T4NSS is at least -0.90 units in children, adolescents, and adults suffering from HDM-induced AR This value could be rounded up to -1 unit for convenience.
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Affiliation(s)
- Philippe Devillier
- UPRES EA220, Foch Hospital University Versailles Saint‐Quentin, University Paris‐Saclay Suresnes France
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Gray AJ, Huston M, Didericksen D, Meyer TK, Merati A, Brisebois S. The minimal clinically important difference of the dyspnea index in laryngotracheal stenosis. Laryngoscope 2019; 130:1775-1779. [PMID: 31593339 DOI: 10.1002/lary.28331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/12/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The Dyspnea Index (DI) is a validated patient-reported outcome (PRO) instrument that has been used in the management of laryngotracheal stenosis (LTS). The minimal clinically important difference (MCID) is an established concept to help determine the change in a PRO instrument that reflects meaningful change for the patient. It is not known what change in the DI is of clinical significance in airway surgery. This study aims to determine the MCID for the DI in patients undergoing surgical treatment for LTS. METHODS This is a prospective cohort study in which 26 patients with LTS completed the DI (score range 0 to 40) before and 6 to 8 weeks postoperatively, in addition to a Global Ratings Change Questionnaire (GRCQ), scored from -7 to +7, at the postoperative interval. A hypothesis test was carried out to test the association between GRCQ and change in DI. The MCID for change in DI was determined using anchor-based analysis. RESULTS Overall mean change in DI was -11, and mean change in GRCQ was +5. Change in DI scores were significantly different among the improvement and no improvement groups (P value <0.002). Area under the receiver operating curve was 0.92, demonstrating high discriminatory ability of the change in DI score. A change of -4 was determined to be the threshold that discriminated between significant improvement and no improvement. CONCLUSION A decrease of 4 in the DI can be considered as the MCID for patients with LTS after surgical treatment. LEVEL OF EVIDENCE 2b Laryngoscope, 130:1775-1779, 2020.
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Affiliation(s)
- Alan J Gray
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Molly Huston
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Devin Didericksen
- Department of Statistics, University of Washington, Seattle, Washington, U.S.A
| | - Tanya K Meyer
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Albert Merati
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Simon Brisebois
- Department of Surgery, Otolaryngology-Head and Neck Division, University of Sherbrooke, Sherbrooke, Quebec, Canada
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Patients With Nonalcoholic Steatohepatitis Experience Severe Impairment of Health-Related Quality of Life. Am J Gastroenterol 2019; 114:1636-1641. [PMID: 31464743 DOI: 10.14309/ajg.0000000000000375] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Although there is substantial evidence suggesting poor health-related quality of life (HRQL) in patients with chronic hepatitis C (CHC), similar data in nonalcoholic steatohepatitis (NASH) have not been fully assessed. The aim is to compare HRQL scores in patients with CHC to those with NASH. METHODS Matched patients with advanced fibrosis (bridging fibrosis and compensated cirrhosis) due to CHC and NASH completed Short Form-36 (SF-36) questionnaire, Chronic Liver Disease Questionnaire (CLDQ), and Work Productivity and Activity Instrument questionnaire. RESULTS We included 1,338 patients with NASH with advanced fibrosis (mean age 57.2 years, 47% men, 55% cirrhosis) and 1,338 matched patients with CHC. Patients with CHC and NASH had similar rates of employment and psychiatric disorders (P > 0.05). As expected, patients with NASH had higher body mass index (mean 33.7 vs 27.6) and more type 2 diabetes (74% vs 16%) (all P < 0.01). Patients with NASH had significantly lower HRQL scores related to physical health: Physical Functioning, Bodily Pain, General Health, Vitality, Physical Summary of SF-36, and Fatigue of CLDQ (P < 0.02). By contrast, patients with CHC had a lower Mental Health score of SF-36 and Emotional score of CLDQ and reported greater impairment in daily activities as measured by the Work Productivity and Activity Instrument questionnaire (P < 0.002). In multivariate analysis, after adjustment for demographic parameters, cirrhosis, and history of psychiatric disorders, having NASH was associated with lower physical HRQL scores and higher mental health-related scores (P < 0.05). DISCUSSION Patients with NASH and advanced fibrosis have more impairment of their physical health-related scores than patients with CHC with advanced fibrosis. These data should dispel the misconception that NASH is an asymptomatic disease with little negative impact on patients' well-being.
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A systematic review of estimates of the minimal clinically important difference and patient acceptable symptom state of the Western Ontario and McMaster Universities Osteoarthritis Index in patients who underwent total hip and total knee replacement. Osteoarthritis Cartilage 2019; 27:1408-1419. [PMID: 31096046 DOI: 10.1016/j.joca.2019.05.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/01/2019] [Accepted: 05/01/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To systematically review the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) estimates in pain and function measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in patients who underwent primary total knee replacement (TKR) and primary total hip replacement (THR). DESIGN The study was carried out following PRISMA recommendations. We searched five electronic databases. Two reviewers independently screened titles, abstracts and full-text papers using a priori inclusion/exclusion criteria. Data were extracted by two independent reviewers. Data were synthesized, with WOMAC values converted to 0-100 scores (0 = best, 100 = worst). RESULTS Thirteen studies were included. Research methods used to calculate MCIDs and PASS varied across studies (e.g., using anchor-based or distribution methods, wording of anchor questions within anchor-based methods). Baseline WOMAC scores also varied across studies. Across studies and methods, MCIDs for the WOMAC in patients undergoing TKR ranged from 13.3 to 36.0 for pain and 1.8-33.0 for function; values for WOMAC in THR ranged from 8.3 to 41.0 for pain and from 9.7 to 34.0 for function. PASS cut-offs for TKR ranged from 25.0 to 28.6 for pain and 32.3-36.7 for function, and cut-offs for THR from 15.0 to 30.6 for pain and 28.0-42.0 for function. CONCLUSION Although the WOMAC is a commonly used measure for a single condition, the variability in methods used to calculate MCID and PASS estimates results in a range of values across studies making it unclear whether values reported in the literature can be applied with confidence. Future research is needed to refine methods used to calculate MCIDs and PASS.
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