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Merker VL, Thompson HL, Wolters PL, Buono FD, Hingtgen CM, Rosser T, Barton B, Barnett C, Smith T, Haberkamp D, McManus ML, Baldwin A, Moss IP, Röhl C, Martin S. Recommendations for assessing appearance concerns related to plexiform and cutaneous neurofibromas in neurofibromatosis 1 clinical trials. Clin Trials 2024; 21:6-17. [PMID: 38140900 PMCID: PMC10922038 DOI: 10.1177/17407745231205577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
BACKGROUND/AIMS Individuals with neurofibromatosis 1 may experience changes in their appearance due to physical manifestations of the disorders and/or treatment sequelae. Appearance concerns related to these physical changes can lead to psychological distress and poorer quality of life. While many neurofibromatosis 1 clinical trials focus on assessing changes in tumor volume, evaluating patients' perspectives on corresponding changes in symptoms such as physical appearance can be key secondary outcomes. We aimed to determine whether any existing patient-reported outcome measures are appropriate for evaluating changes in appearance concerns within neurofibromatosis 1 clinical trials. METHODS After updating our previously published systematic review process, we used it to identify and rate existing patient-reported outcome measures related to disfigurement and appearance. Using a systematic literature search and initial triage process, we focused on identifying patient-reported outcome measures that could be used to evaluate changes in appearance concerns in plexiform or cutaneous neurofibroma clinical trials in neurofibromatosis 1. Our revised Patient-Reported Outcome Rating and Acceptance Tool for Endpoints then was used to evaluate each published patient-reported outcome measures in five domains, including (1) respondent characteristics, (2) content validity, (3) scoring format and interpretability, (4) psychometric data, and (5) feasibility. The highest-rated patient-reported outcome measures were then re-reviewed in a side-by-side comparison to generate a final consensus recommendation. RESULTS Eleven measures assessing appearance concerns were reviewed and rated; no measures were explicitly designed to assess appearance concerns related to neurofibromatosis 1. The FACE-Q Craniofacial Module-Appearance Distress scale was the top-rated measure for potential use in neurofibromatosis 1 clinical trials. Strengths of the measure included that it was rigorously developed, included individuals with neurofibromatosis 1 in the validation sample, was applicable to children and adults, covered item topics deemed important by neurofibromatosis 1 patient representatives, exhibited good psychometric properties, and was feasible for use in neurofibromatosis 1 trials. Limitations included a lack of validation in older adults, no published information regarding sensitivity to change in clinical trials, and limited availability in languages other than English. CONCLUSION The Response Evaluation in Neurofibromatosis and Schwannomatosis patient-reported outcome working group currently recommends the FACE-Q Craniofacial Module Appearance Distress scale to evaluate patient-reported changes in appearance concerns in clinical trials for neurofibromatosis 1-related plexiform or cutaneous neurofibromas. Additional research is needed to validate this measure in people with neurofibromatosis 1, including older adults and those with tumors in various body locations, and explore the effects of nontumor manifestations on appearance concerns in people with neurofibromatosis 1 and schwannomatosis.
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Affiliation(s)
- Vanessa L Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Heather L Thompson
- Department of Communication Sciences and Disorders, California State University, Sacramento, Sacramento, CA, USA
| | - Pamela L Wolters
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Frank D Buono
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Tena Rosser
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Belinda Barton
- Faculty of Health, Discipline of Psychology, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Carolina Barnett
- Division of Neurology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Taylor Smith
- Department of Psychology and Child Development, California Polytechnic State University, San Luis Obispo, CA, USA
| | | | | | - Andrea Baldwin
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | | | - Claas Röhl
- NF Kinder, NF Patients United, Vienna, Austria
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
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2
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Ruffolo AF, Serati M, Casiraghi A, Benini V, Scancarello C, Di Dedda MC, Garbagnati C, Braga A, Candiani M, Salvatore S. The Impact of Systemic Sclerosis on Sexual Health: An Italian Survey. Healthcare (Basel) 2023; 11:2346. [PMID: 37628543 PMCID: PMC10454073 DOI: 10.3390/healthcare11162346] [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: 06/09/2023] [Revised: 08/05/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE To evaluate the impact of systemic sclerosis (SSc) on vulvovaginal atrophy (VVA) and sexual health in an Italian population. METHODS An Italian survey about the prevalence and severity of VVA (on a 0 to 10 scale) and sexual dysfunction (using the Female Sexual Function Index-FSFI) through an anonymous online questionnaire. We investigated couple relationships and intimacy with partners, the predisposition of patients to talk about their sexual problems, physicians' receptivity, and treatment scenarios. Risk factors for VVA symptoms and sexual dysfunction were assessed. RESULTS A total of 107 women affected by SSc were enrolled. Of these, 83.2% of women (89/107) complained about VVA symptoms and 89.7% (among sexually active women; 87/97) about sexual dysfunction. Menopausal status did not affect VVA symptoms, while age was the only independent risk factor for sexual dysfunction. About 70% (74/107) of women reported a negative impact of disturbances on intimacy with their partner. A total of 63 women (58.9%) had never discussed their sexual problems and VVA condition with a physician. Lubricants were the only treatment prescribed, and 75% of women would welcome new therapies, even if experimental (62.9%). CONCLUSIONS In women with SSc, VVA symptoms and sexual dysfunction are highly prevalent, independently from menopause. In more than half of the investigated women with SSc, we found reluctance to talk about their sexual problems, despite being symptomatic. This should encourage physicians to investigate vulvovaginal and sexual health. SSc patients would welcome the advent of new treatment possibilities for their VVA and sexual complaints.
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Affiliation(s)
- Alessandro Ferdinando Ruffolo
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (A.C.); (V.B.); (M.C.); (S.S.)
- Gynecological Department, Jeanne de Flandre Hospital, University Hospital of Lille, Avenue Eugène Avinée, 59037 Lille, France
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy;
| | - Arianna Casiraghi
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (A.C.); (V.B.); (M.C.); (S.S.)
| | - Vittoria Benini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (A.C.); (V.B.); (M.C.); (S.S.)
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy;
| | - Maria Carmela Di Dedda
- Department of Obstetrics and Gynecology, ASST FBF-SACCO Macedonio Melloni Hospital, 20129 Milan, Italy;
| | - Carla Garbagnati
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Via Commenda 12, 20122 Milan, Italy;
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland;
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (A.C.); (V.B.); (M.C.); (S.S.)
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (A.C.); (V.B.); (M.C.); (S.S.)
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3
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Mattsson M, Hesselstrand R, Gunnarsson K, Dyrsmeds E, Holmner M, Nordin A, Boström C. The validity and reliability of the Swedish version of the Satisfaction with appearance scale for individuals with systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2023; 8:53-63. [PMID: 36743814 PMCID: PMC9896191 DOI: 10.1177/23971983221107858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022]
Abstract
Background Systemic sclerosis (SSc) can lead to visible changes in appearance which could generate concerns among patients. Thus, valid questionnaires that capture these concerns are valuable to identify and communicate appearance concerns. Objective To determine aspects of the validity and reliability of the Swedish version of the Satisfaction with Appearance scale for individuals with SSc (SWAP-Swe in SSc). Methods Content validity was assessed by interviews. In a cross-sectional design, construct validity was evaluated by comparing the self-reported questionnaire SWAP-Swe in SSc to the Scleroderma Health Assessment Questionnaire (SSc HAQ), Patient Health Questionnaire-8 (PHQ-8), RAND-36, modified Rodnan skin score (mRSS), disease duration and age using Spearman's rank correlations (rs ). Internal consistency was evaluated by Cronbach's alpha coefficient and corrected item-to-total correlations. Test-retest reliability was investigated using the intraclass correlation coefficient (ICC). Results Eleven patients and 10 health professionals participated in the assessment of content validity. For the other aspects of validity and reliability 134 patients (median age 62 years, women 81%, limited cutaneous SSc 75%) participated. Overall, the content validity was satisfactory. The SWAP-Swe in SSc correlated with SSc HAQ (HAQ-DI rs = 0.50, visual analogue scales rs = 0.24-0.41), PHQ-8 (rs = 0.46), RAND-36 (rs = -0.21 to -0.47), mRSS (rs = 0.28), disease duration (rs = -0.01) and age (rs = -0.15). The Cronbach's alpha coefficient was 0.92, corrected item-to-total correlations ⩾ 0.45 and the ICC 0.82. Conclusion The SWAP-Swe in SSc showed satisfactory content validity, sufficient and good internal consistency and sufficient test-retest reliability. It was more strongly associated with self-reported questionnaires than with physician-assessed skin involvement and age, indicating that appearance concerns in SSc seem to be multidimensional as earlier reported. Our study contributes with a thorough investigation of validity and reliability including aspects that have not been investigated before. However, evaluation of more validity aspects of the SWAP-Swe in SSc is suggested.
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Affiliation(s)
- Malin Mattsson
- Department of Neurobiology, Care
Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Physiotherapy, Sunderby
Hospital, Luleå, Sweden
- Malin Mattsson, Department of
Physiotherapy, Sunderby Hospital, 971 80 Luleå, Sweden.
| | - Roger Hesselstrand
- Department of Clinical Sciences, Lund
University, Lund, Sweden
- Department of Rheumatology, Skåne
University Hospital, Lund, Sweden
| | - Karin Gunnarsson
- Division of Rheumatology, Department of
Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm,
Sweden
| | - Elisabet Dyrsmeds
- Division of Rheumatology, Karolinska
University Hospital, Stockholm, Sweden
| | - Monica Holmner
- The Swedish Rheumatism Association
National Association for Systemic Sclerosis, Stockholm, Sweden
| | - Annica Nordin
- Division of Rheumatology, Department of
Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm,
Sweden
| | - Carina Boström
- Department of Neurobiology, Care
Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women’s Health and Health Professionals
Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University
Hospital, Stockholm, Sweden
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4
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Chang TYJ, Pope JE. An Update of Outcome Measures in Systemic Sclerosis. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:110-133. [PMID: 33091259 DOI: 10.1002/acr.24258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 01/17/2023]
Affiliation(s)
| | - Janet E Pope
- University of Western Ontario and St. Joseph's Health Care London, London, Ontario, Canada
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Doutre MS, Godard D, Benani M, Taieb C. Création et validation d’un outil d’évaluation du handicap lié à l’atteinte du visage de la sclérodermie systémique. Ann Dermatol Venereol 2020; 147:595-601. [DOI: 10.1016/j.annder.2020.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 04/01/2020] [Accepted: 04/16/2020] [Indexed: 11/30/2022]
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Sibeoni J, Verneuil L, Manolios E, Révah-Levy A. A specific method for qualitative medical research: the IPSE (Inductive Process to analyze the Structure of lived Experience) approach. BMC Med Res Methodol 2020; 20:216. [PMID: 32847514 PMCID: PMC7449004 DOI: 10.1186/s12874-020-01099-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This paper reports the construction and use of a specific method for qualitative medical research: The Inductive Process to Analyze the Structure of lived Experience (IPSE), an inductive and phenomenological approach designed to gain the closest access possible to the patients' experience and to produce concrete recommendations for improving care. This paper describes this innovative method. METHODS IPSE has five steps: 1) set up a research group, 2) ensure the originality of the research, 3) organize recruitment and sampling intended to optimize exemplarity, 4) collect data that enable entry into the subjects' experience, and 5) analyze the data. This final stage is composed of one individual descriptive phase, followed by two group phases: i) structure the experience, and ii) translate the findings into concrete proposals that make a difference in care. RESULTS This innovative method has provided original findings that have opened up new avenues of research and have important practical implications, including (1) the development of patient-reported outcomes, (2) clinical recommendations concerning assessment and treatment, (3) innovative ways to improve communication between patients and doctors, and (4) new insights for medical pedagogy. CONCLUSIONS IPSE is a qualitative method specifically developed for clinical medical research to reach concrete proposals, easily combined with quantitative research within a mixed-method study design and then directly integrated within evidence-based medicine.
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Affiliation(s)
- Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, 69 Rue du Lieutenant Colonel Prud'hon, 95107 ARGENTEUIL Cedex, France. .,ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France.
| | - Laurence Verneuil
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France
| | - Emilie Manolios
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France.,Service de Psychologie et Psychiatrie de Liaison et d'Urgences, Hôpital Européen Georges Pompidou AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France
| | - Anne Révah-Levy
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, 69 Rue du Lieutenant Colonel Prud'hon, 95107 ARGENTEUIL Cedex, France.,ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France
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7
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Fox RS, Mills SD, Gholizadeh S, Merz EL, Roesch SC, Clements PJ, Kafaja S, Khanna D, Furst DE, Malcarne VL. Validity and correlates of the Brief Satisfaction With Appearance Scale for patients with limited and diffuse systemic sclerosis: Analysis from the University of California, Los Angeles Scleroderma Quality of Life Study. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2020; 5:143-151. [PMID: 35382027 DOI: 10.1177/2397198319890813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/14/2019] [Indexed: 11/16/2022]
Abstract
Objective The Brief Satisfaction With Appearance Scale measures two dimensions (Dissatisfaction with Appearance and Social Discomfort) of body image dissatisfaction in systemic sclerosis. This study examined the structural validity of the Brief Satisfaction With Appearance Scale across limited and diffuse systemic sclerosis subtypes, compared body image dissatisfaction by systemic sclerosis subtype, and identified the significant sociodemographic and medical correlates of body image dissatisfaction and whether they differed by subtype. Methods Participants were 183 adults participating in the University of California, Los Angeles Scleroderma Quality of Life Study with limited cutaneous (n = 101) or diffuse cutaneous (n = 82) systemic sclerosis who received clinical examinations and completed questionnaires. Multiple-group confirmatory factor analysis, multivariate analysis of variance, and structural equation modeling were used. Results The Brief Satisfaction With Appearance Scale's two-factor structure fit well for both subtypes. Patients with diffuse systemic sclerosis reported greater body image dissatisfaction on both factors than patients with limited disease. Greater Dissatisfaction with Appearance was associated with younger age and being unmarried for limited patients, and with younger age and increased finger/hand skin involvement for diffuse patients. Greater Social Discomfort was associated with younger age and being unmarried for both subtypes. Conclusion The Brief Satisfaction With Appearance Scale scores can be meaningfully compared across limited and diffuse systemic sclerosis. Patients with diffuse disease reported more body image dissatisfaction than those with limited disease. Findings demonstrate that both medical and sociodemographic variables are associated with body image dissatisfaction in systemic sclerosis and can be used to identify which patients may be at increased risk for body image dissatisfaction.
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Affiliation(s)
- Rina S Fox
- San Diego State University / University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah D Mills
- San Diego State University / University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Durham, NC, USA
| | - Shadi Gholizadeh
- San Diego State University / University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Erin L Merz
- Department of Psychology, California State University, Dominguez Hills, Carson, CA, USA
| | - Scott C Roesch
- San Diego State University / University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Philip J Clements
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Suzanne Kafaja
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel E Furst
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Vanessa L Malcarne
- San Diego State University / University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
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8
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Pauling JD, Caetano J, Campochiaro C, De Luca G, Gheorghiu AM, Lazzaroni MG, Khanna D. Patient-reported outcome instruments in clinical trials of systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2020; 5:90-102. [PMID: 35382020 PMCID: PMC8922614 DOI: 10.1177/2397198319886496] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/04/2019] [Indexed: 09/01/2023]
Abstract
Patient-reported outcome instruments provide valuable insight into disease-related morbidity known only to the patient and complement more objective outcome tools in the clinical trial setting. They are of particular importance in systemic sclerosis owing to the challenges around defining disease activity, the episodic nature of many disease-specific manifestations and the paucity of validated objective surrogate outcome measures for use in clinical trials. Early clinical trials of systemic sclerosis often incorporated legacy patient-reported outcome instruments, but the last 20 years has witnessed the emergence of several scleroderma-specific instruments that are now being routinely used alongside other outcomes in systemic sclerosis clinical trials. More recently, the value of patient-reported outcomes has been highlighted by their prominence in the American College of Rheumatology Combined Response Index for Systemic Sclerosis that has been utilized as the primary endpoint of recent clinical trials of early diffuse systemic sclerosis. This review considers the role and performance of the various patient-reported outcome instruments utilized in systemic sclerosis clinical trials, the current positioning of patient-reported outcome instruments within clinical trial endpoint models across the range of systemic sclerosis disease manifestations and, where applicable, we shall highlight areas for future research.
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Affiliation(s)
- John D Pauling
- Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
| | - Joana Caetano
- Systemic Immune-Mediated Diseases Unit, Department of Medicine IV, Fernando Fonseca Hospital, Amadora, Portugal
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ana Maria Gheorghiu
- Internal Medicine and Rheumatology, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Maria Grazia Lazzaroni
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Dinesh Khanna
- Scleroderma Program, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
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9
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Kleinstäuber M, Wolf L, Jones ASK, Dalbeth N, Petrie KJ. Internalized and Anticipated Stigmatization in Patients With Gout. ACR Open Rheumatol 2020; 2:11-17. [PMID: 31943969 PMCID: PMC6957912 DOI: 10.1002/acr2.11095] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/25/2019] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate the relationship between stigma perception and demographic, clinical, and psychosocial variables. Methods A sample of 50 patients with gout and prescribed urate‐lowering medication (84% were males, mean serum urate 0.34 mmol/l) completed questionnaires on internalized and anticipated stigma, demographics, clinical gout‐related variables, and psychosocial variables (illness perceptions, illness‐related disability, illness‐related body satisfaction, intentional nonadherence). Serum urate level was obtained from the most recent blood test. Results In this sample, 26% experienced internalized stigma, 26% expected to be stigmatized by friends or family members, and 14% by health care workers. Univariate regression analyses showed that younger age, ethnicity other than New Zealand European, increased severity of gout pain, cognitive and emotional illness perceptions, greater illness‐related disability, and increased intentional nonadherence to urate‐lowering medication were associated with increased internalized and anticipated stigma. Younger age, emotional illness response, and intentional nonadherence were the only variables explaining incremental variance of the experience of anticipated stigma in a multivariate regression model. Conclusion Internalized and anticipated illness‐related stigma was reported by a subgroup of patients with gout. The experience of stigma is associated with younger age, a negative emotional illness response, and intentions to not adhere with a medical treatment.
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Affiliation(s)
- Maria Kleinstäuber
- University of Otago, Dunedin, New Zealand, and Philipps-University, Marburg, Germany
| | | | | | - Nicola Dalbeth
- Auckland District Health Board, Auckland, New Zealand and University of Auckland, Auckland, New Zealand
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10
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Khedr EM, El Fetoh NA, Gamal RM, Elzohri MH, Azoz NMA, Furst DE. Evaluation of cognitive function in systemic sclerosis patients: a pilot study. Clin Rheumatol 2020; 39:1551-1559. [PMID: 31902028 DOI: 10.1007/s10067-019-04884-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate cognitive dysfunction in adult patients with systemic sclerosis (SSc) who had no known clinical neurological manifestations and to relate it with other disease severity parameters. METHODS In the present study, 20 SSc consecutive female patients, who met the 2013 American College of Rheumatology SSc criteria, were compared with 20 healthy age-, gender-, and educational status-matched volunteer hospital workers. Mean age and duration of illness were 41.8 ± 12.52 and 6.9 ± 5.4 years respectively. Mini-Mental State Examination (MMSE), Wechsler Adult Intelligence scale (WAIS-III), and P300 component of event-related potentials (ERPs) were used to evaluate cognitive function in SS subjectively and objectively respectively. RESULTS Sixty-five percent (13 out of 20) of SSc patients had MMSE score < 25, and cognitive impairment. Despite the lack of clinically apparent neurological manifestations, SSc patients had significantly low MMSE score, high Deterioration Index (DI), and prolonged P300 latency compared with that of the control group (P = 0.0001; 0.010 and 0.008 respectively). A significant positive association was found between (DI) and the Medsger severity vascular score (r = 0.518; P = 0.012).There were few differences between limited and diffuse SSc. CONCLUSIONS To our knowledge, few studies highlighted that subclinical cognitive impairment can occur in the course of SSc disease. Early diagnosis of cognitive impairment should be investigated either subjectively (using psychometrics tests as MMSE or WAIS-III) or objectively using P300 evoked related potentials. Medsger severity vascular score seems to be closely related to cognitive impairment.Key points• Cognitive impairment can be associated with Medsger Vascular severity score and the duration of illness.• Further larger studies will be needed to estimate the effect of disease activity on cognitive function, to further delineate the differences between limited and diffuse SSc in this area, and to understand the underlying pathophysiological mechanisms causing cognitive impairment in patients with SSc.• To investigate impaired cognitive function in patients with SSc, even in the absence of clinically apparent neurological and vascular disease.
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Affiliation(s)
- Eman M Khedr
- Neurology and Psychiatry Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Noha Abo El Fetoh
- Neurology and Psychiatry Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Rania M Gamal
- Rheumatology& Rehabilitation Department, Assiut University, Assiut, 71515, Egypt.
| | - Mona H Elzohri
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nashwa Mostafa A Azoz
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Daniel E Furst
- Division of Rheumatology, University of California in Los Angeles (Emeritus), Los Angeles, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Division of Rheumatology and Experimental Medicine, University of Florence, Florence, Italy
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11
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Mills SD, Kwakkenbos L, Carrier ME, Gholizadeh S, Fox RS, Jewett LR, Gottesman K, Roesch SC, Thombs BD, Malcarne VL. Validation of the Social Appearance Anxiety Scale in Patients With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Study. Arthritis Care Res (Hoboken) 2019; 70:1557-1562. [PMID: 29342510 DOI: 10.1002/acr.23514] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/09/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is an autoimmune disease that can cause disfiguring changes in appearance. This study examined the structural validity, internal consistency reliability, convergent validity, and measurement equivalence of the Social Appearance Anxiety Scale (SAAS) across SSc disease subtypes. METHODS Patients enrolled in the Scleroderma Patient-centered Intervention Network Cohort completed the SAAS and measures of appearance-related concerns and psychological distress. Confirmatory factor analysis (CFA) was used to examine the structural validity of the SAAS. Multiple-group CFA was used to determine whether SAAS scores can be compared across patients with limited and diffuse disease subtypes. Cronbach's alpha was used to examine internal consistency reliability. Correlations of SAAS scores with measures of body image dissatisfaction, fear of negative evaluation, social anxiety, and depression were used to examine convergent validity. SAAS scores were hypothesized to be positively associated with all convergent validity measures, with correlations significant and moderate to large in size. RESULTS A total of 938 patients with SSc were included. CFA supported a 1-factor structure (Comparative Fit Index 0.92, Standardized Root Mean Residual 0.04, and Root Mean Square Error of Approximation 0.08), and multiple-group CFA indicated that the scalar invariance model best fit the data. Internal consistency reliability was good in the total sample (α = 0.96) and in disease subgroups. Overall, evidence of convergent validity was found with measures of body image dissatisfaction, fear of negative evaluation, social anxiety, and depression. CONCLUSION The SAAS can be reliably and validly used to assess fear of appearance evaluation in patients with SSc, and SAAS scores can be meaningfully compared across disease subtypes.
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Affiliation(s)
- Sarah D Mills
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego
| | - Linda Kwakkenbos
- McGill University and Jewish General Hospital, Montreal, Quebec, Canada, and Radboud University, Nijmegen, The Netherlands
| | | | - Shadi Gholizadeh
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego
| | - Rina S Fox
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lisa R Jewett
- McGill University and Jewish General Hospital, Montreal, Quebec, Canada
| | - Karen Gottesman
- Scleroderma Foundation, Southern California Chapter, Los Angeles
| | - Scott C Roesch
- San Diego State University/ University of California San Diego Joint Doctoral Program in Clinical Psychology and San Diego State University, San Diego
| | - Brett D Thombs
- McGill University and Jewish General Hospital, Montreal, Quebec, Canada
| | - Vanessa L Malcarne
- San Diego State University/ University of California San Diego Joint Doctoral Program in Clinical Psychology and San Diego State University, San Diego
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Harel D, Mills SD, Kwakkenbos L, Carrier ME, Nielsen K, Portales A, Bartlett SJ, Malcarne VL, Thombs BD. Shortening patient-reported outcome measures through optimal test assembly: application to the Social Appearance Anxiety Scale in the Scleroderma Patient-centered Intervention Network Cohort. BMJ Open 2019; 9:e024010. [PMID: 30798308 PMCID: PMC6398718 DOI: 10.1136/bmjopen-2018-024010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The Social Appearance Anxiety Scale (SAAS) is a 16-item measure that assesses social anxiety in situations where appearance is evaluated. The objective was to use optimal test assembly (OTA) methods to develop and validate a short-form SAAS based on objective and reproducible criteria. DESIGN This study was a cross-sectional analysis of baseline data from adults enrolled in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort. SETTING Adults in the SPIN Cohort in the present study were enrolled at 28 centres in Canada, the USA and the UK. PARTICIPANTS The SAAS was administered to 926 adults with scleroderma. PRIMARY AND SECONDARY MEASURES The SAAS, Brief Fear of Negative Evaluation II (BFNE II), Brief Satisfaction with Appearance Scale (Brief-SWAP), Patient Health Questionnaire-8 (PHQ8) and Social Interaction Anxiety Scale-6 (SIAS-6) were collected, as well as demographic characteristics. RESULTS OTA methods identified a maximally informative shortened version for each possible form length between 1 and 15 items. The final shortened version was selected based on prespecified criteria for reliability, concurrent validity and statistically equivalent convergent validity with the BFNE II scale. A five-item short version was selected (SAAS-5). The SAAS-5 had a Cronbach's α of 0.95 and had high concurrent validity with the full-length form (r=0.97). The correlation of the SAAS-5 with the BFNE II was 0.66, which was statistically equivalent to that of the full-length form. Furthermore, the correlation of the SAAS-5 with the two subscales of the Brief-SWAP, and the SIAS-6, were statistically equivalent to that of the full-length form. CONCLUSIONS OTA was an efficient method for shortening the full-length SAAS to create the SAAS-5.
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Affiliation(s)
- Daphna Harel
- Applied Statistics, Social Science, Humanities, New York University, New York City, New York, USA
- PRIISM Applied Statistics Center, New York University, New York City, New York, USA
| | - Sarah D Mills
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, UK
| | - Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, The Netherlands
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Karen Nielsen
- Scleroderma Society of Ontario, Hamilton, Ontario, Canada
| | | | - Susan J Bartlett
- Department of Medicine, McGill University, Monteal, Quebec, Canada
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University, San Diego, California, USA
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
| | - Brett D Thombs
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Basta F, Margiotta DPE, Mazzuca C, Batani V, Dolcini G, Moras P, Vadacca M, Afeltra A. Factors related to alexithymia in patients with systemic sclerosis: a tight relationship with facial image dissatisfaction. Rheumatol Int 2018; 39:461-467. [PMID: 30498976 DOI: 10.1007/s00296-018-4214-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022]
Abstract
To assess clinical and psychosocial factors related to alexithymia in systemic sclerosis (SSc). We enrolled 40 consecutive SSc patients in a cross-sectional study evaluating alexithymia with Toronto Alexithymia scale (TAS-20). We measured Beck Depression inventory (BDI), Hamilton Anxiety rating scale (HAM-H), 36-Items Short-Form Healthy Survey (SF-36), Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue, Visual Analog Scale (VAS) pain, Pittsburgh Sleep Quality Index (PSQI), Satisfaction with Appearance Scale (SWAP), and Mouth Handicap in Systemic Sclerosis (MHISS). The prevalence of alexithymia was 42%. Alexithymic patients presented increased depressive (p = ≤ 0.001) and anxiety symptoms (p = ≤ 0.001), sleep disorders (p = 0.03), pain (p = 0.02), esthetic concerns (p = 0.03), disability in activities (p = 0.03) and reduced scores of SF-36 in mental components summary (MCS) (p = ≤ 0.001) and physical components summary (PCS) (p = 0.01). We found significant correlations with sleep disorders (r = 0.41, p = ≤ 0.001), BID (r = 0.35, p = 0.04), facial image dissatisfaction (r = 0.35, p = 0.04), mouth disability (r = 0.51, p = 0.005), depressive (r = 0.6, p = ≤ 0.001), and anxiety symptoms (r = 0.48, p = ≤ 0.001), fatigue (r = - 0.45 p = 0.005), SF-36 PCS (r = - 0.51, p = ≤ 0.001) and MCS (r = - 0.65, p = ≤ 0.001). In multiple linear regression analysis, SWAP facial was the only variable associated with TAS-20 [0.99 (0.48) p = 0.05]. Alexithymia correlates with several psychosocial factors but seems strongly related to facial image dissatisfaction.
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Affiliation(s)
- Fabio Basta
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio, 4, 00165, Rome, Italy.
| | - Domenico Paolo Emanuele Margiotta
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Carmen Mazzuca
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Veronica Batani
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Giulio Dolcini
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Patrizio Moras
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Marta Vadacca
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Antonella Afeltra
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
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Oser ML, Nizzi MC, Zinser JL, Turk M, Epstein R, Bueno E, Gitlin D, Pomahac B. Quality of Life and Psychosocial Functioning 2 Years Following Facial Transplantation. PSYCHOSOMATICS 2018; 59:591-600. [DOI: 10.1016/j.psym.2018.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/28/2022]
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Fox RS, Kwakkenbos L, Carrier M, Mills SD, Gholizadeh S, Jewett LR, Roesch SC, Merz EL, Assassi S, Furst DE, Gottesman K, Mayes MD, Thombs BD, Malcarne VL, Baron M, Bartlett SJ, Ells C, Hudson M, Jang Y, Körner A, Kafaja S, Hoogen F, Mouthon L, Nielson WR, Riggs R, Nielsen K, Wigley F, Boutron I, Maia AC, Leite C, El‐Baalbaki G, Ende C, Fligelstone K, Frech T, Godard D, Harel D, Impens A, Johnson SR, Kennedy AT, Khalidi N, Marra C, Pope J, Portales A, Luna D, Schouffoer AA, Levis B, Suarez‐Almazor ME, Welling J, Wong‐Rieger D, Agard C, Ikic A, Smets P, Roux S, Terrier B, Hij A, Berthier S, Rodriguez E, Chung L, Gill A, Domsic R, Wilcox P, Fortin PR, Spiera R, Granel‐Rey B, Grange C, Sobanski V, Herrick AL, Varga J, Jones N, Manning J, Martin T, Maurier F, Rivière S, Robinson D, Smith D, Steen V, Sutton E, Thorne C, Turner K. Reliability and Validity of Three Versions of the Brief Fear of Negative Evaluation Scale in Patients With Systemic Sclerosis: A Scleroderma Patient‐Centered Intervention Network Cohort Study. Arthritis Care Res (Hoboken) 2018; 70:1646-1652. [DOI: 10.1002/acr.23532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/30/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Rina S. Fox
- Northwestern University Feinberg School of Medicine, Chicago, Illinois and San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego
| | - Linda Kwakkenbos
- Lady Davis Institute for Medical Research, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada and Radboud University Nijmegen The Netherlands
| | - Marie‐Eve Carrier
- Lady Davis Institute for Medical Research Jewish General Hospital Montreal Quebec Canada
| | - Sarah D. Mills
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology San Diego
| | - Shadi Gholizadeh
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology San Diego
| | - Lisa R. Jewett
- Lady Davis Institute for Medical Research, Jewish General Hospital and McGill University Montreal Quebec Canada
| | - Scott C. Roesch
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology and San Diego State University San Diego
| | - Erin L. Merz
- California State University Dominguez Hills Carson
| | | | - Daniel E. Furst
- Geffen School of Medicine at the University of California Los Angeles
| | | | | | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital and McGill UniversityMontreal Quebec Canada
| | - Vanessa L. Malcarne
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology and San Diego State University San Diego
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16
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Merz EL, Kwakkenbos L, Carrier ME, Gholizadeh S, Mills SD, Fox RS, Jewett LR, Williamson H, Harcourt D, Assassi S, Furst DE, Gottesman K, Mayes MD, Moss TP, Thombs BD, Malcarne VL. Factor structure and convergent validity of the Derriford Appearance Scale-24 using standard scoring versus treating 'not applicable' responses as missing data: a Scleroderma Patient-centered Intervention Network (SPIN) cohort study. BMJ Open 2018; 8:e018641. [PMID: 29511009 PMCID: PMC5855329 DOI: 10.1136/bmjopen-2017-018641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Valid measures of appearance concern are needed in systemic sclerosis (SSc), a rare, disfiguring autoimmune disease. The Derriford Appearance Scale-24 (DAS-24) assesses appearance-related distress related to visible differences. There is uncertainty regarding its factor structure, possibly due to its scoring method. DESIGN Cross-sectional survey. SETTING Participants with SSc were recruited from 27 centres in Canada, the USA and the UK. Participants who self-identified as having visible differences were recruited from community and clinical settings in the UK. PARTICIPANTS Two samples were analysed (n=950 participants with SSc; n=1265 participants with visible differences). PRIMARY AND SECONDARY OUTCOME MEASURES The DAS-24 factor structure was evaluated using two scoring methods. Convergent validity was evaluated with measures of social interaction anxiety, depression, fear of negative evaluation, social discomfort and dissatisfaction with appearance. RESULTS When items marked by respondents as 'not applicable' were scored as 0, per standard DAS-24 scoring, a one-factor model fit poorly; when treated as missing data, the one-factor model fit well. Convergent validity analyses revealed strong correlations that were similar across scoring methods. CONCLUSIONS Treating 'not applicable' responses as missing improved the measurement model, but did not substantively influence practical inferences that can be drawn from DAS-24 scores. Indications of item redundancy and poorly performing items suggest that the DAS-24 could be improved and potentially shortened.
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Affiliation(s)
- Erin L Merz
- Department of Psychology, California State University, Dominguez Hills, Carson, California, USA
| | - Linda Kwakkenbos
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Behavioral Science Institute, Clinical Psychology, Radboud University, Nijmegen, The Netherlands
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Shadi Gholizadeh
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Sarah D Mills
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Rina S Fox
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lisa R Jewett
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Educational and Counseling Psychology, McGill University, Montreal, Quebec, Canada
| | - Heidi Williamson
- Centre for Appearance Research, Faculty of Health and Life Science, University of the West of England, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, Faculty of Health and Life Science, University of the West of England, Bristol, UK
| | - Shervin Assassi
- Department of Internal Medicine, Division of Rheumatology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Daniel E Furst
- Division of Rheumatology, Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | | | - Maureen D Mayes
- Department of Internal Medicine, Division of Rheumatology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Tim P Moss
- Centre for Appearance Research, Faculty of Health and Life Science, University of the West of England, Bristol, UK
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Department of Educational and Counseling Psychology, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Vanessa L Malcarne
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
- Department of Psychology, San Diego State University, San Diego, California, USA
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Validation of the Social Interaction Anxiety Scale in scleroderma: a Scleroderma Patient-centered Intervention Network Cohort study. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2017; 3:98-105. [DOI: 10.5301/jsrd.5000264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/24/2017] [Indexed: 11/20/2022]
Abstract
Introduction: Individuals with visible differences due to medical conditions, such as systemic sclerosis (SSc; scleroderma), have reported difficulty navigating social situations because of issues such as staring, invasive questions, and rude comments. Fears or anxiety linked to situations in which a person interacts with others is known as social interaction anxiety. However, there exists no validated measurement tool to examine social interaction anxiety in rheumatologic conditions. Methods: The present study examines the reliability (internal consistency) and validity (structural and convergent) of the Social Interaction Anxiety Scale-6 (SIAS-6) in a sample of 802 individuals with SSc, and compares these psychometric properties across limited and diffuse subtypes of the disease. Multi-group confirmatory factor analysis was used to examine the factor structure of the SIAS-6 in patients with both limited and diffuse SSc. Results: A one-factor structure was found to fit well for individuals with SSc with both limited and diffuse disease. The measure demonstrated strong internal consistency reliability and convergent validity with relevant measures in expected magnitudes and directions. Conclusions: The SIAS-6 is a psychometrically robust measure that can confidently be used in SSc populations to examine social interaction anxiety. Moreover, scores can meaningfully be compared between patients with limited and diffuse disease.
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Jewett LR, Kwakkenbos L, Hudson M, Baron M, Thombs BD. Assessment of English-French differential item functioning of the Satisfaction with Appearance Scale (SWAP) in systemic sclerosis. Body Image 2017; 22:97-102. [PMID: 28711486 DOI: 10.1016/j.bodyim.2017.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 06/09/2017] [Accepted: 06/16/2017] [Indexed: 11/30/2022]
Abstract
The Satisfaction with Appearance Scale (SWAP) has been used to assess body image distress among people with the rare and disfiguring disease systemic sclerosis (SSc); however, it has not been validated across different languages groups. The objective was to examine differential item functioning of the SWAP among 856 Canadian English- or French-speaking SSc patients. Confirmatory factor analysis was used to evaluate the SWAP two-factor structure (Dissatisfaction with Appearance and Social Discomfort). The Multiple-Indicator Multiple-Cause model was utilized to assess differential item functioning. Results revealed that the established two-factor model of the SWAP demonstrated relatively good fit. Statistically significant, but small-magnitude differential item functioning was found for three SWAP items based on language; however, the cumulative effect on SWAP scores was negligible. Findings provided empirical evidence that SWAP scores from Canadian English- and French-speaking patients can be compared and pooled without concern that measurement differences may substantially influence results.
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Affiliation(s)
- Lisa R Jewett
- Department of Educational and Counselling Psychology, McGill University and Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Linda Kwakkenbos
- Department of Psychiatry, McGill University and Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, the Netherlands.
| | - Marie Hudson
- Department of Medicine, McGill University and Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Murray Baron
- McGill University and Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Brett D Thombs
- Departments of Educational and Counselling Psychology; Psychiatry; Medicine; Epidemiology, Biostatistics, and Occupational Health; and Psychology, McGill University and Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
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19
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Jewett LR, Malcarne VL, Kwakkenbos L, Harcourt D, Rumsey N, Körner A, Steele RJ, Hudson M, Baron M, Haythornthwaite JA, Heinberg L, Wigley FM, Thombs BD. Development and Validation of the Body Concealment Scale for Scleroderma. Arthritis Care Res (Hoboken) 2017; 68:1158-65. [PMID: 26663624 DOI: 10.1002/acr.22819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 12/05/2015] [Accepted: 12/08/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Body concealment is a component of social avoidance among people with visible differences from disfiguring conditions, including systemic sclerosis (SSc). The study objective was to develop a measure of body concealment related to avoidance behaviors in SSc. METHODS Initial items for the Body Concealment Scale for Scleroderma (BCSS) were selected using item analysis in a development sample of 93 American SSc patients. The factor structure of the BCSS was evaluated in 742 Canadian patients with single-factor, 2-factor, and bifactor confirmatory factor analysis models. Convergent and divergent validity were assessed by comparing the BCSS total score with the Brief-Satisfaction with Appearance Scale (Brief-SWAP) and measures of depressive symptoms and pain. RESULTS A 2-factor model (Comparative Fit Index [CFI] 0.99, Tucker-Lewis Index [TLI] 0.98, Root Mean Square Error of Approximation [RMSEA] 0.08) fit substantially better than a 1-factor model (CFI 0.95, TLI 0.94, RMSEA 0.15) for the 9-item BCSS, but the Concealment with Clothing and Concealment of Hands factors were highly correlated (α = 0.79). The bifactor model (CFI 0.99, TLI 0.99, RMSEA 0.08) also fit well. In the bifactor model, the omega coefficient was high for the general factor (ω = 0.80), but low for the Concealment with Clothing (ω = 0.01) and Concealment of Hands (ω = 0.33) factors. The BCSS total score correlated more strongly with the Brief-SWAP Social Discomfort (r = 0.59) and Dissatisfaction with Appearance (r = 0.53) subscales than with measures of depressive symptoms and pain. CONCLUSION The BCSS sum score is a valid indicator of body concealment in SSc that extends the concepts of body concealment and avoidance beyond the realms of body shape and weight to concerns of individuals with visible differences from SSc.
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Affiliation(s)
- Lisa R Jewett
- McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Linda Kwakkenbos
- McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Annett Körner
- McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Russell J Steele
- McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marie Hudson
- McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Murray Baron
- McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Leslie Heinberg
- Bariatric and Metabolic Institute, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Brett D Thombs
- McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
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Validation of the Body Concealment Scale for Scleroderma (BCSS): Replication in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort. Body Image 2017; 20:99-106. [PMID: 28068643 DOI: 10.1016/j.bodyim.2016.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/23/2016] [Accepted: 11/25/2016] [Indexed: 11/21/2022]
Abstract
Body concealment is an important component of appearance distress for individuals with disfiguring conditions, including scleroderma. The objective was to replicate the validation study of the Body Concealment Scale for Scleroderma (BCSS) among 897 scleroderma patients. The factor structure of the BCSS was evaluated using confirmatory factor analysis and the Multiple-Indicator Multiple-Cause model examined differential item functioning of SWAP items for sex and age. Internal consistency reliability was assessed via Cronbach's alpha. Construct validity was assessed by comparing the BCSS with a measure of body image distress and measures of mental health and pain intensity. Results replicated the original validation study, where a bifactor model provided the best fit. The BCSS demonstrated strong internal consistency reliability and construct validity. Findings further support the BCSS as a valid measure of body concealment in scleroderma and provide new evidence that scores can be compared and combined across sexes and ages.
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21
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Levis AW, Harel D, Kwakkenbos L, Carrier ME, Mouthon L, Poiraudeau S, Bartlett SJ, Khanna D, Malcarne VL, Sauve M, van den Ende CHM, Poole JL, Schouffoer AA, Welling J, Thombs BD. Using Optimal Test Assembly Methods for Shortening Patient-Reported Outcome Measures: Development and Validation of the Cochin Hand Function Scale-6: A Scleroderma Patient-Centered Intervention Network Cohort Study. Arthritis Care Res (Hoboken) 2016; 68:1704-1713. [PMID: 27015290 DOI: 10.1002/acr.22893] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/14/2016] [Accepted: 03/22/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To develop and validate a short form of the Cochin Hand Function Scale (CHFS), which measures hand disability, for use in systemic sclerosis, using objective criteria and reproducible techniques. METHODS Responses on the 18-item CHFS were obtained from English-speaking patients enrolled in the Scleroderma Patient-Centered Intervention Network Cohort. CHFS unidimensionality was verified using confirmatory factor analysis, and an item response theory model was fit to CHFS items. Optimal test assembly (OTA) methods identified a maximally precise short form for each possible form length between 1 and 17 items. The final short form selected was the form with the least number of items that maintained statistically equivalent convergent validity, compared to the full-length CHFS, with the Health Assessment Questionnaire (HAQ) disability index (DI) and the physical function domain of the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29). RESULTS There were 601 patients included. A 6-item short form of the CHFS (CHFS-6) was selected. The CHFS-6 had a Cronbach's alpha of 0.93. Correlations of the CHFS-6 summed score with HAQ DI (r = 0.79) and PROMIS-29 physical function (r = -0.54) were statistically equivalent to the CHFS (r = 0.81 and r = -0.56). The correlation with the full CHFS was high (r = 0.98). CONCLUSION The OTA procedure generated a valid short form of the CHFS with minimal loss of information compared to the full-length form. The OTA method used was based on objective, prespecified criteria, but should be further studied for viability as a general procedure for shortening patient-reported outcome measures in health research.
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Affiliation(s)
- Alexander W Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada
| | | | - Linda Kwakkenbos
- Lady Davis Institute for Medical Research, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada, and Radboud University, Nijmegen, The Netherlands
| | | | - Luc Mouthon
- Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, and Hôpital Cochin, Paris, France
| | - Serge Poiraudeau
- Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, and IFR Handicap INSERM, Paris, France
| | | | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor
| | - Vanessa L Malcarne
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Maureen Sauve
- Scleroderma Society of Ontario, Hamilton, and Scleroderma Society of Canada, Ottawa, Ontario, Canada
| | | | | | | | - Joep Welling
- NVLE Dutch patient organization for systemic autoimmune diseases, Utrecht, The Netherlands
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada
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Bruni C, Raja J, Denton CP, Matucci-Cerinic M. The clinical relevance of sexual dysfunction in systemic sclerosis. Autoimmun Rev 2015; 14:1111-5. [PMID: 26235995 DOI: 10.1016/j.autrev.2015.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 07/24/2015] [Indexed: 12/18/2022]
Abstract
Systemic sclerosis is a chronic multi-organ autoimmune disease, leading to important clinical and psychological implications. Among organ complications, sexual dysfunction is a major issue for both male and female gender, with high prevalence and great impact on quality of life, although frequently not addressed by both clinicians and patients. While erectile dysfunction is the most common cause of sexual problems in males, genital tract and general physical changes are major contributors to sexual impairment in females. This review presents current state of the art on this topic, discussing published data on presentation, evaluation and therapeutic options.
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Affiliation(s)
- C Bruni
- Dept Clinical and Experimental Medicine, Div Rheumatology, AOU Careggi, Firenze, Italy.
| | - J Raja
- Division of Rheumatology, Department and Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Campus, London, United Kingdom
| | - C P Denton
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Campus, London, United Kingdom
| | - M Matucci-Cerinic
- Dept Clinical and Experimental Medicine, Div Rheumatology, AOU Careggi, Firenze, Italy
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Mills SD, Fox RS, Merz EL, Clements PJ, Kafaja S, Malcarne VL, Furst DE, Khanna D. Evaluation of the Satisfaction with Appearance Scale and Its Short Form in Systemic Sclerosis: Analysis from the UCLA Scleroderma Quality of Life Study. J Rheumatol 2015; 42:1624-30. [PMID: 26034157 DOI: 10.3899/jrheum.141482] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Changes in appearance are common in patients with systemic sclerosis (SSc) and can significantly affect well-being. The Satisfaction with Appearance Scale (SWAP) measures body image dissatisfaction in persons with visible disfigurement; the Brief-Satisfaction with Appearance Scale (Brief-SWAP) is its short form. The present study evaluated the reliability and validity of SWAP and Brief-SWAP scores in SSc. METHODS A sample of 207 patients with SSc participating in the University of California, Los Angeles Scleroderma Quality of Life Study completed the SWAP. Brief-SWAP scores were derived from the SWAP. The structural validity of both measures was investigated using confirmatory factor analysis. Internal consistency reliability of total and subscale scores was assessed with Cronbach's alpha coefficients. Convergent and divergent validity was evaluated using the Center for Epidemiological Studies Depression Scale, the Health Assessment Questionnaire-Disability Index, and the Medical Outcomes Study Short Form-36 questionnaire. RESULTS SWAP and Brief-SWAP total scores were highly correlated (r = 0.97). The 4-factor structure of the SWAP fit well descriptively; the 2-factor structure of the Brief-SWAP fit well descriptively and statistically. Internal consistencies for total and subscale scores were good, and results supported convergent and divergent validity. CONCLUSION Both versions are suitable for use in patients with SSc. The Brief-SWAP is most efficient; the full SWAP yields additional subscales that may be informative in understanding body image issues in patients with SSc.
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Affiliation(s)
- Sarah D Mills
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan
| | - Rina S Fox
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan
| | - Erin L Merz
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan
| | - Philip J Clements
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan
| | - Suzanne Kafaja
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan
| | - Vanessa L Malcarne
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan.
| | - Daniel E Furst
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan
| | - Dinesh Khanna
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan
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Abstract
Systemic sclerosis is a complex autoimmune disease characterized by a chronic and frequently progressive course and by extensive patient-to-patient variability. Like other autoimmune diseases, systemic sclerosis occurs more frequently in women, with a peak of onset in the fifth decade of life. The exact cause of systemic sclerosis remains elusive but is likely to involve environmental factors in a genetically primed individual. Pathogenesis is dominated by vascular changes; evidence of autoimmunity with distinct autoantibodies and activation of both innate and adaptive immunity; and fibrosis of the skin and visceral organs that results in irreversible scarring and organ failure. Intractable progression of vascular and fibrotic organ damage accounts for the chronic morbidity and high mortality. Early and accurate diagnosis and classification might improve patient outcomes. Screening strategies facilitate timely recognition of life-threatening complications and initiation of targeted therapies to halt their progression. Effective treatments of organ-based complications are now within reach. Discovery of biomarkers - including autoantibodies that identify patient subsets at high risk for particular disease complications or rapid progression - is a research priority. Understanding the key pathogenetic pathways, cell types and mediators underlying disease manifestations opens the door for the development of targeted therapies with true disease-modifying potential. For an illustrated summary of this Primer, visit: http://go.nature.com/lchkcA.
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Franzblau LE, Shauver MJ, Chung KC. Patient satisfaction and self-reported outcomes after complete brachial plexus avulsion injury. J Hand Surg Am 2014; 39:948-55.e4. [PMID: 24612838 DOI: 10.1016/j.jhsa.2014.01.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Reconstructive surgery for complete brachial plexus avulsion injuries only partially restores function, and many patients are dissatisfied with results that surgeons consider good. Preoperative expectations have been shown to influence postoperative satisfaction but are poorly understood in patients with complete brachial plexus avulsion injuries. Qualitative methodology can elucidate patient beliefs and attitudes, which are difficult to quantify. The purpose of this study was to examine patient-reported outcomes, including satisfaction, and to understand the patient perspective. METHODS We used qualitative interviews and questionnaires to assess patient-reported outcomes. Two members of the research team analyzed interview data using Grounded Theory methodology. Data from participants who had and did not have reconstructive surgery were compared. RESULTS Twelve patients participated in this study. Of the 7 participants who had reconstructive surgery, 4 felt their expectations had been met and 5 were satisfied with their outcomes. Reconstruction did not produce statistically significant improvements in upper extremity function, pain, or work ability. All patients reported dissatisfaction with upper extremity ability, and 9 expressed hope for innovative treatments (e.g., stem cell therapy, nerve reinsertion) that could potentially provide better outcomes than existing procedures and enable return to work. CONCLUSIONS Satisfaction with surgical outcomes after complete avulsion brachial plexus injury depends heavily on whether preoperative expectations are met, but patients are unfamiliar with nerve avulsion and do not always know what to expect. Low satisfaction with upper extremity ability and the lack of statistically significant differences produced by reconstruction suggest that current treatments may not be meeting patients' needs. Physicians must provide robust preoperative education to encourage realistic expectations and direct patients toward resources for pain management to facilitate comprehensive rehabilitation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Lauren E Franzblau
- Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Melissa J Shauver
- Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Kevin C Chung
- Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI.
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Franzblau L, Chung KC. Psychosocial outcomes and coping after complete avulsion traumatic brachial plexus injury. Disabil Rehabil 2014; 37:135-43. [DOI: 10.3109/09638288.2014.911971] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kwakkenbos L, Jewett LR, Baron M, Bartlett SJ, Furst D, Gottesman K, Khanna D, Malcarne VL, Mayes MD, Mouthon L, Poiraudeau S, Sauve M, Nielson WR, Poole JL, Assassi S, Boutron I, Ells C, van den Ende CHM, Hudson M, Impens A, Körner A, Leite C, Costa Maia A, Mendelson C, Pope J, Steele RJ, Suarez-Almazor ME, Ahmed S, Coronado-Montoya S, Delisle VC, Gholizadeh S, Jang Y, Levis B, Milette K, Mills SD, Razykov I, Fox RS, Thombs BD. The Scleroderma Patient-centered Intervention Network (SPIN) Cohort: protocol for a cohort multiple randomised controlled trial (cmRCT) design to support trials of psychosocial and rehabilitation interventions in a rare disease context. BMJ Open 2013; 3:bmjopen-2013-003563. [PMID: 23929922 PMCID: PMC3740254 DOI: 10.1136/bmjopen-2013-003563] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Psychosocial and rehabilitation interventions are increasingly used to attenuate disability and improve health-related quality of life (HRQL) in chronic diseases, but are typically not available for patients with rare diseases. Conducting rigorous, adequately powered trials of these interventions for patients with rare diseases is difficult. The Scleroderma Patient-centered Intervention Network (SPIN) is an international collaboration of patient organisations, clinicians and researchers. The aim of SPIN is to develop a research infrastructure to test accessible, low-cost self-guided online interventions to reduce disability and improve HRQL for people living with the rare disease systemic sclerosis (SSc or scleroderma). Once tested, effective interventions will be made accessible through patient organisations partnering with SPIN. METHODS AND ANALYSIS SPIN will employ the cohort multiple randomised controlled trial (cmRCT) design, in which patients consent to participate in a cohort for ongoing data collection. The aim is to recruit 1500-2000 patients from centres across the world within a period of 5 years (2013-2018). Eligible participants are persons ≥18 years of age with a diagnosis of SSc. In addition to baseline medical data, participants will complete patient-reported outcome measures every 3 months. Upon enrolment in the cohort, patients will consent to be contacted in the future to participate in intervention research and to allow their data to be used for comparison purposes for interventions tested with other cohort participants. Once interventions are developed, patients from the cohort will be randomly selected and offered interventions as part of pragmatic RCTs. Outcomes from patients offered interventions will be compared with outcomes from trial-eligible patients who are not offered the interventions. ETHICS AND DISSEMINATION The use of the cmRCT design, the development of self-guided online interventions and partnerships with patient organisations will allow SPIN to develop, rigourously test and effectively disseminate psychosocial and rehabilitation interventions for people with SSc.
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Affiliation(s)
- Linda Kwakkenbos
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychiatry, Montréal, Québec, Canada
| | - Lisa R Jewett
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Educational and Counselling Psychology, Montréal, Québec, Canada
| | - Murray Baron
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Dan Furst
- Division of Rheumatology, Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | - Karen Gottesman
- Southern California Chapter, Scleroderma Foundation, Los Angeles, California, USA
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, Michigan, USA
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University, San Diego, California, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Maureen D Mayes
- University of Texas Health Science Center Houston, Houston, Texas, USA
| | - Luc Mouthon
- Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Pôle de Médecine Interne, Hôpital Cochin, Paris, France
| | - Serge Poiraudeau
- Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Pôle Ostéo-articulaire, Hôpital Cochin, Paris, France
- IFR Handicap INSERM, Paris, France
| | - Maureen Sauve
- Scleroderma Societies of Canada and Ontario, Hamilton, Ontario, Canada
| | - Warren R Nielson
- Beryl & Richard Ivey Rheumatology Day Programs, St Joseph's Health Care, London, Ontario, Canada
| | - Janet L Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, New Mexico, USA
| | - Shervin Assassi
- University of Texas Health Science Center Houston, Houston, Texas, USA
| | | | - Carolyn Ells
- Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada
| | | | - Marie Hudson
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Ann Impens
- Internal Medicine, Midwestern University, Downers Grove, Illinois, USA
| | - Annett Körner
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Educational and Counselling Psychology, Montréal, Québec, Canada
- Department of Oncology, McGill University, Montréal, Québec, Canada
| | - Catarina Leite
- School of Psychology, University of Minho, Braga, Portugal
- Federation of European Scleroderma Associations, Froyennes, Belgium
| | | | - Cindy Mendelson
- College of Nursing, University of New Mexico, Albuquerque, New Mexico, USA
| | - Janet Pope
- Medicine, Division of Rheumatology, University of Western Ontario, St Joseph's Health Care, London, Ontario, Canada
| | - Russell J Steele
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Mathematics and Statistics, McGill University, Montréal, Québec, Canada
| | | | - Sara Ahmed
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- McGill University Health Center, Clinical Epidemiology Montréal, Montréal, Québec, Canada
| | | | - Vanessa C Delisle
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Educational and Counselling Psychology, Montréal, Québec, Canada
| | - Shadi Gholizadeh
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Yeona Jang
- Desautels Faculty of Management, McGill University, Montréal, Québec, Canada
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Katherine Milette
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Educational and Counselling Psychology, Montréal, Québec, Canada
| | - Sarah D Mills
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Ilya Razykov
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychiatry, Montréal, Québec, Canada
| | - Rina S Fox
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
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Sexual activity and impairment in women with systemic sclerosis compared to women from a general population sample. PLoS One 2012; 7:e52129. [PMID: 23251692 PMCID: PMC3522627 DOI: 10.1371/journal.pone.0052129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 11/12/2012] [Indexed: 11/19/2022] Open
Abstract
Objective Reports of low sexual activity rates and high impairment rates among women with chronic diseases have not included comparisons to general population data. The objective of this study was to compare sexual activity and impairment rates of women with systemic sclerosis (SSc) to general population data and to identify domains of sexual function driving impairment in SSc. Methods Canadian women with SSc were compared to women from a UK population sample. Sexual activity and, among sexually active women, sexual impairment were evaluated with a 9-item version of the Female Sexual Function Index (FSFI). Results Among women with SSc (mean age = 57.0 years), 296 of 730 (41%) were sexually active, 181 (61%) of whom were sexually impaired, resulting in 115 of 730 (16%) who were sexually active without impairment. In the UK population sample (mean age = 55.4 years), 956 of 1,498 women (64%) were sexually active, 420 (44%) of whom were impaired, with 536 of 1,498 (36%) sexually active without impairment. Adjusting for age and marital status, women with SSc were significantly less likely to be sexually active (OR = 0.34, 95%CI = 0.28–0.42) and, among sexually active women, significantly more likely to be sexually impaired (OR = 1.88, 95%CI = 1.42–2.49) than general population women. Controlling for total FSFI scores, women with SSc had significantly worse lubrication and pain scores than general population women. Conclusions Sexual functioning is a problem for many women with scleroderma and is associated with pain and poor lubrication. Evidence-based interventions to support sexual activity and function in women with SSc are needed.
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Jewett LR, Hudson M, Malcarne VL, Baron M, Thombs BD. Sociodemographic and disease correlates of body image distress among patients with systemic sclerosis. PLoS One 2012; 7:e33281. [PMID: 22457749 PMCID: PMC3311623 DOI: 10.1371/journal.pone.0033281] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 02/13/2012] [Indexed: 11/24/2022] Open
Abstract
Background Body image concerns are infrequently studied in systemic sclerosis (SSc), even though significant visible disfigurement is common. The objective of this study was to identify sociodemographic and disease-related correlates of dissatisfaction with appearance and social discomfort among people with SSc. Methods SSc patients came from the 15-center Canadian Scleroderma Research Group Registry. Sociodemographic information was based on patient self-report. Disease characteristics were obtained via physician examinations. The Brief-SWAP was used to assess dissatisfaction with appearance and social discomfort. Structural equation models were conducted with MPlus to determine the relationship of dissatisfaction with appearance and social discomfort with age, sex, education, marital status, race/ethnicity, disease duration, skin involvement, telangiectasias, skin pigmentation changes, and hand contractures. Results A total of 489 SSc patients (432 female, 57 male) were included. Extent of skin involvement was significantly associated with both dissatisfaction with appearance and social discomfort (standardized regression coefficients = 0.02, p = 0.001; 0.02, p = 0.020, respectively), as was skin involvement in the face (0.18, p = 0.016; 0.23, p = 0.006, respectively). Greater social discomfort was robustly associated with younger age (−0.017, p<0.001) and upper-body telangiectasias (0.32, p = 0.021). Dissatisfaction with appearance was associated with hand contractures (0.07, p = 0.036). Conclusion This study found that dissatisfaction with appearance and social discomfort were associated with numerous disfiguring characteristics of SSc, in addition to age. These results underline that there are multiple factors contributing to body image distress in SSc, as well as the need to attend to both disease and social contexts in understanding the impact of disfigurement among patients.
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Affiliation(s)
- Lisa R. Jewett
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montréal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Division of Rheumatology, Jewish General Hospital, Montréal, Québec, Canada
| | - Vanessa L. Malcarne
- Department of Psychology, San Diego State University, San Diego, California, United States of America
| | - Murray Baron
- Department of Medicine, McGill University, Montréal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Division of Rheumatology, Jewish General Hospital, Montréal, Québec, Canada
| | - Brett D. Thombs
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
- School of Nursing, McGill University, Montréal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Division of Rheumatology, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychiatry, Jewish General Hospital, Montréal, Québec, Canada
- * E-mail:
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Levis B, Hudson M, Knafo R, Baron M, Nielson WR, Hill M, Thombs BD. Rates and correlates of sexual activity and impairment among women with systemic sclerosis. Arthritis Care Res (Hoboken) 2012; 64:340-50. [DOI: 10.1002/acr.20696] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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