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Kiss F, Farkas N, Nagy G, Minier T, Kumánovics G, Faludi R, Czirják L, Varjú C. Minimal Clinically Important Differences (MCID) for the Functional Assessment of Chronic Illness Therapy Fatigue Scale in Patients with Systemic Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:771. [PMID: 36613093 PMCID: PMC9819291 DOI: 10.3390/ijerph20010771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Systemic sclerosis (SSc) is characterized by significant fatigue, causing diminished quality of life (QoL). The aim of this study was to examine fatigue levels and their associations with clinical factors and determine the minimal clinically important difference (MCID) value for the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-FS). (2) Methods: A total of 160 SSc patients and 62 individuals without SSc were followed-up over a 12-month period by measuring the FACIT-FS and the Visual Analogue Scale and the Short Form 36 Vitality Score analyzing changes in exhaustion. (3) Results: Fatigue was strongly correlated with HRQoL, level of pain, emotional disorders, physical capability and functionality. The MCID values for FACIT-FS were calculated as -3 for deterioration and +4 for improvement after a 12-month follow-up. The predictors of improvement of fatigue from baseline parameters were the significant disease activity, the patients' poorer functionality and the short disease duration. Patients with scleroderma-related interstitial lung disease at baseline had approximately tripled risks for worsening fatigue. The independent influential factors regarding the changing of FACIT-FS were improving or worsening in the same direction in reference to physical condition, gastrointestinal and emotional factors. (4) Conclusions: Fatigue is a multi-dimensional symptom, which is strongly correlated to HRQoL. MCID values of FACIT-FS can be useful tools in monitoring the changes of HRQoL in clinical trials and in daily practice among patients with SSc.
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Affiliation(s)
- Franciska Kiss
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Nelli Farkas
- Institute of Bioanalysis, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - Gabriella Nagy
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Tünde Minier
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Gábor Kumánovics
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Réka Faludi
- Heart Institute, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - László Czirják
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Cecília Varjú
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
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2
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Khanna D, Caldron P, Martin RW, Kafaja S, Spiera R, Shahouri S, Shah A, Hsu V, Ervin J, Simms R, Domsic RT, Steen V, Hummers LK, Derk C, Mayes M, Chatterjee S, Varga J, Kesten S, Fraser JK, Furst DE. Adipose-Derived Regenerative Cell Transplantation for the Treatment of Hand Dysfunction in Systemic Sclerosis: A Randomized Clinical Trial. Arthritis Rheumatol 2022; 74:1399-1408. [PMID: 35358372 PMCID: PMC9544105 DOI: 10.1002/art.42133] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/08/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
Abstract
Objective Hand dysfunction is common in systemic sclerosis (SSc). We undertook this study to evaluate the capacity of autologous adipose‐derived regenerative cells (ADRCs) to improve hand function in SSc patients. Methods The Scleroderma Treatment with Celution Processed Adipose Derived Regenerative Cells Trial was a prospective, randomized, double‐blind trial of ADRCs, in which ADRCs were obtained from patients with SSc by small‐volume adipose tissue harvest, and the fingers of each patient were injected with ADRCs. The primary end point was change in hand function at 24 and 48 weeks, assessed using the Cochin Hand Function Scale (CHFS). One of the secondary end points included the change in Health Assessment Questionnaire disability index (HAQ DI) at 48 weeks. Separate prespecified analyses were performed for patients with diffuse cutaneous SSc (dcSSc) and those with limited cutaneous SSc (lcSSc). Results Eighty‐eight patients were randomized to receive ADRCs (n = 48 [32 patients with dcSSc and 16 with lcSSc]) or placebo (n = 40 [19 patients with dcSSc and 21 with lcSSc]). Change in hand function according to CHFS score was numerically higher for the ADRC group compared to the placebo group but did not achieve statistical significance (mean ± SD improvement in the CHFS score at 48 weeks 11.0 ± 12.5 versus 8.9 ± 10.5; P = 0.299). For patients with dcSSc, the between‐group difference in the CHFS at 48 weeks was 6.3 points (nominal P = 0.069). For the secondary end point, the dcSSc group exhibited a between‐group difference of 0.17 points in the HAQ DI (nominal P = 0.044) at 48 weeks. Of the ADRC‐treated patients with dcSSc, 52% reported improvement greater than the minimum clinically important difference for both CHFS and HAQ DI compared to 16% in the placebo group (nominal P = 0.016). Small‐volume adipose tissue harvest and ADRC treatment were well tolerated. Conclusion While the primary end point of this trial was not achieved, efficacy trends were observed in patients with dcSSc. Adipose tissue harvest and ADRC injection were demonstrated to be feasible. Further clinical trials of this intervention in the setting of dcSSc are warranted.
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Affiliation(s)
| | - Paul Caldron
- Arizona Arthritis & Rheumatology Research, Phoenix
| | | | | | | | | | - Ankoor Shah
- Duke University Medical Center, Durham, North Carolina
| | - Vivien Hsu
- Rutgers University, New Brunswick, New Jersey
| | - John Ervin
- Alliance for Multispecialty Research, Kansas City, Missouri
| | - Robert Simms
- Boston University Medical Center, Boston, Massachusetts
| | | | | | | | - Chris Derk
- University of Pennsylvania, Philadelphia
| | | | - Soumya Chatterjee
- Cleveland Clinic Orthopedic & Rheumatologic Institute, Cleveland, Ohio
| | - John Varga
- Northwestern University, Chicago, Illinois, and University of Michigan, Ann Arbor
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Costs of Workplace Productivity Loss in Patients with Connective Tissue Disease-associated Interstitial Lung Disease. Ann Am Thorac Soc 2021; 17:1077-1084. [PMID: 32437249 DOI: 10.1513/annalsats.201911-822oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Interstitial lung disease (ILD) develops in a large percentage of patients with connective tissue disease (CTD) and is associated with increased morbidity and mortality. Patients with CTD-associated ILD (CTD-ILD) often present at a young age, suggesting that ILD likely impacts workplace productivity.Objectives: We aimed to determine the employment rate and workplace productivity loss, along with its associated factors and estimated costs, in patients with fibrotic CTD-ILD.Methods: Patients with fibrotic CTD-ILD from the six centers of the Canadian Registry for Pulmonary Fibrosis were eligible. Health-related productivity loss was assessed using the Work Productivity and Activity Impairment questionnaire. Proposed factors associated with low workplace productivity were forced into a multivariable regression model. Average productivity loss in hours/week was used to calculate the costs of productivity loss based on hourly wages obtained from national census data matched for age and sex. Workplace productivity loss outcomes were compared between patients with CTD-ILD and patients with a non-CTD fibrotic ILD.Results: Of 375 eligible patients with fibrotic CTD-ILD, 113 (30%) were employed. Productivity loss was reported by 59% of employed patients, with a mean loss of 9.4 ± 1.2 hours/week, including 3.9 ± 0.9 hours/week from absenteeism and 5.5 ± 0.7 hours/week from presenteeism. Employment among patients 25-54 years of age with fibrotic CTD-ILD was 27% lower than that in the matched general Canadian population (56% vs. 83%; P < 0.001). Employment among patients ≥55 years of age with CTD-ILD was 17% lower than that in the matched population (19% vs. 36%; P < 0.001). Workplace productivity loss was not associated with respiratory symptoms or lung physiology. Annual costs of productivity loss were calculated at 13,593 Canadian dollars per employee with fibrotic CTD-ILD. Workplace productivity loss was similar in patients with fibrotic CTD-ILD and those with non-CTD fibrotic ILD.Conclusions: Patients with fibrotic CTD-ILD frequently report workplace productivity loss, which is unexplained by respiratory symptoms or lung physiology and is associated with significant costs.
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Murphy SL, Whibley D, Kratz AL, Poole JL, Khanna D. Fatigue Predicts Future Reduced Social Participation, not Reduced Physical Function or Quality of Life in People with Systemic Sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2021; 6:187-193. [PMID: 34337153 PMCID: PMC8320783 DOI: 10.1177/2397198320965383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/20/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although fatigue is one of the most problematic symptoms for people with systemic sclerosis, little is known about how fatigue impacts daily life over time. Such information is important when developing fatigue management interventions. This study was conducted to examine 1) if fatigue severity predicted outcomes of worse functioning (social participation, physical function), and quality of life and 2) if level of self-efficacy moderated significant relationships between fatigue and these outcomes. METHODS Data were utilized from a clinical trial in which an online self-management intervention was tested (N = 267). Fatigue, social participation, and physical function were assessed by PROMIS measures. Quality of life was assessed by the EuroQol 5-domain instrument (EQ-5D-5L). Linear regressions were performed to examine how baseline fatigue related to functioning and quality of life outcomes 16 weeks later controlling for relevant covariates. PROMIS measures were used to measure self-efficacy in managing symptoms, daily activities, medications and treatments, emotions, and social interactions. RESULTS Fatigue at baseline significantly predicted social participation 16 weeks later; but did not predict physical functioning or quality of life. Self-efficacy variables did not moderate the association between fatigue and social participation. CONCLUSION Fatigue severity predicted decreased social participation in people with systemic sclerosis. Interventions targeting fatigue should include support to maintain participation of social roles and activities. The level of reported self-efficacy did not vary the strength of the association between fatigue and decline in social participation indicating that there may be other targets to treat fatigue intervention beyond self-management. TRIAL REGISTRATION NCT02494401.
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Affiliation(s)
- Susan L Murphy
- Department of Physical Medicine and
Rehabilitation, University of Michigan, Ann Arbor, MI, USA
- Geriatric Research Education and
Clinical Center (GRECC), VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Daniel Whibley
- Epidemiology Group, School of Medicine,
Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
- Department of Anesthesiology, Chronic
Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Anna L Kratz
- Department of Physical Medicine and
Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Janet L Poole
- Department of Occupational Therapy,
University of New Mexico, Albuquerque, New Mexico, USA
| | - Dinesh Khanna
- Rheumatology Division, Department of
Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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5
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Abstract
Work disability is highly prevalent in the systemic sclerosis (SSc) population; yet, it is an area of research that continues to be underrecognized and underexplored. In this chapter, we review the burden of this work disability by exploring the reported prevalence of work loss, the risk factors associated with reduced work participation, the impact on work productivity outcomes, and the economic consequences of work disability in individuals with SSc. Finally, we discuss the potential challenges in the workplace and strategies that may foster employment retention in this population. We subsequently present a conceptual framework for work disability in the context of SSc, which incorporates our understanding of the various work disability concepts and the potential facilitators that may accelerate a worker toward complete work loss.
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Affiliation(s)
- Jennifer J Y Lee
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Monique A M Gignac
- Institute for Work and Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sindhu R Johnson
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, Toronto Western Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Jetha A, Johnson SR, Gignac MAM. Unmet Workplace Support Needs and Lost Productivity of Workers With Systemic Sclerosis: A Path Analysis Study. Arthritis Care Res (Hoboken) 2021; 73:423-431. [DOI: 10.1002/acr.24123] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/10/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Arif Jetha
- Institute for Work and Health and Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
| | - Sindhu R. Johnson
- Toronto Scleroderma Program Toronto Western Hospital Mount Sinai Hospital, and University of Toronto Toronto Ontario Canada
| | - Monique A. M. Gignac
- Institute for Work and Health and Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
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Xiang L, Kua SM, Low AH. Work Productivity and Economic Burden of Systemic Sclerosis in a Multi-Ethnic Asian Population. Arthritis Care Res (Hoboken) 2020; 74:818-827. [PMID: 33253494 PMCID: PMC9314801 DOI: 10.1002/acr.24521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/28/2020] [Accepted: 11/24/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess work productivity, identify associated factors and evaluate the economic burden of systemic sclerosis (SSc) in a multi-ethnic Asian population. METHODS Data on employment status and work productivity loss were collected. Associations between demographic and disease characteristics and unemployment status, work productivity loss and activity impairment were examined using logistic and linear regression analyses, as appropriate. Costs of unemployment and work productivity loss were estimated using the human capital approach. RESULTS Of 111 patients with a mean disease duration of 9.1 years, 33 (29.7%) were unemployed. Their mean age at unemployment was 44.2 years, equating to 22.8 years of lost employment. No demographic and disease characteristics were significantly associated with unemployment status in multivariable analysis. Of 73 employed patients, 39 (53.4%) reported work productivity loss, accounting for 45.9% of the working week. Presence of hyperlipidemia (coefficient= -19.01, p=0.03) was associated with work productivity loss in multivariable analysis. Of 78 employed and 33 unemployed patients, 37 (47.4%) and 19 (57.6%) reported activity impairment, accounting for 42.2% and 50.0% of the preceding week, respectively. Presence of hyperlipidemia (coefficient= -18.56, p<0.01) was associated with activity impairment in multivariable analysis. Annual cost of unemployment and work productivity loss were estimated to be SGD$53,244 and SGD$13,045 per patient, respectively. CONCLUSION SSc imposes significant unemployment and work productivity loss and causes substantial economic burden to both affected individuals and society. Modifying the identified factors associated with unemployment and work productivity loss may reduce the burden of SSc.
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Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sandra My Kua
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Andrea Hl Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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8
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Iudici M, Bafeta A, Atal I, Ravaud P. Ten Years of Interventional Research in Systemic Sclerosis: A Systematic Mapping of Trial Registries. Arthritis Care Res (Hoboken) 2019; 72:140-148. [DOI: 10.1002/acr.23817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Michele Iudici
- INSERMUMR 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center Paris France
| | - Aïda Bafeta
- INSERMUMR 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center Paris France
| | - Ignacio Atal
- INSERMUMR 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center Paris France
| | - Philippe Ravaud
- INSERMUMR 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research CenterHôpital Hôtel‐DieuAssistance Publique des Hôpitaux de Paris, and Cochrane France, Paris, France, and Columbia University, Mailman School of Public Health New York New York
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9
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Khanna D, Serrano J, Berrocal VJ, Silver RM, Cuencas P, Newbill SL, Battyany J, Maxwell C, Alore M, Dyas L, Riggs R, Connolly K, Kellner S, Fisher JJ, Bush E, Sachdeva A, Evnin L, Raisch DW, Poole JL. Randomized Controlled Trial to Evaluate an Internet-Based Self-Management Program in Systemic Sclerosis. Arthritis Care Res (Hoboken) 2019; 71:435-447. [PMID: 29741230 DOI: 10.1002/acr.23595] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 05/01/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE In a pilot study, our group showed that an internet-based self-management program improves self-efficacy in systemic sclerosis (SSc). The objective of the current study was to compare an internet-based self-management program to a patient-focused educational book developed to assess measures of self-efficacy and other patient-reported outcomes in patients with SSc. METHODS We conducted a 16-week randomized, controlled trial. RESULTS Of the 267 participants who completed baseline questionnaires and were randomized to the intervention (internet: www.selfmanagescleroderma.com) or control (book) group, 123 participants (93%) in the internet group and 124 participants (94%) in the control group completed the 16-week randomized controlled trial (RCT). The mean ± SD age of all participants was 53.7 ± 11.7 years, 91% were women, and 79.4% had some college or a higher degree. The mean ± SD disease duration after diagnosis of SSc was 8.97 ± 8.50 years. There were no statistical differences between the 2 groups for the primary outcome measure (Patient-Reported Outcomes Measurement Information System Self-Efficacy for Managing Symptoms: mean change of 0.35 in the internet group versus 0.94 in the control group; P = 0.47) and secondary outcome measures, except the EuroQol 5-domain instrument visual analog scale score (P = 0.05). Internet group participants agreed that the self-management modules were of importance to them, the information was presented clearly, and the website was easy to use and at an appropriate reading level. CONCLUSION Our RCT showed that the internet-based self-management website was not statistically superior to an educational patient-focused book in improving self-efficacy and other measures. The participants were enthusiastic about the content and presentation of the self-management website.
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Affiliation(s)
| | | | | | | | | | | | - Josephine Battyany
- Scleroderma Foundation Southern California Chapter, Culver City, California
| | | | | | - Laura Dyas
- Scleroderma Foundation Michigan Chapter, Southfield
| | - Robert Riggs
- National Scleroderma Foundation, Danvers, Massachusetts
| | | | - Saville Kellner
- Lake Industries, Revenue Media Group, and JLS Financial Inc., Henderson, Nevada
| | | | | | | | - Luke Evnin
- MPM Capital, Boston, Massachusetts, and Scleroderma Research Foundation, San Francisco, California
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10
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Morrisroe K, Sudararajan V, Stevens W, Sahhar J, Zochling J, Roddy J, Proudman S, Nikpour M. Work productivity in systemic sclerosis, its economic burden and association with health-related quality of life. Rheumatology (Oxford) 2017; 57:73-83. [PMID: 29155994 DOI: 10.1093/rheumatology/kex362] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate work productivity and its economic burden in SSc patients. Methods Consecutive SSc patients enrolled in the Australian Scleroderma Cohort Study were mailed questionnaires assessing employment (Workers' Productivity and Activity Impairment Questionnaire and a custom-made questionnaire) and health-related quality of life (HRQoL) (36-item Short Form Health Survey and Patient-Reported Outcomes Measurement Information System 29). Linear regression methods were used to determine factors associated with work productivity. Results Among 476 patients submitting responses, 55.2% <65 years of age were employed. Unemployed patients were older at the time of survey completion (57.1 vs 53.7 years; P < 0.001) and had longer disease duration from first SSc clinical manifestation (16.2 vs 14.9 years; P = 0.01) than employed patients. The mean age at unemployment onset was 13.2 years below the average Australian retirement age. Of those working in the week prior to completing the survey, 16.0% reported missing work (absenteeism) due to their SSc, accounting for 32.9% of their working week. Reduced productivity while at work (presenteeism) accounted for 22% of their working week. Annual costs per patient as a consequence of unemployment and reduced productivity equated to a total of AUD$67 595.40. Factors independently associated with reduced work productivity were presence of synovitis and sicca symptoms, while tertiary education protected against work impairment. Patients with low HRQoL scores also had low work productivity. Conclusion SSc is associated with considerable unemployment and reduced productivity, which in turn is associated with a substantial economic burden and poor HRQoL. Raising awareness and identifying modifiable factors are possible ways of reducing this burden.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, University of Melbourne at St Vincent's Hospital Melbourne.,Department of Rheumatology St Vincent's Hospital Melbourne, Melbourne
| | - Vijaya Sudararajan
- Department of Medicine, University of Melbourne at St Vincent's Hospital Melbourne
| | - Wendy Stevens
- Department of Rheumatology St Vincent's Hospital Melbourne, Melbourne
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health, Monash University, Clayton, VIC
| | - Jane Zochling
- Department of Rheumatology, Menzies Institute for Medical Research, Hobart, Tasmania
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, WA
| | - Susanna Proudman
- Royal Adelaide Hospital, Rheumatology Unit.,Department of Rheumatology, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Mandana Nikpour
- Department of Medicine, University of Melbourne at St Vincent's Hospital Melbourne.,Department of Rheumatology St Vincent's Hospital Melbourne, Melbourne
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11
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McCormick N, Marra CA, Aviña-Zubieta JA. Productivity Losses and Costs in the Less-Common Systemic Autoimmune Rheumatic Diseases. Curr Rheumatol Rep 2017; 19:72. [PMID: 29086172 DOI: 10.1007/s11926-017-0698-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW We synthesised the literature on productivity losses and costs in the less-common systemic autoimmune rheumatic diseases: Sjogren's syndrome (SjS), systemic sclerosis (SSc), poly/dermatomyositis (PM/DM), and systemic vasculitides (SV). RECENT FINDINGS Of 29 studies located, 12 were published 2012 onwards (SSc = 6, SjS = 2, PM/DM = 2, SV = 2). In these, 25% of PM/DM, and 21-26% of SV, were work disabled, 22% of SSc stopped work within 3 years of diagnosis, and annual costs of absenteeism in SSc averaged $12,024 2017 USD. Very few studies reported on costs, presenteeism (working at reduced levels), or unpaid productivity loss. Across multiple systemic autoimmune rheumatic diseases (SARDs), major drivers of lost productivity were generalised items like pain, depression, and fatigue, rather than disease-specific factors. Evidence suggests that work disability is common in SSc and strikes quickly. However, in SSc and other SARDs, more comprehensive estimates are needed, which include absenteeism and presenteeism from paid and unpaid work, costs, and drivers of productivity loss.
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Affiliation(s)
- Natalie McCormick
- Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Arthritis Research Canada, Richmond, BC, Canada.
| | - Carlo A Marra
- Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Arthritis Research Canada, Richmond, BC, Canada.,School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, Richmond, BC, Canada.,Division of Rheumatology, Department of Medicine, The University of British Columbia, Vancouver, Canada
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12
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Poole JL, Anwar S, Mendelson C, Allaire S. Workplace barriers encountered by employed persons with systemic sclerosis. Work 2016; 55:923-929. [DOI: 10.3233/wor-162448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Janet L. Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, USA
| | - Sahar Anwar
- University of New Mexico Hospital, Albuquerque, NM, USA
| | - Cindy Mendelson
- College of Nursing, University of New Mexico, Albuquerque, NM, USA
| | - Saralynn Allaire
- College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
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13
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Effects of osteopathic manipulative treatment on hand function, disease symptoms and functional status in systemic sclerosis: a series of single-case studies in working women. INT J OSTEOPATH MED 2016. [DOI: 10.1016/j.ijosm.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Impaired quality of life in systemic sclerosis and patient perception of the disease: A large international survey. Semin Arthritis Rheum 2016; 46:115-23. [PMID: 27132536 DOI: 10.1016/j.semarthrit.2016.02.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/22/2015] [Accepted: 02/20/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The purpose of this study was to assess health-related quality of life (HRQoL) and disease perception in a large, international group of patients with systemic sclerosis (SSc). METHODS We placed a standardized questionnaire on a website for patient access. Socio-demographic information, disease characteristics, and self-assessment questionnaires-the Short Form 36 (SF-36) and the Revised Illness Perception Questionnaire (IPQ-R)-were collected. RESULTS A total of 1902 patients from 60 countries were included. HRQoL appeared to be impaired in SSc, particularly for physical health (PCS, mean ± SD = 43.4 ± 23.4). SSc patients also had strong perceptions about the chronic nature and negative consequence of the disease, and experienced negative emotions due to SSc. Patients with diffuse cutaneous SSc had a poorer HRQoL than those with limited cutaneous SSc, for both physical (PCS, mean ± SD = 46.6 ± 23.7 vs. 39.8 ± 22.3; p < 0.0001) and mental components (MCS, mean ± SD = 53.8 ± 23.0 vs. 50.3 ± 23.2; p = 0.003). Late-stage SSc patients were more likely to perceive their disease chronic (p < 0.0001), less controllable (p = 0.03) and with more consequences (p = 0.008), but they had a better understanding of their disease and experienced fewer negative emotions. Raynaud's phenomenon and gastrointestinal complications were the organ involvements with the greatest impact on QoL, they were the two variables associated with the most negative perception of illness severity. CONCLUSION This study, performed on the largest group ever set up for this purpose, confirms the major impact on QoL and the negative perceptions of their disease expressed by SSc patients. However, the perception of this illness tended to improve with disease duration, suggesting that patients find effective coping strategies.
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Abstract
Systemic sclerosis (SSc) is a chronic multi-system autoimmune disease associated with disability and reduced quality of life. There is no effective treatment or cure to SSc, so it is important improve global health of these patients and reduce morbidity and mortality associated with SSc. It was made a literature review about quality of life in patients with SSc, regarding the several factors that should be considered and evaluated when attending to SSc patients. It was also considered the validated scales and questionnaires used to measure outcomes in patients with SSc. We concluded that it is important to have an interdisciplinary approach to SSc patients considering the patient's cognitive representations of the disease and what they value most like mobility and hand function, pain, fatigue, sleep, depression and body image.
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Affiliation(s)
- Cristiana Almeida
- Department of Medicine, Centro Hospitalar Vila Nova Gaia/Espinho (CHVNG/E), Gaia, Portugal.
| | - Isabel Almeida
- Clinical Immunology Unit, Department of Medicine, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal; Multidisciplinary Unit for Biomedical Investigation (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Portugal.
| | - Carlos Vasconcelos
- Clinical Immunology Unit, Department of Medicine, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal; Multidisciplinary Unit for Biomedical Investigation (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Portugal.
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Lima TRL, Guimarães FS, Carvalho MN, Sousa TLM, Menezes SLS, Lopes AJ. Lower limb muscle strength is associated with functional performance and quality of life in patients with systemic sclerosis. Braz J Phys Ther 2015; 19:129-36. [PMID: 25789555 PMCID: PMC4481833 DOI: 10.1590/bjpt-rbf.2014.0084] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 11/18/2014] [Indexed: 01/01/2023] Open
Abstract
Background: Complaints of peripheral muscle weakness are quite common in patients with
systemic sclerosis (SSc). It is likely that the muscle impairments may reduce the
patients' exercise performance, which in turn may decrease their functional
capacity and exert a direct impact on their quality of life. Objectives: To assess the peripheral and respiratory muscle strength in individuals with SSc
and to investigate their correlation with the 6-min walk distance (6MWD) and
quality of life measurements. Moreover, we aimed to characterize their nutritional
status, pulmonary function, functional capacity, and quality of life compared to
the controls. Method: The present cross-sectional study included 20 patients with SSc and 20 control
subjects. All of the participants were subjected to isometric dynamometry, surface
electromyography, bioelectrical impedance analysis, pulmonary function testing,
and the 6-min walk test. Patients with SSc also responded to the Medical Outcomes
Study 36-Item Short-Form Health Survey (SF-36) and the Health Assessment
Questionnaire Disability Index (HAQ-DI). Results: The individuals with SSc exhibited a reduction in quadriceps strength (p=0.0001),
increased quadriceps fatigability (p=0.034), impaired pulmonary function, and a
reduced 6MWD (p=0.0001) compared to the controls. Quadriceps strength was
significantly correlated with the 6MWD (Rho=0.719; p=0.0004) and
the HAQ-DI (Rho=-0.622; p=0.003). We also found significant
correlations between quadriceps fatigability and maximal inspiratory
(Rho=0.684; p=0.0009) and maximal expiratory
(Rho=0.472; p=0.035) pressure. Conclusions: Patients with SSc exhibited reduced respiratory muscle and quadriceps strength and
an increase in its fatigability. In these individuals, there was a relationship
between quadriceps strength, functional capacity, and quality of life.
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Affiliation(s)
| | | | | | - Thaís L M Sousa
- Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brazil
| | | | - Agnaldo J Lopes
- Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brazil
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Nihtyanova SI, Schreiber BE, Ong VH, Rosenberg D, Moinzadeh P, Coghlan JG, Wells AU, Denton CP. Prediction of pulmonary complications and long-term survival in systemic sclerosis. Arthritis Rheumatol 2014; 66:1625-35. [PMID: 24591477 DOI: 10.1002/art.38390] [Citation(s) in RCA: 307] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 01/28/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess survival and incidence of organ-based complications in a large single-center cohort of unselected systemic sclerosis (SSc) patients, and to explore predictors of survival and clinically significant pulmonary fibrosis (PF) and pulmonary hypertension (PH). METHODS The study cohort consisted of 398 consecutive SSc patients, followed up for up to 15 years. Cox proportional hazards analysis with demographic, clinical, and laboratory characteristics as predictor variables was used to develop prediction models for pulmonary complications and survival. RESULTS The overall survival estimate at the end of followup was 57% among patients with limited cutaneous SSc (lcSSc) and 50% among patients with diffuse cutaneous SSc (dcSSc) (P = 0.017). We found that greater age at disease onset, dcSSc, lower diffusing capacity for carbon monoxide (DLco), lower hemoglobin levels, higher serum creatinine levels, and the presence of PH or cardiac involvement were independent predictors of worse survival. Over the entire followup period, 42% of dcSSc patients and 22% of lcSSc patients developed clinically significant PF (P < 0.001). The variables that predicted clinically significant PF development were dcSSc, greater age at onset, lower forced vital capacity and DLco, and the presence of anti-topoisomerase I antibody, while the presence of anticentromere antibody was protective. There was no difference in cumulative incidence of PH between the 2 subsets-24% in lcSSc and 18% in dcSSc (P = 0.558). Incidence rates were 1-2% per year. The PH prediction model demonstrated that greater age at onset, increase in serum creatinine levels, lower DLco, and the presence of anti-RNA polymerase III or anti-U3 RNP antibodies were associated with increased risk of PH, while anti-topoisomerase I antibody positivity reduced the hazard. CONCLUSION Our study provides data on long-term outcome of SSc and the timing and frequency of major organ complications. The predictive models we present could be used as clinical tools for patient risk stratification and could facilitate cohort enrichment for event-driven studies.
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Orlandi AC, Cardoso FP, Santos LM, Cruz VDG, Jones A, Kyser C, Natour J. Translation and cross-cultural adaptation of the Scleroderma Health Assessment Questionnaire to Brazilian Portuguese. SAO PAULO MED J 2014; 132:163-9. [PMID: 24788030 PMCID: PMC10852091 DOI: 10.1590/1516-3180.2014.1323621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 07/12/2013] [Accepted: 07/16/2013] [Indexed: 01/27/2023] Open
Abstract
CONTEXT AND OBJECTIVE Systemic sclerosis is an autoimmune disease characterized by abnormalities of vascularization that may cause fibrosis of the skin and other organs and lead to dysfunction. It is therefore essential to have tools capable of evaluating function in individuals with this condition. The aim of this study was to translate the Scleroderma Health Assessment Questionnaire (SHAQ) into Portuguese, adapt it to Brazilian culture and test its validity and reliability. DESIGN AND SETTING The validation of SHAQ followed internationally accepted methodology, and was performed in university outpatient clinics. METHODS SHAQ was translated into Portuguese and back-translated. In the cultural adaptation phase, it was applied to 20 outpatients. Items not understood by 20% of the patients were modified and applied to another 20 outpatients. Twenty patients were interviewed on two different occasions to determine the validity and reliability of the questionnaire: two interviewers on the first occasion and one interviewer 14 days later. To determine the external validity, comparisons were made with Health Assessment Questionnaire (HAQ), Disabilities of the Arm, Shoulder and Hand (DASH) and short form-36 (SF-36). RESULTS In the interobserver evaluation, Pearson's correlation coefficient and the intraclass correlation coefficient were both 0.967. In the intraobserver evaluation, Pearson's correlation coefficient was 0.735 and the intraclass correlation coefficient was 0.687. Regarding external validity, SHAQ scores were statistically correlated with all measurements, except the general health domain of SF-36 and the work-related score (Q2) of DASH. CONCLUSION The Brazilian version of SHAQ proved to be valid and reliable for assessing function in patients with diffuse systemic sclerosis.
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Affiliation(s)
- Aline Cristina Orlandi
- MSc. Student, Rheumatology Division, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Fernanda Pontes Cardoso
- MSc. Occupational therapist, Rheumatology Division, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Lucas Macedo Santos
- Physiotherapist, Rheumatology Division, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Vaneska da Graça Cruz
- PhD. Student, Rheumatology Division, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Anamaria Jones
- PhD. Physiotherapist, Rheumatology Division, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Cristiane Kyser
- MD, PhD. Affiliated Professor, Rheumatology Division, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Jamil Natour
- MD, PhD. Associate Professor, Rheumatology Division, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
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Bérezné A, Nguyen C, Mouthon L. [Professional consequences of systemic sclerosis]. Presse Med 2013; 42:1159-70. [PMID: 23958211 DOI: 10.1016/j.lpm.2013.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 03/26/2013] [Accepted: 04/03/2013] [Indexed: 01/21/2023] Open
Abstract
Work disability is a major issue in patients with systemic sclerosis (SSc) and seems to be substantially higher than other connective tissue diseases. Working ability results from complex interactions between factors related to socio-demographic characteristics, SSc specificities and working conditions. Working ability is related to global disability, altered hand function, fatigue, pain, type of work and opportunities to adapt workstation. Work disability is responsible for reduced income in patients with SSc.
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Affiliation(s)
- Alice Bérezné
- Université Paris Descartes, faculté de médecine, Assistance publique-Hôpitaux de Paris, hôpital Cochin, service de médecine interne, centre de référence pour les vascularites nécrosantes et la sclérodermie systémique, 75679 Paris, France.
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Evaluation of a mail-delivered, print-format, self-management program for persons with systemic sclerosis. Clin Rheumatol 2013; 32:1393-8. [DOI: 10.1007/s10067-013-2282-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/20/2013] [Accepted: 04/21/2013] [Indexed: 11/25/2022]
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Current world literature. Curr Opin Rheumatol 2012; 24:694-702. [PMID: 23018859 DOI: 10.1097/bor.0b013e328359ee5b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harel D, Thombs BD, Hudson M, Baron M, Steele R. Measuring fatigue in SSc: a comparison of the Short Form-36 Vitality subscale and Functional Assessment of Chronic Illness Therapy–Fatigue scale. Rheumatology (Oxford) 2012; 51:2177-85. [DOI: 10.1093/rheumatology/kes206] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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