Validation of the Social Appearance Anxiety Scale in Patients With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Study

A machine learning-based hybrid recommender framework for smart medical systems

This article presents a hybrid recommender framework for smart medical systems by introducing two methods to improve service level evaluations and doctor recommendations for patients. The first method uses big data techniques and deep learning algorithms to develop a registration review system in medical institutions. This system outperforms conventional evaluation methods, thus achieving higher accuracy. The second method implements the term frequency and inverse document frequency (TF-IDF) algorithm to construct a model based on the patient's symptom vector space, incorporating score weighting, modified cosine similarity, and K-means clustering. Then, the alternating least squares (ALS) matrix decomposition and user collaborative filtering algorithm are applied to calculate patients' predicted scores for doctors and recommend top-performing doctors. Experimental results show significant improvements in metrics called precision and recall rates compared to conventional methods, making the proposed approach a practical solution for department triage and doctor recommendation in medical appointment platforms.

The effect of a self-management program on the quality of life of patients with scleroderma

BACKGROUND

Scleroderma is a rare disease with complex disorders. It affects the quality of life with severe impacts on the skin and extensive complications in the internal organs, and does not have a definitive treatment. This study aimed to investigate the effect of a self-management program on the quality of life of patients with scleroderma.

MATERIALS AND METHODS

This was a clinical trial in which 54 patients with scleroderma were randomly divided into two groups of 27 each (experimental and control groups). The data were collected using the Systemic Sclerosis Questionnaire. A self-management program was sent to the experimental group via a mobile phone application (WhatsApp) every day for three months. Statistical analysis was performed in Statistical Package for the Social Sciences V21.

RESULTS

The Wilcoxon signed-rank test showed that the average overall quality of life score of the experimental group showed a significant increase after the implementation of the program (P value: 0.00). The average overall quality of life score of the control group also significantly declined after the intervention (P value: 0.00). The Mann-Whitney U test revealed that there was no significant difference in the overall quality of life score of the two groups before the intervention (P value: 0.31); however, after the implementation of the self-management program, a significant difference was observed between the two groups (P value: 0.00).

CONCLUSION

According to the results, the self-management program can help improve the quality of life of patients with scleroderma.

Development and Psychometric Validation of the Athletes' Perceived Body Pressures from Coaches Questionnaire (APBPCQ)

This study aimed to develop a questionnaire to assess male and female athletes' perceived weight and shape pressure from coaches and establish its psychometric properties. Exploratory factor analysis (N = 412 in each female sample 1 and 2) provided evidence for 4 scales for female athletes and 3 scales for male athletes which were confirmed in confirmatory factor analysis (N = 260 in each male sample 1 and 2). For both females and males, KMO testing and Bartlett's test of sphericity indicated that the sampling was adequate and survey items were appropriate for factor analysis. Additionally, all scales for both sexes had strong factor loadings (≥0.65), good Cronbach alpha coefficients (>0.70), and made contextual sense. The magnitude of difference results were indicative of a stable factor structure. Goodness-of-fit indicators were all in the expected direction. Good convergent validity was demonstrated. The questionnaire's excellent psychometric properties and novelty make it a valuable tool for researchers and practitioners. This questionnaire has the potential to identify training needs in coaching staff, as well as to identify athletes who may benefit from support and guidance for effectively coping with pressure from coaches.

Further support for the validity of the social appearance anxiety scale (SAAS) in a variety of German-speaking samples

PURPOSE

Eating disorders (ED) and social anxiety disorder are highly comorbid with potentially shared symptoms like social appearance anxiety (SAA) referring to a fear of being negatively evaluated by others' because of overall appearance. SAA constitutes a risk factor for eating psychopathology and bridges between EDs and social anxiety disorder.

METHODS

The present studies examined internal consistency, factor structure, test-retest reliability, gender and age invariance, convergent validity and differences between individuals with and without an ED of a German version of the social appearance anxiety scale (SAAS) in four independent samples (n₁ = 473; n₂ = 712; n₃ = 79; n₄ = 33) including adolescents and patients with EDs.

RESULTS

Consistently, the SAAS showed excellent internal consistency (ωs ≥ 0.947) and a one-factorial structure. Convergent validity was shown via high correlations of the SAAS with social anxiety (e.g., social interaction anxiety r = 0.642; fear of negative evaluation rs ≥ 0.694), body image disturbance measures (e.g., shape concerns rs ≥ 0.654; weight concerns rs ≥ 0.607; body avoidance rs ≥ 0.612; body checking rs ≥ 0.651) and self-esteem (r = -0.557) as well as moderate correlations with general eating psychopathology (e.g., restrained rs ≥ 0.372; emotional r = 0.439; external eating r = 0.149). Additionally, the SAAS showed gender and age invariance and test-retest reliability after 4 weeks with r = 0.905 in Study 2 and was able to discriminate between individuals with and without an ED in Study 4.

CONCLUSION

Hence, the German version of the SAAS can reliably and validly assess SAA in female and male adolescents or adults with or without an ED. Additionally, the SAAS might be used in a therapeutic context to especially target patient groups suffering from EDs with comorbid social anxiety.

LEVEL OF EVIDENCE

Level III: Evidence obtained from cohort or case-control analytic studies.

The Scleroderma Patient-centered Intervention Network Self-Management (SPIN-SELF) Program: protocol for a two-arm parallel partially nested randomized controlled feasibility trial with progression to full-scale trial

BACKGROUND

Systemic sclerosis (scleroderma; SSc) is a rare autoimmune connective tissue disease. We completed an initial feasibility trial of an online self-administered version of the Scleroderma Patient-centered Intervention Network Self-Management (SPIN-SELF) Program using the cohort multiple randomized controlled trial (RCT) design. Due to low intervention offer uptake, we will conduct a new feasibility trial with progression to full-scale trial, using a two-arm parallel, partially nested RCT design. The SPIN-SELF Program has also been revised to include facilitator-led videoconference group sessions in addition to online material. We will test the group-based intervention delivery format, then evaluate the effect of the SPIN-SELF Program on disease management self-efficacy (primary) and patient activation, social appearance anxiety, and functional health outcomes (secondary).

METHODS

This study is a feasibility trial with progression to full-scale RCT, pending meeting pre-defined criteria, of the SPIN-SELF Program. Participants will be recruited from the ongoing SPIN Cohort ( http://www.spinsclero.com/en/cohort ) and via social media and partner patient organizations. Eligible participants must have SSc and low to moderate disease management self-efficacy (Self-Efficacy for Managing Chronic Disease (SEMCD) Scale score ≤ 7.0). Participants will be randomized (1:1 allocation) to the group-based SPIN-SELF Program or usual care for 3 months. The primary outcome in the full-scale trial will be disease management self-efficacy based on SEMCD Scale scores at 3 months post-randomization. Secondary outcomes include SEMCD scores 6 months post-randomization plus patient activation, social appearance anxiety, and functional health outcomes at 3 and 6 months post-randomization. We will include 40 participants to assess feasibility. At the end of the feasibility portion, stoppage criteria will be used to determine if the trial procedures or SPIN-SELF Program need important modifications, thereby requiring a re-set for the full-scale trial. Otherwise, the full-scale RCT will proceed, and outcome data from the feasibility portion will be utilized in the full-scale trial. In the full-scale RCT, 524 participants will be recruited.

DISCUSSION

The SPIN-SELF Program may improve disease management self-efficacy, patient activation, social appearance anxiety, and functional health outcomes in people with SSc. SPIN works with partner patient organizations around the world to disseminate its programs free-of-charge.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04246528 . Registered on 27 January 2020.

Development and validation of a Patient-Reported Outcome in systemic sclerosis: the Hand scleroDerma lived Experience Scale (HAnDE Scale)

OBJECTIVES

to develop and validate a Patient Reported Outcome (PRO) scale-the HAnDE (Hand-ScleroDerma Disease lived Experience) scale-assessing the lived experience of hand involvement in patients with systemic sclerosis (SSc).

METHODS

explanatory sequential mixed-method study with two phases: 1) PRO development through an Inductive Process to analyze the Structure of lived Experience approach, involving 21 SSc patients, 2) PRO validation by assessing the psychometric properties of the scale among 105 SSc patients.

RESULTS

1) Phase-1 enabled to generate the 18-item provisional scale. 2) The mean total score of the scale was 29,16 (SD 16,15). The item reduction process retained 16 items with 5 levels of answers (range 0-64). Internal consistency of the 16-item version was excellent (Cronbach-alpha coefficient=0,946). Construct validity was very good, the Principal Component Analysis being in favour of a unidimensional instrument, with one factor explaining 56% of the variance, and concurrent validity being confirmed: Cochin Hand Function Scale r=0,66; Health Assessment Questionnaire-Disability index r=0.58; Hospital Anxiety Depression, anxiety r=0,51, depression r=0,4; Mouth Handicap in Systemic Sclerosis r=0,61; SF-36, physical component r=-0,48, mental component r=-0,46; and Kapandji score r=-0,46. The correlations were statistically significant (p<0,05).

CONCLUSION

We propose, for future trials and clinical practice in SSc, a new PRO the HAnDE scale, that assesses all the dimensions -functional, aesthetic, relational, existential, and emotional- of the lived experience of hand involvement.

Assessing differential item functioning for the Social Appearance Anxiety Scale: a Scleroderma atient-centred Intervention Network (SPIN) Cohort Study

OBJECTIVES

The Social Appearance Anxiety Scale (SAAS) is a 16-item questionnaire developed to evaluate fear of appearance-based evaluation by others. The primary objective of this research was to investigate the existence of differential item functioning (DIF) for the 16 SAAS items, comparing patients who completed the SAAS in English and French, either to confirm that scores are comparable or provide guidance on calculating comparable scores. A secondary research objective was to investigate the existence of DIF based on sex and disease status. A tertiary research objective was to assess DIF related to language, sex, and disease status on the recently developed SAAS-5.

DESIGN

This was a cross-sectional analysis using baseline data from patients enrolled in the Scleroderma Patient-centred Intervention Network (SPIN).

SETTING

SPIN patients included in the present study were enrolled at 43 centres in Canada, USA, UK, France and Australia, with questionnaires completed in April 2014 to July 2019.

PARTICIPANTS

1640 SPIN patients completed the SAAS in French (n=600) or English (n=1040).

PRIMARY AND SECONDARY MEASURES

The SAAS was collected along with demographic and disease characteristics.

RESULTS

Six items were identified with statistically significant language-based DIF, four with sex-based DIF and one with disease type-based DIF. However, factor scores before and after accounting for DIF were similar (Pearson correlation >0.99), and individual score differences were small. This was true for both the full and shortened versions of the SAAS.

CONCLUSION

SAAS and SAAS-5 scores are comparable across language, sex, and disease-type, despite small differences in how patients respond to some items.

Cognitive dysfunction in autoimmune rheumatic diseases

For people with chronic autoimmune rheumatic diseases (AIRD), such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) or systemic sclerosis (SSc), normal cognitive functions are essential for performing daily activities. These diseases may be associated with cognitive dysfunction (CD). In RA, CD has been associated with age, lower education and disease duration and activity. Great advances have been achieved in neuropsychiatric SLE in the identification of pathogenic pathways, assessment and possible treatment strategies. SSc rarely exerts direct effects on the brain and cognitive function. However, the psychological burden that includes depression, anxiety and social impact may be high. AIRD patients with sustained disease activity, organ damage or lower education should be evaluated for CD. The control of systemic inflammation together with tailored behavioural cognitive therapies may benefit these patients.

Factors associated with patient-reported likelihood of using online self-care interventions: a Scleroderma Patient-centered Intervention Network (SPIN) cohort study

OBJECTIVES

The Scleroderma Patient-centered Intervention Network (SPIN) Cohort uses the cohort multiple randomised controlled trial design to embed trials of online self-care interventions for people living with systemic sclerosis (SSc; scleroderma). To offer interventions to patients interested in using them, participants complete signalling items that query about the likelihood that patients would agree to participate in nine different hypothetical online programmes addressing common SSc-related problems. It is not known what factors influence patient-reported interest in participating in a particular online intervention and if intervention-specific signalling questions provide unique information or replicate broader characteristics, such as overall willingness to participate or self-efficacy. This study assessed factors that explain responses to intervention-specific signalling items.

DESIGN

Cross-sectional survey.

SETTING

SPIN Cohort participants enrolled at 42 centres from Canada, the USA, the UK, France, Spain and Mexico who completed study questionnaires from March 2014 to January 2018 were included.

MEASURES

Demographic and disease characteristics, self-efficacy and symptoms related to each specific intervention were completed in addition to signalling items. General likelihood of using interventions was calculating by taking the mean score of the remaining signalling questions.

PARTICIPANTS

1060 participants with complete baseline data were included in the analyses.

RESULTS

For all individual signalling questions, controlling for other variables, the mean of the remaining signalling questions was the strongest predictor (standardised regression coefficient β from 0.61 (sleep) to 0.80 (self-management)). Smaller, but statistically significant, associations were found with the symptom associated with the respective signalling question and with general self-efficacy for 7 of 9 signalling questions.

CONCLUSIONS

The main factor associated with patients' interest in participating in a disease-specific online self-care intervention is their general interest in participating in online interventions. Factors that may influence this general interest should be explored and taken into consideration when inviting patients to try online interventions.

Shortening patient-reported outcome measures through optimal test assembly: application to the Social Appearance Anxiety Scale in the Scleroderma Patient-centered Intervention Network Cohort

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.

Measuring and managing appearance anxiety in patients with systemic sclerosis

INTRODUCTION

Systemic sclerosis (SSc, scleroderma) is a progressive, autoimmune, connective tissue disease of unknown etiology that can cause changes in appearance in socially important areas of the body (e.g. face and hands). Social concerns related to changes in appearance can contribute to anxiety specific to situations where one's appearance will be evaluated, or appearance anxiety. Appearance anxiety is a relevant but underexplored construct in SSc. Areas covered: We review the current knowledge on appearance anxiety in SSc, including assessment of the construct and interventions. Relevant references in the field were obtained through a literature search in MEDLINE/PubMed and PsycINFO for articles published through September 2018. Expert commentary: There is a dearth of research in the SSc literature examining the construct of appearance anxiety. A growing interest in appearance anxiety in SSc has led to several relevant measures being validated in this population, including the Social Appearance Anxiety Scale. Important areas for future research are the development of interventions to address appearance anxiety and the use of randomized controlled trials to evaluate these interventions.