Patient-Reported Outcomes in Rheumatology Patients With Limited English Proficiency and Limited Health Literacy

Effects of Language, Age, and Hearing Loss on Health-Related Quality of Life

Objective

To understand the effect of age on health-related quality of life (HRQoL) in patients with hearing loss and determine how primary language mediates this relationship.

Study Design

Cross-sectional study.

Setting

General otolaryngology clinic in Los Angeles.

Methods

Demographics, medical records, and HRQoL data of adult patients presenting with otology symptoms were reviewed. HRQoL was measured using the Short-Form 6-Dimension utility index. All patients underwent audiological testing. A path analysis was performed to generate a moderated path analysis with HRQoL as the primary outcome.

Results

This study included 255 patients (mean age = 54 years; 55% female; 27.8% did not speak English as a primary language). Age had a positive direct association with HRQoL (p < .001). However, the direction of this association was reversed by hearing loss. Older patients exhibited significantly worse hearing (p < .001), which was negatively associated with HRQoL (p < .05). Primary language moderated the relationship between age and hearing loss. Specifically, patients who did not speak English as a primary language had significantly worse hearing (p < .001) and therefore worse HRQoL (p < .01) than patients who spoke English as a primary language with hearing loss. Increasing age was associated with bilateral hearing loss compared to unilateral hearing loss (p < .001) and subsequently lower HRQoL (p < .001). Polypharmacy (p < .01) and female gender (p < .01) were significantly associated with lower HRQoL.

Conclusion

Among otolaryngology patients with otology symptoms, older age and not speaking English as a primary language were associated with worse hearing and subsequently lower HRQoL.

Cross-cultural adaptation and measurement properties of the Malay Shoulder Pain and Disability Index

Objective

The purpose of this study is to cross-culturally adapt the Shoulder Pain and Disability Index from English to Malay, and to evaluate the measurement properties of the Malay version among Malay speakers with shoulder pain.

Methods

Cross-cultural adaptation of the Malay version of Shoulder Pain and Disability Index (M-SPADI) was conducted according to international guidelines. 260 participants (Shoulder pain = 130, No shoulder pain = 130) completed the M-SPADI, the Numerical Rating Scale (NRS), and measurement of shoulder active range of motion (AROM). 54 participants repeated M-SPADI within a mean of 9.2 days.

Results

Cross-cultural adaptation of M-SPADI had no major issues. The M-SPADI had good face validity; item and scale content validity indexes (I-CVI, S-CVI) were >0.79 except for Disability Item 3 (I-CVI = 0.75), and exploratory factor analysis showed that M-SPADI had a bidimensional structure. There was a strong positive correlation between M-SPADI and NRS (rPain = 0.845, rDisability = 0.722, rTotal = 0.795, p <0.001) and a negative correlation between M-SPADI and shoulder AROM with the following correlation ranges (rPain = -0.316 to -0.637, rDisability = -0.419 to -0.708, rTotal = -0404 to -0.697, p<0.001). M-SPADI’s total score was higher in participants with shoulder pain (Mdn: 33.8, IQR = 37.3) compared to no shoulder pain (Mdn:0, IQR = 0.8) and the difference was statistically significant (U = 238.5, z = -13.89, p<0.001). M-SPADI had no floor or ceiling effects (floor/ceiling <15%), high internal consistency (Cronbach’s αPain = 0.914, Cronbach’s αDisability = 0.945) and good to excellent test-retest reliability (ICCPain = 0.922, ICCDisability = 0.859, ICCTotal = 0.895).

Conclusion

M-SPADI has a bi-dimensional structure with no floor or ceiling effects, established face, content and construct validity, internal consistency, and test-retest reliability. M-SPADI is a reliable and valid tool for assessing Malay-speaking individuals with shoulder pain in clinical and research settings.

Best Practices for Virtual Care, a Consensus Statement from the Canadian Rheumatology Association

Objective

To develop best practice statements for the provision of virtual care in adult and pediatric rheumatology for the Canadian Rheumatology Association's (CRA) Telehealth Working Group (TWG).

Methods

Four members of the TWG representing adult, pediatric, university-based and community rheumatology practices defined the scope of the project. A rapid literature review was conducted between April-May 2021 of existing systematic reviews, policy documents and published literature and abstracts on the topic. The review informed a candidate set of 7 statements and a supporting document. The statements were submitted to a 3-round (R) modified Delphi process with 22 panelists recruited through the CRA and patient advocacy organizations. Panelists rated the importance and feasibility of the statements on a Likert scale of 1-9. Statements with final median ratings between 7-9 with no disagreement were retained in the final set.

Results

21 (95%) panelists participated in R1, 15 (71%) in R2 and 18 (82%) in R3. All but one statement met inclusion criteria during R1. Revisions were made to 5/7 statements following R2 and an additional statement was added. All statements met inclusion criteria following R3. The statements addressed the following themes in the provision of virtual care: adherence to existing standards and regulations, appropriateness, consent, physical examination, patient-reported outcomes, use in addition to in-person visits, and complex co-management of disease.

Conclusion

The best practice statements represent a starting point for advancing virtual care in rheumatology. Future educational efforts to help implement these best practices and research to address identified knowledge gaps are planned.

Patient-reported outcome measure of the quality of life in Ugandans living with autoimmune rheumatic diseases

Aim of the work:

To assess the patient reported outcome measure (PROM) of the quality of life (QoL) of patients with autoimmune rheumatic diseases (RDs) attending two tertiary care rheumatology clinics in Uganda.

Patients and methods:

Patients with a confirmed diagnosis of RD and receiving disease modifying anti-rheumatic drugs (DMARDs) were studied. Health index and overall self-rated health status were assessed using the EuroQol 5-dimension (ED-5D-5L) questionnaire tool.

Results:

74 patients were studied: 48 (64.9%) had rheumatoid arthritis (RA), 14(18.9%) systemic lupus erythematosus (SLE), and 12(16.2%) had other RDs; spondyloarthritis (n = 5), systemic sclerosis (n = 3), juvenile idiopathic arthritis (n = 2), and idiopathic inflammatory myositis (n = 2). Their mean age was 45 ± 17 years and 69 (93.2%) were female. 14(18.9%) were on concomitant herbal medication and 26 (35.1%) self-reported at least 1 adverse drug reaction. Any level of problem was reported by 54(72.5%) participants for mobility, 47(63.5%) for self-care, 56(75.6%) for usual activity, 66(89.1%) for pain and discomfort, and 56(75.6%) for anxiety/depression. The mean health index of the patients was 0.64 ± 0.16 and the overall self-rated health status was 58.1 ± 16.7. Patients with SLE (0.74 ± 0.12) had higher health index compared to those with RA (0.60 ± 0.17) or other RDs (0.70 ± 0.1) (p < 0.007). Overall self-rated health status was comparable across clinical diagnoses (p = 0.23). Both the index and self-reported status were better for patients who received private hospital care compared to public hospital (p < 0.0001 and p = 0.01).

Conclusion:

There is a substantial negative impact of autoimmune rheumatic diseases on quality of life of patients, especially those receiving care from a public facility in Uganda.