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Elefante E, Cornet A, Andersen J, Somers A, Mosca M. The communication GAP between patients and clinicians and the importance of patient reported outcomes in Systemic Lupus Erythematosus. Best Pract Res Clin Rheumatol 2023; 37:101939. [PMID: 38485601 DOI: 10.1016/j.berh.2024.101939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/20/2024] [Indexed: 06/23/2024]
Abstract
Systemic Lupus Erythematosus (SLE) imposes a great burden on the lives of patients. Patients' and physicians' concerns about the disease diverge considerably. Physicians focus on controlling disease activity to prevent damage accrual, while patients focus on symptoms that impact on Health-Related Quality of Life (HRQoL). We explored the physicians' and patients' perspective and the potential role of Patient Reported Outcomes (PROs). Physicians are aware of the theoretical usefulness of PROs to collect information deriving from the patients' perspective. However, they often do not know how to interpret and use these questionnaires in a real shared therapeutic strategy. For the patients, it's important to be seen as a whole person with a true consideration of how they feel and function. Strategies to help bridge the communication gap could include: better use of time during visits, preparing for the consultation, a more understandable lay language used by the doctor, a dedicated nurse.
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Affiliation(s)
- Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, Italy
| | | | | | | | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, Italy.
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Taheri N, Mageau A, Chauveheid MP, Dossier A, Farhi F, Mendes C, Papo T, Goulenok T, Sacre K. Impact of adherence to EULAR quality indicators on the quality of life of patients with systemic lupus erythematosus. Eur J Intern Med 2023; 109:68-72. [PMID: 36585323 DOI: 10.1016/j.ejim.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Quality indicators (QIs) for systemic lupus erythematosus (SLE) management based on the 2019 update of European League Against Rheumatism (EULAR) recommendations have been recently proposed. We aimed to determine whether adherence to QIs was associated with patient reported outcome (PRO). METHODS Adherence to a set of 18 EULAR-based QIs and correlation with PRO assessed by Lupus Impact Tracker (LIT) was tested in a cohort of 162 SLE patients. RESULTS On average, SLE patients received 41% (33; 52.5) of recommended care. Higher adherence to monitoring-related QIs was associated with an older age, a shorter SLE disease duration and a more severe disease (i.e. Class III/IV/V nephritis). LIT demonstrated that the average impact of lupus on patients' life was of 30% (12.5;47.5). In multivariable analysis, patients of female gender (OR 0.25, 95% 0.05-0.94; p = 0.05), with lupus CNS (OR 0.33, 95%CI 0.08-1.05; p = 0.08) and skin involvements (OR 0.49, 95%CI 0.23-1.04; p = 0.07) had higher odds of experiencing a negative impact of the lupus on their life. No association were found between adherences to QIs by physicians and reported quality of life in lupus patients. CONCLUSION Our study confirms a variable degree of clinicians' adherence to QIs for SLE and shows no clear association between QIs adherence and patient reported outcome. Adherence to QIs by physicians are not enough to impact the quality of life of patients.
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Affiliation(s)
- Nadim Taheri
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Arthur Mageau
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France; Université Paris Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, CNRS ERL8252, Faculté de Médecine site Bichat, Laboratoire d'Excellence Inflamex, Paris, France
| | - Marie-Paule Chauveheid
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Antoine Dossier
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Fatima Farhi
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Celine Mendes
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Thomas Papo
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Tiphaine Goulenok
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Karim Sacre
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France; Université Paris Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, CNRS ERL8252, Faculté de Médecine site Bichat, Laboratoire d'Excellence Inflamex, Paris, France.
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Investigation and Analysis of Anxiety and Quality of Life among Systemic Lupus Erythematosus Patients in Northwestern China. Healthcare (Basel) 2022; 10:healthcare10112180. [DOI: 10.3390/healthcare10112180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/04/2022] Open
Abstract
The aim of this study was to provide targeted psychological support and effective nursing for systemic lupus erythematosus (SLE) patients. SLE is a complex, systemic autoimmune disease characterized by recurrent episodes and the involvement of multiple organs. With improvements in SLE treatment and the corresponding increase in patients’ survival time, the quality of life (QoL) of SLE patients has become an important indicator for evaluating the effectiveness of clinical treatments. To explore the anxiety states and health-related QoL of SLE patients, 106 SLE patients were asked to provide responses for the short-form 36 health survey (SF36), and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Visual Analog Scale(VAS). Additionally, the Systemic Lupus Collaborative Clinics Damage Index (SDI) was analyzed. Data regarding patients’ age, gender, education level, occupation, family income, and duration of disease were collected. Regression analysis was performed to identify factors related to patients’ health-related QoL. For the SF36, the mental components score (MCS), mental health (MH), and bodily pain (BP) occupied dominant positions. Additionally, the MH domain was significantly associated with anxiety in SLE patients. Negative relationships were identified between irregular sleep and the scores for role limitations due to physical problem (RP), vitality (VT), and role limitations due to emotional problem (RE) domains. From the analysis of SLEDAI and SDI scores, anxiety among SLE patients was mainly affected by disease activity and quality of life. This study provides a preliminary understanding of the QoL of SLE patients in western China and highlights the need for the future development of strategies to provide targeted psychological support and effective nursing for SLE patients, in order to improve patients’ self-awareness, mental health, and QoL.
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Strand V, O'Quinn S, Furie RA, Morand EF, Kalunian KC, Schwetje EG, Abreu G, Tummala R. Clinical meaningfulness of a British Isles Lupus Assessment Group-based Composite Lupus Assessment response in terms of patient-reported outcomes in moderate to severe systemic lupus erythematosus: a post-hoc analysis of the phase 3 TULIP-1 and TULIP-2 trials of anifrolumab. THE LANCET. RHEUMATOLOGY 2022; 4:e198-e207. [PMID: 38288936 DOI: 10.1016/s2665-9913(21)00387-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The British Isles Lupus Assessment Group-based Composite Lupus Assessment (BICLA) is a validated global measure of treatment response in systemic lupus erythematosus (SLE) clinical trials but does not include patient-reported outcomes. To evaluate the clinical meaningfulness of a BICLA response from the patient perspective, we aimed to analyse patient-reported outcomes by BICLA responses with anifrolumab or placebo in patients with moderate to severe SLE. METHODS We did a post-hoc analysis of pooled data from the phase 3 TULIP-1 (NCT02446912) and TULIP-2 (NCT02446899) trials of anifrolumab, which assessed health-related quality of life using the Short Form 36 Health Survey (SF-36; version 2) and Lupus Quality of Life, fatigue using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), pain using the Numerical Rating Scale, and disease activity using Patient Global Assessment. Changes from baseline and proportions of patients reporting improvements in patient-reported outcomes greater than or equal to the minimum clinically important differences and scores greater than or equal to the normative values were compared in BICLA responders and non-responders and by treatment group (intravenous anifrolumab 300 mg or placebo). FINDINGS 726 patients were included in the TULIP trials, of whom 366 received placebo (184 patients in TULIP-1 and 182 in TULIP-2) and 360 received anifrolumab 300 mg (180 patients in each trial). The mean patient age was 41·8 years (SD 11·9). 674 (93%) patients were female, 52 (7%) were male, and 479 (66%) were White; 283 (39%) were BICLA responders and 443 (61%) were BICLA non-responders. Compared with non-responders, BICLA responders reported greater mean improvements from baseline at week 52 in Patient Global Assessment, SF-36, Lupus Quality of Life, FACIT-F, and pain Numerical Rating Scale scores (all nominal p<0·0053). Compared with non-responders, a greater proportion of BICLA responders reported improvements greater than or equal to the minimum clinically important difference across all SF-36 domains; eg, Physical Component Summary (165 [60%] of 277 for responders vs 63 [15%] of 416 for non-responders), Mental Component Summary (140 [51%] of 276 vs 59 [15%] of 416), and role physical (184 [70%] of 264 vs 76 [19%] of 398); Lupus Quality of Life domains; eg, physical health (151 [58%] of 262 vs 60 [15%] of 396), and intimate relationships (77 [41%] of 187 vs 33 [11%] of 286), and FACIT-F (155 [56%] of 276 vs 66 [15%] of 439). Similarly, a greater proportion of BICLA responders had scores equal to or greater than the normative values across all SF-36 domains and FACIT-F compared with BICLA non-responders at week 52. Patients who received anifrolumab reported greater numerical improvements in Patient Global Assessment, SF-36, Lupus Quality of Life, FACIT-F, and pain Numerical Rating Scale scores than those who received placebo. INTERPRETATION BICLA responders reported significant and clinically meaningful improvements in Patient Global Assessment, health-related quality of life, fatigue, and pain compared with BICLA non-responders. More patients with moderate to severe SLE who received anifrolumab were BICLA responders and had improved health-related quality of life, fatigue, and pain than those who received placebo. FUNDING AstraZeneca.
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Affiliation(s)
- Vibeke Strand
- Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Sean O'Quinn
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | - Richard A Furie
- Division of Rheumatology, Zucker School of Medicine at Hofstra-Northwell, Great Neck, NY, USA
| | - Eric F Morand
- Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia
| | - Kenneth C Kalunian
- Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla, CA, USA
| | - Erik G Schwetje
- BioPharmaceuticals Research and Development, AstraZeneca, Gaithersburg, MD, USA
| | - Gabriel Abreu
- BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Raj Tummala
- BioPharmaceuticals Research and Development, AstraZeneca, Gaithersburg, MD, USA.
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SHAYESTEHPOUR SHIVA, SHARMA KARAN, MOSOR ERIKA, OMARA MAISA, Ritschl V, SHAYESTEHPOUR SHIMA, STAMM TANJA, BEKES KATRIN. PATIENT-REPORTED OUTCOME MEASURES FOR PEDIATRIC DENTAL PATIENTS: A METHODOLOGICAL REVIEW AND MAPPING EXERCISE. J Evid Based Dent Pract 2022; 22:101661. [DOI: 10.1016/j.jebdp.2021.101661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
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Mosor E, Studenic P, Alunno A, Padjen I, Olsder W, Ramiro S, Bini I, Caeyers N, Gossec L, Kouloumas M, Nikiphorou E, Stones S, Wilhelmer TC, Stamm TA. Young people's perspectives on patient-reported outcome measures in inflammatory arthritis: results of a multicentre European qualitative study from a EULAR task force. RMD Open 2021; 7:rmdopen-2020-001517. [PMID: 33514672 PMCID: PMC7849893 DOI: 10.1136/rmdopen-2020-001517] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/24/2020] [Accepted: 01/14/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Although patient-reported outcome measures (PROMs) are increasingly used in clinical practice and research, it is unclear whether these instruments cover the perspective of young people with inflammatory arthritis (IA). The aims of this study were to explore whether PROMs commonly used in IA adequately cover the perspective of young people from different European countries. METHODS A multinational qualitative study was conducted in Austria, Croatia, Italy and the Netherlands. Young people with either rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), Still's disease, psoriatic arthritis (PsA) or spondyloarthritis (SpA), aged 18-35 years, participated in semistructured focus group interviews. Thematic analysis was used and data saturation was defined as no new emergent concepts in at least three subsequent focus groups. RESULTS Fifty-three patients (21 with RA/JIA/Still's, 17 with PsA, 15 with SpA; 72% women) participated in 12 focus groups. Participants expressed a general positive attitude towards PROMs and emphasised their importance in clinical practice. In addition, 48 lower level concepts were extracted and summarised into 6 higher level concepts describing potential issues for improvement. These included: need for lay-term information regarding the purpose of using PROMs; updates of certain outdated items and using digital technology for data acquisition. Some participants admitted their tendency to rate pain, fatigue or disease activity differently from what they actually felt for various reasons. CONCLUSIONS Despite their general positive attitude, young people with IA suggested areas for PROM development to ensure that important concepts are included, making PROMs relevant over the entire course of a chronic disease.
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Affiliation(s)
- Erika Mosor
- Section for Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Wien, Austria
| | - Paul Studenic
- Internal Medicine 3, Division of Rheumatology, Medical University Vienna, Wien, Austria.,Department of Medicine (Solna), Division of Rheumatology, Karolinska Institute, Stockholm, Sweden
| | - Alessia Alunno
- Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Umbria, Italy
| | - Ivan Padjen
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.,University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Wendy Olsder
- EULAR Young PARE, Zürich, Switzerland.,Youth-R-Well, Nieuwegein, The Netherlands
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, South Holland, The Netherlands.,Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Ilaria Bini
- EULAR Young PARE, Zürich, Switzerland.,Anmar Young, Rome, Italy
| | - Nele Caeyers
- EULAR PARE, Zurich, Switzerland.,ReumaNET, Leuven, Belgium
| | - Laure Gossec
- Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, Paris, France.,APHP, Rheumatology Department, Pitie Salpetriere University Hospital, Paris, France
| | | | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK.,Rheumatology Department, King's College Hospital NHS Trust, London, UK
| | - Simon Stones
- EULAR Patient Research Partner, Manchester, UK.,University of Leeds, Leeds, West Yorkshire, UK
| | | | - Tanja A Stamm
- Section for Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Wien, Austria
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Nguyen MH, Huang FF, O’Neill SG. Patient-Reported Outcomes for Quality of Life in SLE: Essential in Clinical Trials and Ready for Routine Care. J Clin Med 2021; 10:jcm10163754. [PMID: 34442047 PMCID: PMC8396817 DOI: 10.3390/jcm10163754] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
Patient-reported outcome (PRO) instruments are widely used to assess quality of life in Systemic Lupus Erythematosus (SLE) research, and there is growing evidence for their use in clinical care. In this review, we evaluate the current evidence for their use in assessing quality of life in SLE in both research and clinical settings and examine the different characteristics of the commonly used PRO tools. There are now several well-validated generic and SLE-specific tools that have demonstrated utility in clinical trials and several tools that complement activity and damage measures in the clinical setting. PRO tools may help overcome physician–patient discordance in SLE and are valuable in the assessment of fibromyalgia and type 2 symptoms such as widespread pain and fatigue. Future work will identify optimal PRO tools for different settings but, despite current limitations, they are ready to be incorporated into patient care.
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Affiliation(s)
- Matthew H. Nguyen
- Liverpool Hospital, Liverpool, NSW 2170, Australia;
- Pathology Department, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Frank F. Huang
- Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia;
| | - Sean G. O’Neill
- Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia;
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
- Correspondence: ; Tel.: +61-02-94631890
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Dietz B, Katz P, Dall'Era M, Murphy LB, Lanata C, Trupin L, Criswell LA, Yazdany J. Major Depression and Adverse Patient-Reported Outcomes in Systemic Lupus Erythematosus: Results From a Prospective Longitudinal Cohort. Arthritis Care Res (Hoboken) 2021; 73:48-54. [PMID: 32741124 PMCID: PMC7775294 DOI: 10.1002/acr.24398] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/15/2020] [Accepted: 07/21/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Health-related quality of life (HRQoL) is reduced in systemic lupus erythematosus (SLE), partly driven by comorbid depression. Among patients with SLE, the association between major depression and HRQoL, measured using the NIH's Patient-Reported Outcomes Measurement Information System (PROMIS), is not well characterized. The objective was to determine an association between major depression and HRQoL as measured by PROMIS. METHODS Cross-sectional data were obtained from the California Lupus Epidemiology Study, a cohort of adults in the San Francisco Bay Area with SLE. We studied the association between major depression (score ≥10 on the Patient Health Questionnaire 8 depression scale) and T scores (scaled to population mean ± SD of 50 ± 10) on 12 PROMIS domains representing physical, mental, and social health. Mean T scores in depressed and nondepressed individuals were compared using multiple linear regression models adjusting for age, sex, race/ethnicity, disease activity, damage, body mass index, and household income. RESULTS Mean age of the 326 participants was 45 years; ~89% were women, 29% White, 23% Hispanic, 10% African American, and 36% Asian. One-fourth met the criteria for major depression. In multivariable analyses, major depression was independently associated with worse T scores on all 12 PROMIS domains (P < 0.001); compared with those without major depression, depressed individuals scored >10 points (1 SD) worse on fatigue, sleep impairment, negative psychosocial impact of illness, satisfaction in discretionary social activities, and satisfaction in social roles. CONCLUSION In individuals with SLE, major depression is associated with markedly worse PROMIS scores in physical, mental, and social domains. Diagnosing and treating depression may help improve HRQoL in individuals with SLE.
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Affiliation(s)
| | | | | | - Louise B Murphy
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Kenney-Riley K, Berkowitz SS, Rapoza K. Understanding patient-provider discordance in adolescents with lupus: The role of pain and antidepressant medication use. Health Psychol Open 2020; 7:2055102920977714. [PMID: 33343916 PMCID: PMC7727063 DOI: 10.1177/2055102920977714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The current study examines depression and pain as potential contributors to patient-provider discordance in the assessment of lupus disease activity. The study conducted a secondary analysis of data obtained from the Childhood Arthritis and Rheumatology Research Alliance registry, with N = 859 adolescent participants. Assessments of pain, disease activity, and antidepressant medication use were collected from the patient and provider. Results indicated that depression might be underdiagnosed in pediatric lupus patients. While psychotropic medication and pain scores were independently related to greater patient-provider discordance regarding health status, pain mediated this relationship. Implications for treatment outcomes are discussed.
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An Innovative Online Qualitative Study to Explore the Symptom Experience of Patients with Primary Sjögren's Syndrome. Rheumatol Ther 2020; 7:601-615. [PMID: 32725407 PMCID: PMC7410917 DOI: 10.1007/s40744-020-00220-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Primary Sjögren's syndrome (pSS) is a complex, heterogenous autoimmune disease; no immunomodulatory drug has demonstrated efficacy, and no current treatments target the underlying cause. This study aimed to explore the disease and treatment experiences of patients with pSS. METHODS This qualitative study (208399) comprised moderated online forum discussions and online one-to-one questions conducted in the USA over a 2-week period. Participants were self-reported patients with pSS; physician confirmation of diagnosis was sought. Participants described disease and symptom severity and satisfaction with current pSS treatments. Qualitative data analysis was performed using inductive coding analysis via open coding. RESULTS Fifty-two participants entered the study, of whom 48 provided analysable data. Symptoms were described as highly unpredictable and variable, with fatigue rated as the most severe and burdensome. Participants discussed how their pSS symptoms and the frequent need for regular treatment impacted their daily activities, social life, career and finances. Many participants perceived a poor understanding of pSS amongst physicians, leading to emotional distress and difficulties obtaining a diagnosis. All participants stated that an ideal medication would address the cause of pSS and not just treat symptoms. CONCLUSION New insights into patients' perspectives of pSS were generated from online discussion forums, revealing the additional impact of unpredictable symptoms and multiple symptomatic treatments to the high disease burden. Improving physician education of pSS may help to alleviate frustrations and delays associated with diagnosis; the advent of novel effective treatments would be welcomed by patients with pSS.
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Carter K, Tannous C, Walmsley S, Rome K, Turner DE. Linking the patient experience of foot involvement related to psoriatic arthritis to the International Classification of Functioning, Disability and Health. Rheumatol Adv Pract 2020; 4:rkaa028. [PMID: 32914051 PMCID: PMC7474858 DOI: 10.1093/rap/rkaa028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/16/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE The aim was to categorize the patient experience of PsA-related foot involvement by linking it to the International Classification of Functioning, Disability and Health (ICF) framework. METHODS Concepts, obtained from a previous qualitative investigation of people with PsA and health professionals into their perspective of PsA-related foot involvement, were linked to the full version of the ICF classification. Concepts were linked to the most appropriate ICF category using established linking rules, which enable a systematic and standardized linking process. All concepts were linked independently to the ICF by two investigators, followed by a third investigator for adjudication. The professional backgrounds of the investigators included occupational therapy and podiatry. RESULTS More than 100 distinct ICF categories were linked to the interview concepts. The most represented ICF category was body functions (35%), followed by environmental factors (31%), activities and participation (19%) and body structure (15%). Concepts that could not be linked to the ICF were related to coping, aspects of time and knowledge. Health professionals identified a greater proportion of body functions and fewer activity and participation categories compared with patients, indicating a possible mismatch of key concerns. Interdisciplinary group analysis demonstrated merit. CONCLUSION A list of ICF categories was generated, defining aspects of functioning important and relevant to the impact of PsA-related foot involvement. Despite the localized anatomical focus of this study, the effect of foot problems in PsA was linked to all components of the ICF, confirming the profound impact on functioning and daily life.
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Affiliation(s)
| | - Caterina Tannous
- Occupational Therapy Department, School of Health and Sciences, Western Sydney University, Sydney, NSW, Australia
| | | | - Keith Rome
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Science, AUT University, Auckland, New Zealand
| | - Deborah E Turner
- Podiatry Department
- Podiatry Department, School of Clinical Sciences, Queensland University of Technology, Queensland, Australia
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Katz P, Yazdany J, Trupin L, Rush S, Helmick CG, Murphy LB, Lanata C, Criswell LA, Dall'Era M. Psychometric Evaluation of the National Institutes of Health Patient-Reported Outcomes Measurement Information System in a Multiracial, Multiethnic Systemic Lupus Erythematosus Cohort. Arthritis Care Res (Hoboken) 2019; 71:1630-1639. [PMID: 30354017 DOI: 10.1002/acr.23797] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/16/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE We examined psychometric performance of Patient-Reported Outcomes Measurement Information System (PROMIS) measures in a racially/ethnically and linguistically diverse cohort with systemic lupus erythematosus (SLE). METHODS Data were from the California Lupus Epidemiology Study, a multiracial/multiethnic cohort of individuals with physician-confirmed SLE. The majority (n = 332) attended in-person research visits that included interviews conducted in English, Spanish, Cantonese, or Mandarin. Up to 12 PROMIS short forms were administered (depending on language availability). An additional 99 individuals completed the interview by phone only. Internal consistency was examined with Cronbach's alpha and item-total correlations. Correlations with the Short Form 36 subscales and both self-reported and physician-assessed disease activity assessed convergent validity. All analyses were repeated within each racial/ethnic group. Differences in scores by race/ethnicity were examined in bivariate analyses and by multiple regression analyses controlling for age, sex, disease duration, and disease damage and activity. RESULTS The total sample was 30.0% white, 22.3% Hispanic, 10.9% African American, 33.7% Asian, and 3.0% other race/ethnicity. Seventy-seven percent of interviews were conducted in-person. Non-English interviews were conducted in 26.0% of the Hispanic subjects and 18.6% of the Asian subjects. Each scale demonstrated adequate reliability and validity overall and within racial/ethnic groups. Minimal floor effects were observed, but ceiling effects were noted. Missing item responses were minimal for most scales, except for items related to work. No differences were noted by mode of administration or by language of administration among Hispanics and Asians. After accounting for differences in disease status, age, and sex, few differences in mean scores between whites and other racial/ethnic groups were noted. CONCLUSION PROMIS measures appear reliable and valid in persons with lupus across racial/ethnic groups.
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Affiliation(s)
| | | | | | | | | | - Louise B Murphy
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Gäbler G, Coenen M, Lycett D, Stamm T. Towards a standardized nutrition and dietetics terminology for clinical practice: An Austrian multicenter clinical documentation analysis based on the International Classification of Functioning, Disability and Health (ICF)-Dietetics. Clin Nutr 2019; 38:791-799. [DOI: 10.1016/j.clnu.2018.02.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/08/2018] [Accepted: 02/26/2018] [Indexed: 01/07/2023]
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Pisoni CN, Muñoz SA, Tamborenea MN, García M, Curti A, Cappuccio A, Rillo O, Imamura PM, Schneeberger E, Ballent M, Cousseau ML, Velasco Zamora J, Saurit V, Toloza S, Danielsen MC, Bellomio VI, Graf C, Paira S, Cavallasca J, Pons Estel B, Moreno JLC, Díaz M, Alba P, Verando M, Tate G, Mysler E, Sarano J, Civit EE, Risueño F, Álvarez Sepúlveda P, Larroude MS, Méndez MF, Conforti A, Sohn D. Work disability in Argentinian patients with systemic lupus erythematosus is prevalent and it is due to ethnic, socioeconomic and disease-related factors. Int J Rheum Dis 2018; 21:2019-2027. [PMID: 29611343 DOI: 10.1111/1756-185x.13269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the prevalence and the associated factors of work disability (WD) in systemic lupus erythematosus (SLE) patients. METHODS A sample of 419 SLE patients from an observational cross-sectional multicenter study was included. Sociodemographic features, disease characteristics, comorbidities, quality of life, unhealthy behaviors, and work-related factors were measured in a standardized interview. Work disability was defined by patient self-report of not being able to work because of SLE. To identify variables associated with work disability, two different multivariate regression models using a stepwise backward method were performed. RESULTS Prevalence of WD due to SLE was 24.3%. Eighty-nine percent were female and 51% were Caucasians. Mean disease duration was 8.9 ± 7.2 years, and median System Lupus International Collaborating Clinics/American College of Rheumatology damage index SLICC-SDI was 1.5 (range 0-17). In stepwise multivariate logistic regression, living below the poverty line (odds ratio [OR] = 4.65), less than 12 years of education (OR = 2.84), Mestizo ethnicity (OR = 1.94) and SLICC-SDI (OR = 1.25) were predictors of WD. A second model was performed including patient-derived measures; in this model sedentary lifestyle (OR = 2.69) and lower emotional health domain score of the Lupus Quality of Life (LupusQoL) questionnaire (OR = 1.03) were found to be associated to WD and a higher score in LupusQoL physical health domain (OR = 0.93) was protective. CONCLUSION The prevalence of WD in Argentinian SLE patients was 24.3%. WD was associated with ethnic (Mestizo), socioeconomic (poverty) and disease-related factors. Patient-related outcomes such us sedentary lifestyle and poor emotional quality of life were also associated with WD.
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Affiliation(s)
- Cecilia N Pisoni
- Immunology and Rheumatology Section, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Ciudad Autónoma de, Buenos Aires, Argentina
| | - Sebastián A Muñoz
- Hospital General de Agudos Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - María N Tamborenea
- Organización Médica de Investigaciones (OMI), Ciudad Autónoma de Buenos Aires, Argentina
| | - Mercedes García
- Hospital Interzonal General de Agudos "General José de San Martín", Ciudad Autónoma de Buenos Aires, Argentina, Ciudad de La Plata, Argentina
| | - Ana Curti
- Hospital de Clínicas "José de San Martín", Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana Cappuccio
- Hospital Cesar Milstein, Ciudad Autónoma de Buenos Aires, Argentina
| | - Oscar Rillo
- Hospital General de Agudos "Dr. Ignacio Pirovano", Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Emilce Schneeberger
- Instituto de Rehabilitación Psicofísica (IREP), Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | | | - Verónica Saurit
- Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina
| | - Sergio Toloza
- Hospital Interzonal San Juan Bautista, Fernando del Valle de Catamarca, Argentina
| | | | | | - Cesar Graf
- Centro Médico Mitre, Ciudad de Paraná, Argentina
| | - Sergio Paira
- Hospital José Maria Cullen, Ciudad de Santa Fé, Argentina
| | - Javier Cavallasca
- Hospital José Bernardo Iturraspe, Ciudad de San Francisco, Argentina
| | | | | | - Mónica Díaz
- Centro Traumatológico Bariloche, Ciudad de San Carlos de Bariloche, Argentina
| | - Paula Alba
- Hospital de Córdoba, Ciudad de Córdoba, Argentina
| | - Marcela Verando
- Hospital General de Agudos Bernardino Rivadavia, Ciudad Autónoma de Buenos Aires, Argentina
| | - Guillermo Tate
- Organización Médica de Investigaciones (OMI), Ciudad Autónoma de Buenos Aires, Argentina
| | - Eduardo Mysler
- Organización Médica de Investigaciones (OMI), Ciudad Autónoma de Buenos Aires, Argentina
| | - Judith Sarano
- Instituto de Investigaciones Médicas "Dr. Alfredo Lanari", Ciudad Autónoma de Buenos Aires, Argentina
| | - Emma E Civit
- Hospital del Carmen, Ciudad de Godoy Cruz, Argentina
| | | | | | - María S Larroude
- Hospital Cesar Milstein, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | - Débora Sohn
- Instituto de Diagnóstico Roche, Ciudad de Escobar, Argentina
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The Role of Patient-Reported Outcomes in Systemic Lupus Erythematosus. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2017. [DOI: 10.1007/s40674-017-0079-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ng X, dosReis S, Beardsley R, Magder L, Mullins CD, Petri M. Understanding systemic lupus erythematosus patients' desired outcomes and their perceptions of the risks and benefits of using corticosteroids. Lupus 2017; 27:475-483. [PMID: 28857718 DOI: 10.1177/0961203317726375] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction The use of corticosteroids in systemic lupus erythematosus (SLE) patients requires difficult trade-offs between efficacy and risk of toxicity. This qualitative study examined SLE patients' most desired outcomes and their concerns with corticosteroid use in SLE treatment. Methods SLE patients with current/past experience with using corticosteroids were recruited from the clinics at the Johns Hopkins Lupus Center and the University of Maryland Medical Center. Five in-depth interviews ( N = 5) and four focus groups ( N = 15) were conducted during which discussions were transcribed and analyzed based on a grounded theory approach. Results We identified five major themes describing SLE patients' most desired outcomes: reduction in flares, maintenance of normal activities, minimization of treatment side effects, prevention of future organ damage, and finding a cure. Further, SLE patients reported these primary concerns with the adverse effects of corticosteroids: weight gain, organ damage (particularly bone-related damage), mood swings/irritability, sleep disturbances, and dental issues. Patients appeared to be more concerned with adverse effects that immediately affected their day-to-day lives. Conclusion Knowledge gained during this study better informs how patients view the benefits and risks of corticosteroids. This can facilitate discussions between physicians and patients as they work together to determine the appropriate use of corticosteroids.
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Affiliation(s)
- X Ng
- 1 Department of Pharmaceutical Health Services Research, 12265 University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - S dosReis
- 1 Department of Pharmaceutical Health Services Research, 12265 University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - R Beardsley
- 1 Department of Pharmaceutical Health Services Research, 12265 University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - L Magder
- 2 Department of Epidemiology and Public Health, 12265 University of Maryland School of Medicine, Baltimore, MD, USA
| | - C D Mullins
- 1 Department of Pharmaceutical Health Services Research, 12265 University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - M Petri
- 3 Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Schneider M, Mosca M, Pego-Reigosa JM, Gunnarsson I, Maurel F, Garofano A, Perna A, Porcasi R, Devilliers H. Cross-cultural validation of Lupus Impact Tracker in five European clinical practice settings. Rheumatology (Oxford) 2017; 56:818-828. [PMID: 28204765 DOI: 10.1093/rheumatology/kew492] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives The aim was to evaluate the cross-cultural validity of the Lupus Impact Tracker (LIT) in five European countries and to assess its acceptability and feasibility from the patient and physician perspectives. Methods A prospective, observational, cross-sectional and multicentre validation study was conducted in clinical settings. Before the visit, patients completed LIT, Short Form 36 (SF-36) and care satisfaction questionnaires. During the visit, physicians assessed disease activity [Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLEDAI], organ damage [SLICC/ACR damage index (SDI)] and flare occurrence. Cross-cultural validity was assessed using the Differential Item Functioning method. Results Five hundred and sixty-nine SLE patients were included by 25 specialists; 91.7% were outpatients and 89.9% female, with mean age 43.5 (13.0) years. Disease profile was as follows: 18.3% experienced flares; mean SELENA-SLEDAI score 3.4 (4.5); mean SDI score 0.8 (1.4); and SF-36 mean physical and mental component summary scores: physical component summary 42.8 (10.8) and mental component summary 43.0 (12.3). Mean LIT score was 34.2 (22.3) (median: 32.5), indicating that lupus moderately impacted patients' daily life. A cultural Differential Item Functioning of negligible magnitude was detected across countries (pseudo- R 2 difference of 0.01-0.04). Differences were observed between LIT scores and Physician Global Assessment, SELENA-SLEDAI, SDI scores = 0 (P < 0.035) and absence of flares (P = 0.004). The LIT showed a strong association with SF-36 physical and social role functioning, vitality, bodily pain and mental health (P < 0.001). The LIT was well accepted by patients and physicians. It was reliable, with Cronbach α coefficients ranging from 0.89 to 0.92 among countries. Conclusion The LIT is validated in the five participating European countries. The results show its reliability and cultural invariability across countries. They suggest that LIT can be used in routine clinical practice to evaluate and follow patient-reported outcomes in order to improve patient-physician interaction.
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Affiliation(s)
- Matthias Schneider
- Policlinic of Rheumatology, Hiller Research Unit, Heinrich-Heine University, Düsseldorf, Germany
| | - Marta Mosca
- Department of Internal Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - José-Maria Pego-Reigosa
- Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Ourense y Pontevedra, Spain
| | - Iva Gunnarsson
- Department of Medicine, Unit of Rheumatology, Karolinska Institutet, Solna, Sweden
| | - Frédérique Maurel
- HEOR, Real-World Evidence Solutions (RWES) unit, IMS Health, Paris-La Défense, France
| | - Anna Garofano
- HEOR, Real-World Evidence Solutions (RWES) unit, IMS Health, Paris-La Défense, France
| | - Alessandra Perna
- Global Specialty Pharma Franchise, GlaxoSmithKline; Services Unlimited, Brentford, UK
| | - Rolando Porcasi
- Immunology Medical Department, GlaxoSmithKline spa, Verona, Italy
| | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases, University Hospital of Dijon, 5bis INSERM U866 5ter INSERM CIC-EC 1432, Dijon, France
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Stummvoll G, Stamm T. The patients' perspective: living with lupus in Austria. Wien Klin Wochenschr 2017; 129:593-597. [PMID: 28229290 PMCID: PMC5599433 DOI: 10.1007/s00508-017-1175-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/28/2017] [Indexed: 12/28/2022]
Abstract
Systemic lupus erythematosus (SLE) is a heterogeneous disease with a vast variety of clinical manifestations. Timely diagnosis is important for gaining access to specific therapy and care. In this survey, we asked SLE patients with an established diagnosis to report about their personal history and their daily life with SLE in order to gain knowledge about diagnostics, treatment pathways and potential problems in daily living and functioning. In most cases, the diagnosis of SLE was made by a specialist in rheumatology or dermatology. Of the patients 41.5% were diagnosed within the first year after onset of disease symptoms, while 37.3% of the patients waited for 3 or more years for the final diagnosis of SLE. Interestingly, we found no differences with respect to patients living in urban or rural areas. Specific therapy worked well in many but not in all patients: the majority of patients reported problems with paid work, social life and leisure activities including traveling. Patients reported a need for better information for the general public about SLE. In addition, they wanted be better informed themselves. Despite all successful efforts in recent years, there is still room for improvement with respect to early diagnosis, early start of specific therapy and for better information of the public on the mysterious disorder named SLE.
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Affiliation(s)
- Georg Stummvoll
- Department of Rheumatology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Tanja Stamm
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
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Lackner A, Ficjan A, Stradner MH, Hermann J, Unger J, Stamm T, Stummvoll G, Dür M, Graninger WB, Dejaco C. It's more than dryness and fatigue: The patient perspective on health-related quality of life in Primary Sjögren's Syndrome - A qualitative study. PLoS One 2017; 12:e0172056. [PMID: 28182787 PMCID: PMC5300216 DOI: 10.1371/journal.pone.0172056] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/30/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES In Primary Sjögren's Syndrome (PSS), there is an apparent lack of data concerning the perspectives of patients, their needs, preferences and difficulties of daily life. This qualitative study was conducted to explore perspectives and needs of patients with PSS that influence health related quality of life (HRQL). METHODS We recruited 20 PSS patients fulfilling the American-European consensus classification criteria out of the PSS cohort of the Medical University Graz, Austria. In total, 6 focus group sessions (with three to four patients per group) were performed. A modified meaning condensation procedure was used to analyse the data. RESULTS The interview analysis resulted in 484 meaning units, 254 subconcepts and 86 concepts. The identified concepts were grouped into three dimensions: physical dimension, psychological & emotional challenges and social life & daily living. A dependency between the three categories was identified. The concepts most commonly reported by patients were related to the physical dimension: pain and dryness as well as complaints associated with/provoked by these symptoms. Patients also reported shortness of breath, fatigue und constipation. CONCLUSIONS This qualitative study underpins that HRQL in PSS patients is affected by several factors. The problems are not limited to dryness, pain and fatigue while the complaints secondary to these symptoms are important to patients with PSS significantly affecting physical, psychological and social life components of HRQL. A disease-specific patient related outcome measures for clinical practice and trials should be developed considering the different aspects of HRQL in PSS.
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Affiliation(s)
- Angelika Lackner
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Anja Ficjan
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Martin H. Stradner
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Josef Hermann
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Julia Unger
- University of Applied Sciences JOANNEUM, Department of Health Studies, Institute of Occupational Therapy, Bad Gleichenberg, Austria
| | - Tanja Stamm
- Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Georg Stummvoll
- Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Mona Dür
- IMC University of Applied Sciences Krems, Krems an der Donau, Austria
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Vienna, Austria
| | - Winfried B. Graninger
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Christian Dejaco
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University Graz, Graz, Austria
- Rheumatology Service, South Tyrolean Health Trust, Hospital of Bruneck, Bruneck, Italy
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Abstract
Successful management of complex conditions such as systemic lupus erythematosus (SLE) and comorbid conditions benefit from patient-reported outcomes (PRO). Measuring health-related quality of life with PROs provides SLE patients with an opportunity to participate in their treatment and to facilitate better communication with the multidisciplinary team involved in their care. Health outcomes research has produced well-validated instruments that can be used across diseases; others have been specifically developed for SLE. The use of generic and SLE-specific PROs depends on needs, including population monitoring, treatment decision making, clinical trials research, and for evaluating and comparing the effect of therapies.
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Dür M, Coenen M, Stoffer MA, Fialka-Moser V, Kautzky-Willer A, Kjeken I, Drăgoi RG, Mattsson M, Boström C, Smolen J, Stamm TA. Do patient-reported outcome measures cover personal factors important to people with rheumatoid arthritis? A mixed methods design using the International Classification of Functioning, Disability and Health as frame of reference. Health Qual Life Outcomes 2015; 13:27. [PMID: 25879438 PMCID: PMC4379722 DOI: 10.1186/s12955-015-0214-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 01/24/2015] [Indexed: 02/08/2023] Open
Abstract
Background Personal factors (PFs) are internal factors that determine functioning and the individuals’ experience of disability. Their coverage by patient-reported outcome measures (PROMs) has not been examined in rheumatoid arthritis (RA) so far. The aims of this study were to identify PFs important in the life stories of people with RA and to determine their coverage by PROMs used in RA. Methods The qualitative data of people with RA was explored to identify PFs. Additionally a systematic literature search was conducted to find PROMs used in RA. PROMs items were linked to the components, domains and categories of the International Classification of Functioning, Disability and Health (ICF) to determine the coverage of important PFs by PROMs. Results Twelve PFs were found to be important in the life stories of people with RA. The PFs coping and reflecting about one’s life in an optimistic way were covered most frequently, each by 14 of the 42 explored PROMs, while job satisfaction was not covered at all. The London Coping with Rheumatoid Arthritis Questionnaire, General Self-Efficacy Scale, Arthritis Self-Efficacy Scale, Rheumatoid Arthritis Self-Efficacy Questionnaire and Revised Ways of Coping Inventory covered most PFs. Nineteen PROMs did not cover any of the PFs. Conclusion Several PFs were identified as important in the life stories of people with RA, but only 55% of the PROMS covered some of these PFs. When evaluating PFs important to people with RA, health professionals should be alert on which PROMs can be used to assess which PFs.
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Affiliation(s)
- Mona Dür
- Medical University of Vienna, Department of Internal Medicine III, Division of Rheumatology, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,IMC University of Applied Sciences Krems, Department of Health Sciences, Occupational Therapy, Piaristengasse 1, 3500, Krems, Austria.
| | - Michaela Coenen
- Ludwig-Maximilians-University, Department of Medical Informatics, Biometry and Epidemiology, Research Unit for Bio Psychosocial Health, Marchioninistraße 17, 81377, Munich, Germany.
| | - Michaela Alexandra Stoffer
- Medical University of Vienna, Department of Internal Medicine III, Division of Rheumatology, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Veronika Fialka-Moser
- Medical University of Vienna, Department of Physical Medicine and Rehabilitation, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Alexandra Kautzky-Willer
- Medical University of Vienna, Department of Internal Medicine III, Division of Diabetology, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Ingvild Kjeken
- Diakonhjemmet Hospital, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Postbox 23 Vinderen, 0319, Oslo, Norway.
| | - Răzvan Gabriel Drăgoi
- "Victor Babeş" University of Medicine and Pharmacy, Department of Rehabilitation, Physical Medicine and Rheumatology, Piata Eftimie Murgu 2, Timişoara, 300041, Timis, Romania.
| | - Malin Mattsson
- Luleå University of Technology, Department of Health Sciences, SE-971 87, Luleå, Sweden. .,Sunderby Hospital, Department of Physiotherapy, SE-971 80, Luleå, Sweden.
| | - Carina Boström
- Karolinska Institutet, Department of Neurobiology, Care sciences and Society, Division of Physiotherapy, Alfred Nobels Allé 23, 141 83 Huddinge, Stockholm, Sweden.
| | - Josef Smolen
- Medical University of Vienna, Department of Internal Medicine III, Division of Rheumatology, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Tanja Alexandra Stamm
- Medical University of Vienna, Department of Internal Medicine III, Division of Rheumatology, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Fachhochschule Campus Wien, University of Applied Sciences, Department of Health, Favoritenstraße 226, 1100, Vienna, Austria.
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Leuchten N, Bauernfeind B, Kuttner J, Stamm T, Smolen JS, Pisetsky DS, Aringer M. Relevant concepts of functioning for patients with systemic lupus erythematosus identified in a Delphi exercise of experts and a literature review. Arthritis Care Res (Hoboken) 2015; 66:1895-904. [PMID: 24839085 DOI: 10.1002/acr.22372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 05/13/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify in a Delphi exercise of international systemic lupus erythematosus (SLE) experts and a systematic literature review the most relevant concepts that impact on the functioning of SLE patients. METHODS Sixty SLE experts participated in all rounds of a 3-round e-mail-based Delphi exercise; for the literature review, 573 manuscripts out of 4 decades were analyzed. Concepts in the first Delphi round and from the literature were linked to categories of the International Classification of Functioning, Disability and Health (ICF). Categories were voted on individually in a feedback-driven Delphi process, and ranked by frequency in the literature, respectively. RESULTS In the Delphi exercise, at least 80% of the participants found 30 categories of the domain body functions and structures, and 3 categories in the domain activities and participation and environmental factors important. In general, the categories identified in the literature review overlapped with those in the Delphi exercise with regard to body functions and structures, while showing some differences in other domains. The highest agreement concerned the ICF categories "joints," "skin and related structures," "fatiguability," "immunological system functions," and "handling stress and other psychological demands." Agreement with an earlier patient Delphi exercise was considerable. CONCLUSION A 3-step Delphi exercise of 60 SLE experts and a literature review identified a wide spectrum of relevant ICF categories with impact on functioning of SLE patients. The categories derived from these approaches overlap with each other and with those of a patient Delphi exercise.
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Affiliation(s)
- Nicolai Leuchten
- University Medical Center Carl Gustav Carus, Technische Universitaet of Dresden, Dresden, Germany
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Malcus Johnsson P, Sandqvist G, Nilsson JÅ, Bengtsson AA, Sturfelt G, Nived O. Hand function and performance of daily activities in systemic lupus erythematosus: a clinical study. Lupus 2014; 24:827-34. [PMID: 25542902 DOI: 10.1177/0961203314565690] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 12/03/2014] [Indexed: 11/17/2022]
Abstract
This clinical study was performed to investigate hand problems in individuals with systemic lupus erythematosus (SLE) in comparison with healthy controls, and to explore problems in the performance of daily activities related to these hand problems, in order to objectify findings from a previous mail survey. We also investigated whether a simple hand test could detect hand problems in SLE. All individuals, 71 with SLE and 71 healthy controls, were examined for manifestations in body structures and body functions of the hands with a study-specific protocol. The simple hand test was performed by all the individuals and the arthritis impact measurement scale (AIMS 2) questionnaire was completed by the SLE individuals. In the SLE group, 58% had some kind of difficulty in the simple hand test, compared with 8% in the control group. Fifty percent of the SLE individuals experienced problems in performing daily activities due to hand deficits. Pain in the hands, reduced strength and dexterity, Raynaud's phenomenon and trigger finger were the most prominent body functions affecting the performance of daily activities. Deficits in hand function are common in SLE and affect the performance of daily activities. The simple hand test may be a useful tool in detecting hand problems.
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Affiliation(s)
- P Malcus Johnsson
- Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden
| | - G Sandqvist
- Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden
| | - J-Å Nilsson
- Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden
| | - A A Bengtsson
- Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden
| | - G Sturfelt
- Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden
| | - O Nived
- Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden
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Stamm T. Medical versus bio-psycho-social model: possible reasons why the ICF is hardly used in Austria from an occupational therapy perspective. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2014. [DOI: 10.1179/otb.2009.59.1.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Alves VLP, Carniel AQ, Costallat LTL, Turato ER. Meanings of the sickening process for patients with systemic lupus erythematosus: a review of the literature. REVISTA BRASILEIRA DE REUMATOLOGIA 2014; 55:522-7. [PMID: 25440711 DOI: 10.1016/j.rbr.2014.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 07/12/2014] [Accepted: 08/26/2014] [Indexed: 12/22/2022] Open
Abstract
Systemic lupus erythematosus is an autoimmune disease that causes many psychological repercussions that have been studied through qualitative research. These are considered relevant, since they reveal the amplitude experienced by patients. Given this importance, this study aims to map the qualitative production in this theme, derived from studies of experiences of adult patients of both genders and that had used as a tool a semi-structured interview and/or field observations, and had made use of a sampling by a saturation criterion to determine the number of participants in each study. The survey was conducted in Pubmed, Lilacs, Psycinfo e Cochrane databases, searching productions in English and Portuguese idioms published between January 2005 and June 2012. The 19 revised papers that have dealt with patients in the acute phase of the disease showed themes that were categorized into eight topics that contemplated the experienced process at various stages, from the onset of the disease, extending through the knowledge of the diagnosis and the understanding of the manifestations of the disease, drug treatment and general care, evolution and prognosis. The collected papers also point to the difficulty of understanding, of the patients, on what consists the remission phase, revealing also that this is a clinical stage underexplored by psychological studies.
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Jolly M, Garris CP, Mikolaitis RA, Jhingran PM, Dennis G, Wallace DJ, Clarke A, Dooley MA, Parke A, Strand V, Alárcon GS, Kosinski M. Development and Validation of the Lupus Impact Tracker: A Patient-Completed Tool for Clinical Practice to Assess and Monitor the Impact of Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2014; 66:1542-50. [DOI: 10.1002/acr.22349] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 04/08/2014] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | - Daniel J. Wallace
- Cedars-Sinai Medical Center and David Geffen School of Medicine at the University of California; Los Angeles
| | - Ann Clarke
- McGill University; Montreal, Quebec Canada
| | | | - Ann Parke
- University of Connecticut at St. Francis Hospital and Medical Center; Hartford
| | - Vibeke Strand
- biopharmaceutical consultant; Portola Valley California
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Stamm T, Hieblinger R, Boström C, Mihai C, Birrell F, Thorstensson C, Fialka-Moser V, Meriaux-Kratochvila S, Smolen J, Coenen M. Similar problem in the activities of daily living but different experience: a qualitative analysis in six rheumatic conditions and eight European countries. Musculoskeletal Care 2014; 12:22-33. [PMID: 23362188 DOI: 10.1002/msc.1047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of the present study was to compare and contrast the concepts of functioning in daily life which were important to patients with different rheumatological conditions. METHOD The study comprised a qualitative analysis of 44 focus groups in eight European countries, in 229 patients with fibromyalgia, hand osteoarthritis, psoriatic arthritis, rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis, using the World Health Organization, 2001 International Classification of Functioning, Disability and Health as a framework. Concepts and - where necessary - also sub-concepts and transcripts were combined and compared independently by two researchers who, in case of disagreement, achieved consensus through discussion. RESULTS Twenty concepts out of 109 (e.g. body image, fatigue, emotional issues, mobility and hand function) were similarly described in all six diseases. However, even if the same concept was mentioned, patients' experiences were different, such as mental AND physical aspects limiting the ability to drive in patients with fibromyalgia compared with ONLY physical problems in all other diseases. Within body functions and structures, several concepts were relevant for certain conditions only. CONCLUSION A large number of similar problems are mentioned as 'typical' by patients with different rheumatic conditions. These could probably be targeted, using a disease-specific approach, in interventions by non-physician health professionals.
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Affiliation(s)
- Tanja Stamm
- Medical University of Vienna, Department of Internal Medicine III, Division of Rheumatology, Vienna, Austria; FH Campus Wien, University of Applied Sciences, Department of Health, Vienna, Austria
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Leiss H, Niederreiter B, Bandur T, Schwarzecker B, Blüml S, Steiner G, Ulrich W, Smolen JS, Stummvoll GH. Pristane-induced lupus as a model of human lupus arthritis: evolvement of autoantibodies, internal organ and joint inflammation. Lupus 2014; 22:778-92. [PMID: 23817510 DOI: 10.1177/0961203313492869] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Arthritis is frequently seen in human lupus, but rarely in lupus models. Pristane-induced lupus (PIL) can be induced in various mouse strains such as BALB/c and C57BL/6. We herein characterize clinical and histological features of arthritis in the context of systemic lupus and provide a prudent comparison with models of rheumatoid arthritis (RA). METHODS A total of 57 BALB/c mice received pristane (PIL group) and were analyzed for serum autoantibodies (anti-chromatin-, -histone, -Sm, -dsDNA), as well as for clinical features and histopathology of joints, lungs and kidneys. Joint pathology was quantified by image analysis and tissue cytometry. Ten C57BL/6 mice (Bl/6-PIL) and historical groups of two different RA models were analyzed accordingly. RESULTS In BALB/c PIL, clinical arthritis started at three months, occurred finally in 79% of PIL (but not in controls, p<0.001) and correlated with areas of inflammation, erosion, cartilage damage, osteoclast numbers and total severity score (for all: r>0.7, p<0.001). After eight months, 58% of PIL (but no controls, p<0.001) had mild-erosive arthritis. In contrast to RA, the most frequent inflammatory cell type of the pannus was granulocytes (17.7%), PIL had lower numbers of osteoclasts, erosions rarely affected both layers of the cortical bone and there was no progression to complete joint destruction (even after one year of observation). Serum autoantibodies (auto-abs) preceded arthritis and became significantly elevated in all PIL; affected joints showed increased deposits of IgG (and IgM) within the inflammatory tissue, indicative of an ab-mediated process. PIL mice with arthritis also showed signs of pulmonary (100%) and renal (46%) lupus. In contrast to BALB/c, Bl/6-PIL mice did not develop any signs of arthritis. CONCLUSION PIL in BALB/c mice is characterized by severe organ involvement, typical autoabs and by a mild-erosive arthritis with similarities to, but also with distinct differences from, RA. PIL may help to study arthritis along with other key features of systemic lupus erythematosus after therapeutic interventions or in knock-out models based on a BALB/c but not on a C57BL/6 background.
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Affiliation(s)
- H Leiss
- Department of Rheumatology, Medical University of Vienna, Austria
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Dür M, Sadloňová M, Haider S, Binder A, Stoffer M, Coenen M, Smolen J, Dejaco C, Kautzky-Willer A, Fialka-Moser V, Moser G, Stamm TA. Health determining concepts important to people with Crohn's disease and their coverage by patient-reported outcomes of health and wellbeing. J Crohns Colitis 2014; 8:45-55. [PMID: 23375212 PMCID: PMC3889494 DOI: 10.1016/j.crohns.2012.12.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 12/14/2012] [Accepted: 12/30/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Busy clinical settings often restrict the possibility to focus on concepts that determine health in a positive way, commonly assessed by using patient-reported outcomes (PROs). We aimed to explore which determinants of health (DHs) are important to people with Crohn's disease (CD), to understand possible gender differences and to analyze whether these DHs are covered by PROs used in CD. METHODS Two systematic literature reviews were done to identify relevant DHs and clinically relevant PROs. We conducted a qualitative narrative biographical study and mapped the patients' experiences to concepts that determine health in a positive way. Experiences, DHs and the items of the PROs were compared by the WHO International Classification of Functioning, Disability and Health (ICF) as a common framework. RESULTS 15 people with CD with a median age of 46 years (IQR 34-60) and median disease duration of 15 years (IQR 8-30) participated. Self-efficacy, social support, job satisfaction and occupational balance were mentioned most frequently. While participation appeared to have greater meaning to men, appreciation and resilience seemed to be more important for women. Of 18 PROs the Perceived Stress Questionnaire (PSQ), the Inflammatory Bowel disease - Self-efficacy scale (IBD-SES), the Life Orientation Test - Revised (LOT-R) and the Patient Activation Measure 13 (PAM-13) cover most DHs. CONCLUSIONS This is the first study elaborating the coverage of patient's perspective by commonly used PROs in CD. The findings could support health professionals to focus on DHs in people with CD in clinical practice and research.
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Affiliation(s)
- Mona Dür
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Austria.
| | - Martina Sadloňová
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Austria.
| | - Stefanie Haider
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Austria.
| | - Alexa Binder
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Austria.
| | - Michaela Stoffer
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Austria.
| | - Michaela Coenen
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany.
| | - Josef Smolen
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Austria.
| | - Clemens Dejaco
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria.
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Division of Diabetology, Medical University of Vienna, Austria.
| | - Veronika Fialka-Moser
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Austria.
| | - Gabriele Moser
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria.
| | - Tanja Alexandra Stamm
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Austria.
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Sarac C, Bastiaansen E, Van der Holst M, Malessy MJA, Nelissen RGHH, Vliet Vlieland TPM. Concepts of functioning and health important to children with an obstetric brachial plexus injury: a qualitative study using focus groups. Dev Med Child Neurol 2013; 55:1136-42. [PMID: 24127685 DOI: 10.1111/dmcn.12270] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 11/30/2022]
Abstract
AIMS The aims of this study were to explore and understand the perspectives of children with an obstetric brachial plexus injury (OBPI) regarding functioning and health, and to create an overview of problems and difficulties that patients encounter in daily life. METHOD We conducted a focus group study with 48 children (25 male, 23 female), aged 8 to 18 years, with an OBPI. Eleven open-ended questions regarding problems or difficulties in daily life were asked in group sessions with 4 to 7 children within the same age range. These group sessions were tape-recorded and transcribed verbatim. All problems and difficulties mentioned in each focus group were linked to corresponding categories of the International Classification of Functioning, Disability and Health - Children & Youth Version (ICF-CY). RESULTS Eight focus groups were conducted. A total of 143 unique ICF-CY categories were identified. Of these categories, 61 (43%) were related to the ICF-CY component 'activities and participation', 31 (22%) were related to 'body functions', 29 (20%) were related to 'environmental factors', and 22 (15%) were related to 'body structures'. INTERPRETATION This study shows that children with OBPI experience difficulties in all areas of functioning, as well as in both environmental and personal factors.
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Affiliation(s)
- Cigdem Sarac
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Sterling K, Gallop K, Swinburn P, Flood E, French A, Al Sawah S, Iikuni N, Naegeli A, Nixon A. Patient-reported fatigue and its impact on patients with systemic lupus erythematosus. Lupus 2013; 23:124-32. [PMID: 24197552 DOI: 10.1177/0961203313511554] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fatigue is a hallmark symptom of systemic lupus erythematosus (SLE), often associated with flares, side effects of treatment, and extensive organ damage and may have a significant impact on health-related quality of life (HrQoL). To date, the experience of fatigue in patients with SLE is underexplored. This study explored the experience of fatigue in patients with SLE and its impact on their lives through qualitative interviews. This cross-sectional qualitative study was conducted with 22 adult patients with SLE, recruited from two clinical sites in the United States. In-person semi-structured interviews were conducted and thematic analysis was performed focusing on the experience of fatigue in SLE. Results indicated that 21 out of 22 patients experienced fatigue due to SLE. Patients reported that fatigue was variable in nature in terms of both severity and frequency. Fatigue was described as having an impact on multiple aspects of a patient's life: emotions, cognition, work, activities of daily living, leisure activities, social activities, and family activities. Understanding how patients with SLE describe the symptom of fatigue and how it impacts their lives is the key to better understanding how to measure fatigue in clinical studies evaluating new treatments for SLE.
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Affiliation(s)
- Kl Sterling
- 1Eli Lilly and Company, Indianapolis, IN, USA
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Sutanto B, Singh-Grewal D, McNeil HP, O'Neill S, Craig JC, Jones J, Tong A. Experiences and Perspectives of Adults Living With Systemic Lupus Erythematosus: Thematic Synthesis of Qualitative Studies. Arthritis Care Res (Hoboken) 2013; 65:1752-65. [DOI: 10.1002/acr.22032] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/03/2013] [Accepted: 04/10/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Bernadet Sutanto
- University of Sydney and The Children's Hospital at Westmead; Sydney, New South Wales Australia
| | - Davinder Singh-Grewal
- University of Sydney, The Children's Hospital at Westmead, University of New South Wales, and Liverpool Hospital; Sydney, New South Wales Australia
| | - H. Patrick McNeil
- University of New South Wales and Liverpool Hospital; Sydney, New South Wales Australia
| | - Sean O'Neill
- University of New South Wales and Liverpool Hospital; Sydney, New South Wales Australia
| | - Jonathan C. Craig
- University of Sydney and The Children's Hospital at Westmead; Sydney, New South Wales Australia
| | - Julie Jones
- University of Sydney; Sydney, New South Wales Australia
| | - Allison Tong
- University of Sydney and The Children's Hospital at Westmead; Sydney, New South Wales Australia
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Dua AB, Touma Z, Toloza S, Jolly M. Top 10 Recent Developments in Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus. Curr Rheumatol Rep 2013; 15:380. [DOI: 10.1007/s11926-013-0380-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kasitanon N, Wangkaew S, Puntana S, Sukitawut W, Leong KP, Louthrenoo W. The reliability, validity and responsiveness of the Thai version of systemic lupus erythematosus quality of life (SLEQOL-TH) instrument. Lupus 2013; 22:289-96. [DOI: 10.1177/0961203312474702] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The English version of the Systemic Lupus Erythematosus Quality of Life Questionnaire (SLEQOL) is a validated disease-specific quality of life instrument. The aim of this study was to evaluate the psychometric properties of the Thai version of the SLEQOL (SLEQOL-TH). Methods Two independent translators translated the SLEQOL into Thai. The back translation of this version was performed by two other independent translators. The final version, SLEQOL-TH, was completed after resolving the discrepancies revealed by the back translation. One hundred and nine patients with SLE were enrolled to test the reliability, construct validity, floor and ceiling effects, and sensitivity to the changes of the SLEQOL-TH at six months. The differential item functioning (DIF) between the Thai and English versions was analyzed using the partial gamma. Results The internal consistency of the SLEQOL-TH was satisfactory with the overall Cronbach’s alpha of 0.86. The test-retest reliability of the SLEQOL-TH was acceptable with the intra-class correlation coefficient of 0.86. Low correlations between the SLEQOL-TH and SLEDAI were observed. The total score of the SLEQOL-TH was moderately responsive to changes in quality of life, with a standardized response mean of 0.50. When comparing the SLEQOL-TH from Thai SLE patients with the original SLEQOL version obtained from Singapore SLE patients, 11 out of 40 items showed a moderate to large DIF. Conclusions The SLEQOL-TH has acceptable psychometric properties and shows construct validity. In comparison with the English version of SLEQOL, there are some items that showed DIF. The applicability of the SLEQOL-TH in real-life clinical practice and clinical trials needs to be determined.
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Affiliation(s)
- N Kasitanon
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand
| | - S Wangkaew
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand
| | - S Puntana
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand
| | - W Sukitawut
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand
| | - KP Leong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore and Health Promotion Board, Singapore
| | - W Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand
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Sabariego C, Barrera AE, Neubert S, Stier-Jarmer M, Bostan C, Cieza A. Evaluation of an ICF-based patient education programme for stroke patients: a randomized, single-blinded, controlled, multicentre trial of the effects on self-efficacy, life satisfaction and functioning. Br J Health Psychol 2012; 18:707-28. [PMID: 23252844 DOI: 10.1111/bjhp.12013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 11/05/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There is a current need for interventions that provide information to stroke survivors in a patient-centred, interactive, personalized and flexible manner. To this purpose, a standardized but content-flexible patient education programme based on the International Classification of Functioning, Disability and Health (ICF) was developed. This study evaluated the effect of this programme on perceived self-efficacy. DESIGN Single-blind, randomized, multi-centre controlled trial. METHODS Stroke patients undergoing neurological rehabilitation were enrolled. Perceived self-efficacy was measured with the Liverpool Self-Efficacy Scale. Secondary outcomes were life satisfaction and self-perception of the impact of the stroke on life, measured with the WHOQOL and the Stroke Impact Scale, respectively. Data obtained at baseline, post-intervention and 6-month follow-up were analysed using multi-level models of change. RESULTS Two hundred and thirteen patients received either the ICF-based patient education (n = 110) or an attention-placebo (n = 103) control intervention. Over time, patients' self-efficacy (p < .01) and participation (p < .01) improved, while emotional functioning (p < .01) deteriorated, although no significant between-group differences were observed. Explorative analyses showed that gender, loci of control, difficulty in accessing health services after discharge and life satisfaction were significant predictors of self-efficacy. CONCLUSION There was no significant benefit of the ICF-based patient education in comparison with an attention-placebo control group. Considering the importance of the programme for the further implementation of the ICF and the need of developing effective health education interventions for stroke, the methodology used was reviewed and an updated version proposed.
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Affiliation(s)
- Carla Sabariego
- Department of Medical Informatics, Biometry and Epidemiology (IBE), Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University, Munich, Germany
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Pettersson S, Lövgren M, Eriksson LE, Moberg C, Svenungsson E, Gunnarsson I, Welin Henriksson E. An exploration of patient-reported symptoms in systemic lupus erythematosus and the relationship to health-related quality of life. Scand J Rheumatol 2012; 41:383-90. [DOI: 10.3109/03009742.2012.677857] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Mattsson M, Möller B, Stamm T, Gard G, Boström C. Uncertainty and opportunities in patients with established systemic lupus erythematosus: a qualitative study. Musculoskeletal Care 2012; 10:1-12. [PMID: 22009870 DOI: 10.1002/msc.220] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED Systemic lupus erythematosus (SLE) is a chronic disease which can affect any organ, and the impact of the condition will affect each person differently. There are few qualitative studies including the experiences of both women and men with a diagnosis of SLE corresponding to the American College of Rheumatology (ACR) criteria where both negative and positive impacts of the disease have been presented. PURPOSE The aim was to describe how patients with established SLE experience their illness in everyday life, including both negative and positive aspects. METHOD Four focus group interviews were conducted with 16 women and three men with SLE according to ACR criteria, with varied disease activity and no or little organ damage. The interviews were tape recorded, transcribed verbatim and analysed using qualitative content analysis. RESULTS Two themes emerged: multifaceted uncertainty contained the categories 'an unreliable body', 'obtrusive pain and incomprehensible fatigue', 'mood changes and worries', 'reliance on medication and health care'; Focus on health and opportunities included 'learning process implying personal strength', 'limitations and possibilities in activities and work', 'a challenge to explain and receive support' and 'living an ordinary life incorporating meaningful occupations'. CONCLUSIONS While we expected to find a mainly negative impact, positive aspects were also described. Our findings were complex and showed that patients with established SLE can experience both uncertainty and opportunities. This highlights the importance for healthcare professionals of gaining a better understanding of patients' uncertainty, to enable them to support patients, allowing them to focus on health and opportunities. Measurement instruments that capture different aspects of uncertainty and opportunities needs to be developed.
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Affiliation(s)
- M Mattsson
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
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Geyh S, Peter C, Müller R, Bickenbach JE, Kostanjsek N, Üstün BT, Stucki G, Cieza A. The Personal Factors of the International Classification of Functioning, Disability and Health in the literature – a systematic review and content analysis. Disabil Rehabil 2011; 33:1089-102. [DOI: 10.3109/09638288.2010.523104] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Ow YLM, Thumboo J, Cella D, Cheung YB, Yong Fong K, Wee HL. Domains of health-related quality of life important and relevant to multiethnic English-speaking Asian systemic lupus erythematosus patients: a focus group study. Arthritis Care Res (Hoboken) 2011; 63:899-908. [PMID: 21425244 DOI: 10.1002/acr.20462] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To identify health-related quality of life (HRQOL) domains of importance to multiethnic Asian systemic lupus erythematosus (SLE) patients, to identify content gaps in existing SLE-specific HRQOL measures, and to determine whether the Patient-Reported Outcomes Measurement Information System (PROMIS) item banks could serve as a core set of questions for HRQOL assessment among SLE patients. METHODS English-speaking patients with physician-diagnosed SLE from a specialist clinic in a tertiary care hospital in Singapore and a patient support group were recruited. Thematic analysis was performed to distill themes from transcripts through open coding by 2 independent coders and axial coding for refinement of categories. Items from 3 existing SLE-specific measures and PROMIS Version 1.0 Item Banks were compared with identified subthemes. RESULTS Twenty-seven female and 2 male participants (21 Chinese, 4 Malay, 3 Indian, 1 other) ages 23-62 years participated in 6 focus groups and 2 individual interviews, respectively. Twenty-one domains and 92 subthemes were identified. Domains of family, relationships, stigma and discrimination, and freedom were unaddressed by existing SLE-specific measures. Forty subthemes from 14 domains were addressed by the PROMIS Version 1.0 Item Banks (Physical Function, Pain, Fatigue, Sleep Disturbance, Sleep-Related Impairment, Anger, Anxiety, and Depression banks). CONCLUSION Family and stigma and discrimination (identified as content gaps) may be accentuated in the Asian sociocultural context. PROMIS item banks have tremendous potential to serve as a core set of items for HRQOL assessment in SLE patients. Additional items may be written to fill the gaps in existing PROMIS item banks.
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Neubert S, Sabariego C, Stier-Jarmer M, Cieza A. Development of an ICF-based patient education program. PATIENT EDUCATION AND COUNSELING 2011; 84:e13-e17. [PMID: 20705411 DOI: 10.1016/j.pec.2010.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 07/12/2010] [Accepted: 07/15/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To describe the development of an ICF-based patient education program, to present the results of its pilot test and to present the adaptations and final version of the program. METHODS The education program was developed in five steps: (1) definition of relevant areas of functioning, (2) development of strategies to enhance self-efficacy in these areas, (3) development of material and instructions, (4) definition of modules and setting and (5) performance of a pilot test targeting acceptability and feasibility of the program. RESULTS Eleven stroke patients were enrolled in the pilot test. The intervention was well accepted on the part of participants. The developed patient education program is structured in three modules. Module 1 targets to increase patients' understanding of their current level of functioning. Module 2 targets to identify concrete problems and corresponding solutions regarding limited areas. Module 3 is a refresher session. CONCLUSION Feasibility and acceptability of the intervention were verified and a final version of the patient education program was developed. The effectiveness of the program will be evaluated in a randomized controlled trial. PRACTICE IMPLICATIONS Due to the universality of the ICF and availability of ICF tools, it is possible to adapt the intervention to different chronic conditions.
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Affiliation(s)
- Silvia Neubert
- Institute for Health and Rehabilitation Sciences, Ludwig-Maximilians-University, Munich, Germany
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Zhu TY, Tam LS, Li EK. Labour and non-labour market productivity in Chinese patients with systemic lupus erythematosus. Rheumatology (Oxford) 2011; 51:284-92. [PMID: 21752871 DOI: 10.1093/rheumatology/ker247] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES A cross-sectional study was performed to assess the self-reported loss of labour and non-labour market productivity, as well as to characterize the risk factors of loss of productivity in patients with SLE. METHODS A consecutive sample of 125 Chinese patients with a diagnosis of SLE and within working age was recruited. Work disability, daily activity limitations and receipt of social help, along with demographic information and health status, were collected from a self-reported questionnaire. Disease characteristics were collected by clinical examination and chart review. Univariate and multivariate logistic analyses were used to describe the relationships between labour/non-labour productivity and demographic/clinical variables. RESULTS Twenty (16%) patients reported complete work disability as a result of SLE after a median duration of 9 years since disease onset. A total of 46 (36.8%) patients reported difficulty in performing their daily activities, including household work, studying and leisure activities, among which 28% received social help from families or friends. Risk of work disability was strongly predicted by low education level, long disease duration and history of having pleurisy. Patients' global well-being, physical health status and functional status were factors independently associated with impaired non-labour market productivity. CONCLUSIONS SLE has a profound impact on individuals' labour and non-labour market productivity. Vocational education programmes may be useful in lowering the work disability rate in SLE. Preserving patients' physical and mental functioning or improving patients' quality of life may help in restoring both labour and non-labour productivity.
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Affiliation(s)
- Tracy Y Zhu
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, 9/F Clinical Sciences Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong.
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Stamm TA, Mattsson M, Mihai C, Stöcker J, Binder A, Bauernfeind B, Stummvoll G, Gard G, Hesselstrand R, Sandqvist G, Draghicescu O, Gherghe AM, Voicu M, Machold KP, Distler O, Smolen JS, Boström C. Concepts of functioning and health important to people with systemic sclerosis: a qualitative study in four European countries. Ann Rheum Dis 2011; 70:1074-9. [PMID: 21540204 PMCID: PMC3086051 DOI: 10.1136/ard.2010.148767] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective To describe the experiences of people with systemic sclerosis (SSc) in different European countries of functioning and health and to link these experiences to the WHO International Classification of Functioning, Disability and Health (ICF) to develop a common understanding from a bio-psycho-social perspective. Method A qualitative multicentre study with focus-group interviews was performed in four European countries: Austria, Romania, Sweden and Switzerland. The qualitative data analysis followed a modified form of ‘meaning condensation’ and the concepts that emerged in the analysis were linked to the ICF. Results 63 people with SSc participated in 13 focus groups. In total, 86 concepts were identified. 32 (37%) of these were linked to the ICF component body functions and structures, 21 (24%) to activities and participation, 26 (30%) to environmental factors, 6 (7%) to personal factors and 1 (1%) to the health condition itself. 19 concepts (22%) were identified in all four countries and included impaired hand function, household activities, paid work, drugs, climate and coldness, support from others and experiences with healthcare institutions, non-pharmacological treatment, social security and benefits. Conclusion Concepts identified in all four countries could be used for guiding clinical assessment, as well as interdisciplinary team care and rheumatological rehabilitation for patients with SSc. For a full understanding of the aspects of the disease that were most relevant to people with SSc, people with SSc from multiple countries needed to be involved.
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Affiliation(s)
- Tanja A Stamm
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Pettersson I, Pettersson V, Frisk M. ICF from an occupational therapy perspective in adult care: an integrative literature review. Scand J Occup Ther 2011; 19:260-73. [DOI: 10.3109/11038128.2011.557087] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fayed N, Cieza A, Bickenbach JE. Linking health and health-related information to the ICF: a systematic review of the literature from 2001 to 2008. Disabil Rehabil 2011; 33:1941-51. [PMID: 21303198 DOI: 10.3109/09638288.2011.553704] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In 1976, the World Health Organization (WHO) estimated worldwide disability prevalence at 10%; recent evidence suggests the prevalence is even higher. Given the extent of disability around the world, it is essential for researchers and policy makers to have a uniform language for describing and discussing disability. The International Classification of Functioning, Disability and Health (ICF) is WHO's attempt to provide that standard language. Linking rules were published in 2002 and 2005 suggesting a method for standardising the process of connecting outcome measures to the ICF classification. The objective of this study is to study the extent to which the linking rules have been used by researchers to link health and health-related information to the ICF and collect the feedback about the current practices, applications and areas to improve the linking method. METHOD Using a systematic review of health-based literature between 2001 and February 2008, we (1) determined research areas where the linking method is applied, (2) examined the characteristics of studies that linked information to the ICF and (3) described current practices and issues related to the process of linking health and health-related information to the ICF both quantitatively and qualitatively. RESULTS The systematic review yielded 109 articles from 58 journals that linked health information to the ICF and 58 of the articles employed published linking rules. The majority of articles were descriptive in nature, used linking for connecting content of health instruments to the ICF and linked English health content. Quality controls such as reliability checks, multiple raters and iterative linking processes were found frequently among users of the linking rules. Qualitative analysis created themes about: preparing units of information, who links to the ICF, reliability, matching or translating concepts from text to ICF categories, information unable or difficult to capture, quantitative reporting standards and overall linking process. DISCUSSION This review also shows that the linking process is a useful way to apply the ICF classification in research. With over 100 articles published in 58 peer-reviewed journals across 50 focus areas, linking health and health-related information to the ICF has been shown to be a useful tool for describing, comparing and contrasting information from outcome measures used to collect quantitative data, qualitative research results and clinical patient reports across diagnoses, settings, languages and countries.
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Affiliation(s)
- Nora Fayed
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
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Cerniauskaite M, Quintas R, Boldt C, Raggi A, Cieza A, Bickenbach JE, Leonardi M. Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation. Disabil Rehabil 2010; 33:281-309. [PMID: 21073361 DOI: 10.3109/09638288.2010.529235] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To present a systematic literature review on the state of the art of the utilisation of the International Classification of Functioning, Disability and Health (ICF) since its release in 2001. METHOD The search was conducted through EMBASE, MEDLINE and PsychInfo covering the period between 2001 and December 2009. Papers were included if ICF was mentioned in title or abstract. Papers focussing on the ICF-CY and clinical research on children and youth only were excluded. Papers were assigned to six different groups covering the wide scenario of ICF application. RESULTS A total of 672 papers, coming from 34 countries and 211 different journals, were included in the analysis. The majority of publications (30.8%) were conceptual papers or papers reporting clinical and rehabilitation studies (25.9%). One-third of the papers were published in 2008 and 2009. CONCLUSIONS The ICF contributed to the development of research on functioning and on disability in clinical, rehabilitation as well as in several other contexts, such as disability eligibility and employment. Diffusion of ICF research and use in a great variety of fields and scientific journals is a proof that a cultural change and a new conceptualisation of functioning and disability is happening.
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Affiliation(s)
- Milda Cerniauskaite
- Neurology, Public Health and Disability Unit-Scientific Directorate, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy
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McElhone K, Abbott J, Gray J, Williams A, Teh LS. Patient perspective of systemic lupus erythematosus in relation to health-related quality of life concepts: a qualitative study. Lupus 2010; 19:1640-7. [PMID: 20709719 DOI: 10.1177/0961203310378668] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We sought to understand the patients' 'lived experiences of systemic lupus erythematosus (SLE)' by exploring, describing and clarifying the patients' perspective of how they felt about having SLE and how the disease impacted on their lives, both positively and/or negatively. An interpretative phenomenological approach was employed. Semi-structured interviews were undertaken with 30 females with SLE across a wide range of age (21 to 75 years), disease characteristics, disease duration (1 to 28 years) and ethnicity (Whites, South Asians). Eleven themes emerged as important to the patients: prognosis and course of disease; body image; effects of treatment; emotional difficulties; inability to plan due to disease unpredictability; fatigue; pain; career prospects and loss of income; memory loss/concentration; reliance on others to assist with everyday tasks; and pregnancy issues. Most patients reported a negative impact of SLE on their lives although a few patients found positive aspects to having SLE. The findings of this study identified themes important to patients with SLE and these themes will inform clinicians on the patients' perspective of having SLE.
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Affiliation(s)
- K McElhone
- Department of Rheumatology, Royal Blackburn Hospital, Blackburn, UK
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Baker K, Pope J, Fortin P, Silverman E, Peschken C. Work disability in systemic lupus erythematosus is prevalent and associated with socio-demographic and disease related factors. Lupus 2009; 18:1281-8. [PMID: 19854811 DOI: 10.1177/0961203309345784] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Our objectives were to examine the prevalence of work disability (WD) and factors associated with job loss in systemic lupus erythematosus (SLE) in a large, multi-centered Canadian sample to determine the current prevalence of WD and identify the contribution of disease activity, damage, and co-morbidities with respect to WD in this cohort. Cross-sectional data on WD status from the 1000 Canadian Faces of Lupus database (a multi-center multi-ethnic cohort of SLE patients) along with clinical measures (number of ACR criteria ever, SLICC Damage Index, SLAM, SLEDAI, SF-36 and Charlson Co-morbidity Index scores), demographic features (age, sex, high school education, household income, marital status, disease duration, employment status) and co-morbidities (including self-reported fibromyalgia, arthralgias, depression and fatigue) were used in bivariate and logistic regression analyses. The 1137 SLE patients had a mean age of 50 years (SE 0.75) and mean disease duration was 18 years (SE 0.70); 19.09% were work disabled and 49.78% were employed. Those with WD were more likely than non-WD SLE patients to have: a higher number of ACR criteria for SLE; not completed high school; older age; single marital status; a lower household income; longer disease duration; higher SLICC Damage Index and SLAM scores; lower SF-36 PCS and SF-36 MCS scores; less vigorous activity per week; and fibromyalgia, arthralgias, fatigue and depression (p < 0.05). This contemporary rate of WD is lower than many past reports. Socio-demographic factors, co-morbidities (fibromyalgia and fatigue) and disease related factors were strongly associated with WD. We cannot determine cause and effect as the study was cross-sectional.
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Affiliation(s)
- K Baker
- Meds 2010, School of Medicine, Queen's University, Kingston, Ontario, Canada
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Yee CS, McElhone K, Teh LS, Gordon C. Assessment of disease activity and quality of life in systemic lupus erythematosus - New aspects. Best Pract Res Clin Rheumatol 2009; 23:457-67. [PMID: 19591777 DOI: 10.1016/j.berh.2009.01.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Outcomes in systemic lupus erythematosus (SLE) can be described in three domains: disease activity, accumulated damage and health-related quality of life (HRQoL). Over the past decade, our understanding and perception of SLE have changed considerably. Gastrointestinal and ophthalmic manifestations have increasingly been recognised, and they are associated with significant morbidity and mortality. Furthermore, it has been realised that there is a deficiency in using generic scales (such as the short form-36 (SF-36)) to assess HRQoL in patients with SLE as they fail to identify issues that are important to patients. As a result, SLE-specific measures of HRQoL have been developed recently. This article looks at the recent updates and changes in the standardised assessment of disease activity and HRQoL in SLE.
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Affiliation(s)
- Chee-Seng Yee
- Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
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Measuring Participation as Defined by the International Classification of Functioning, Disability and Health: An Evaluation of Existing Measures. Arch Phys Med Rehabil 2009; 90:856-66. [DOI: 10.1016/j.apmr.2008.11.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 11/18/2008] [Accepted: 11/20/2008] [Indexed: 11/16/2022]
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Bauernfeind B, Aringer M, Prodinger B, Kirchberger I, Machold K, Smolen J, Stamm T. Identification of relevant concepts of functioning in daily life in people with systemic lupus erythematosus: A patient Delphi exercise. ACTA ACUST UNITED AC 2009; 61:21-8. [PMID: 19116959 DOI: 10.1002/art.24165] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify the most important and relevant concepts of daily functioning from the perspective of patients with systemic lupus erythematosus (SLE). METHODS We conducted a consensus-building, 3-round, electronic mail survey with SLE patients using the Delphi technique. The Delphi technique is a structured communication process with 4 key characteristics: anonymity, iteration with controlled feedback, statistical group response, and informed input. The concepts contained in the answers of the patients were extracted and linked to the International Classification of Functioning, Disability and Health (ICF). RESULTS Of the total 225 participants, 194 (86.2%) completed the questionnaires from all 3 Delphi rounds. In total, after the third Delphi round, 307 concepts were identified. Ninety concepts (55 in the domain body functions and structures, 16 in activities and participation, and 19 in environmental factors) were considered relevant by at least 50% of the participants in the third round and linked to the ICF. Twelve concepts were considered important by at least 75% of the participants. CONCLUSION The high number of concepts resulting from this large-scale patient Delphi approach underlines the great variety of SLE patients' problems in daily functioning. The results of this patient Delphi project supplement the findings of our focus-group study in establishing a comprehensive overview of the patient perspective in SLE.
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