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Banovic I, Scrima F, Fornasieri I, Beaugerie L, Coquart J, Fourgon C, Iodice P, Nion-Larmurier I, Savoye G, Sorin AL, Tourny C, Augustinova M. Psychometric validation of the French Multidimensional Chronic Asthenia Scale (MCAS) in a sample of 621 patients with chronic fatigue. BMC Psychol 2023; 11:324. [PMID: 37817287 PMCID: PMC10566142 DOI: 10.1186/s40359-023-01358-1] [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: 11/24/2022] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Psychometric validation of the Multidimensional Chronic Asthenia Scale (MCAS) was conducted in order to provide an effective tool for assessing the health-related quality of life of French-speaking patients with chronic asthenia (CA). METHODS Items resulting from the initial formulation of the self-reported MCAS (along with other materials) were completed by French-speaking volunteers with inactive or active inflammatory bowel disease (IBD-I vs. IBD-A) or chronic fatigue syndrome (CFS). Responses from 621 participants (180 patients with IBD-A, 172 with IBD-I, 269 with CFS) collected in a single online survey were divided into three subsamples to test the construct validity of the MCAS (Step 1, N = 240), to confirm its factorial structure (Step 2, N = 204) and to explore its convergent-discriminant validity with the Fatigue Symptoms Inventory (FSI) and revised Piper Fatigue Scale (r-PFS, Step 3, N = 177). RESULTS Steps 1 and 2 showed that, as expected, MCAS has four dimensions: feeling of constraint (FoC), physical (PC), life (LC) and interpersonal consequences (IC), which are also related to the duration of CA (i.e., the longer it lasts, the more the dimensions are impacted). The results further showed that the MCAS is sensitive enough to capture between-group differences, with the CFS group being the most impaired, followed by IBD-A and IBD-I. While convergent-discriminant validity between the 4 factors of MCAS and FSI and r-PFS, respectively, was satisfactory overall, Step 3 also pointed to some limitations that call for future research (e.g., shared variances between the PC and IC dimensions of MCAS and behavioral dimension of r-PFS). CONCLUSION Despite these limitations, the MCAS clearly constitutes a promising tool for measuring quantitative differences (i.e., severity/intensity) in CA associated with various diseases, but also, and importantly, the clinically important differences in domains of its expression (i.e., qualitative differences).
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Affiliation(s)
- Ingrid Banovic
- CRFDP Lab., University of Rouen Normandy, 76821, Mont-Saint-Aignan Cedex, France.
| | - Fabrizio Scrima
- CRFDP Lab., University of Rouen Normandy, 76821, Mont-Saint-Aignan Cedex, France
| | | | - Laurent Beaugerie
- Department of Gastroenterology, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpital Saint-Antoine, 75012, Paris, France
| | - Jérémy Coquart
- CETAPS Lab., University of Rouen Normandy, Mont-Saint-Aignan, France
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 7369, Lille, France
| | - Chloé Fourgon
- CRFDP Lab., University of Rouen Normandy, 76821, Mont-Saint-Aignan Cedex, France
| | - Pierpaolo Iodice
- CETAPS Lab., University of Rouen Normandy, Mont-Saint-Aignan, France
| | - Isabelle Nion-Larmurier
- Department of Gastroenterology, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpital Saint-Antoine, 75012, Paris, France
| | - Guillaume Savoye
- UMR 10173, Université de Rouen Normandie, Centre Hospitalier Universitaire Charles Nicolle, 76000, Rouen, France
| | - Anne-Laure Sorin
- CRFDP Lab., University of Rouen Normandy, 76821, Mont-Saint-Aignan Cedex, France
| | - Claire Tourny
- CETAPS Lab., University of Rouen Normandy, Mont-Saint-Aignan, France
| | - Maria Augustinova
- CRFDP Lab., University of Rouen Normandy, 76821, Mont-Saint-Aignan Cedex, France
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2
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Ross L, Lindqvist A, Costello B, Hansen D, Brown Z, Day JA, Stevens W, Burns A, Perera W, Pianta M, La Gerche A, Nikpour M. Using magnetic resonance imaging to map the hidden burden of muscle involvement in systemic sclerosis. Arthritis Res Ther 2022; 24:84. [PMID: 35410246 PMCID: PMC8996589 DOI: 10.1186/s13075-022-02768-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Skeletal muscle can be directly affected by systemic sclerosis (SSc); however, a significant burden of SSc-associated myopathy is undetected because clinical parameters such as weakness and creatine kinase (CK) are unreliable biomarkers of muscle involvement. This study presents qualitative and quantitative magnetic resonance imaging (MRI) findings that quantify the prevalence of myopathy and evaluate any association between skeletal and cardiac muscle involvement in SSc. METHODS Thirty-two patients with SSc who fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria underwent skeletal muscle MRI in addition to cardiac MRI. Skeletal muscles were independently assessed by two musculoskeletal radiologists for evidence of oedema, fatty infiltration and atrophy. Skeletal muscle T2 mapping times and percentage fat fraction were calculated. Linear regression analysis was used to evaluate the clinical and myocardial associations with skeletal muscle oedema and fatty infiltration. Cardiac MRI was performed using post gadolinium contrast imaging and parametric mapping techniques to assess focal and diffuse myocardial fibrosis. RESULTS Thirteen participants (40.6%) had MRI evidence of skeletal muscle oedema. Five (15.6%) participants had fatty infiltration. There was no association between skeletal muscle oedema and muscle strength, creatine kinase, inflammatory markers or fibroinflammatory myocardial disease. Patients with skeletal muscle oedema had higher T2-mapping times; there was a significant association between subjective assessments of muscle oedema and T2-mapping time (coef 2.46, p = 0.02) and percentage fat fraction (coef 3.41, p = 0.02). Diffuse myocardial fibrosis was a near-universal finding, and one third of patients had focal myocardial fibrosis. There was no association between skeletal myopathy detected by MRI and burden of myocardial disease. CONCLUSIONS MRI is a sensitive measure of muscle oedema and systematic assessment of SSc patients using MRI shows that myopathy is highly prevalent, even in patients without symptoms or other signs of muscle involvement. Similarly, cardiac fibrosis is highly prevalent but occurs independently of skeletal muscle changes. These results indicate that novel quantitative MRI techniques may be useful for assessing sub-clinical skeletal muscle disease in SSc.
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Affiliation(s)
- Laura Ross
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Anniina Lindqvist
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Benedict Costello
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Cardiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Dylan Hansen
- Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Zoe Brown
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Jessica A Day
- Inflammation Division, Walter and Eliza Hall Institute, Parkville, VIC, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Andrew Burns
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Department of Cardiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Warren Perera
- Department of Radiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Marcus Pianta
- Department of Radiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - André La Gerche
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Cardiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia. .,Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia.
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3
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Subcutaneous Gammanorm® by pump or rapid push infusion: Impact of the device on quality of life in adult patients with primary immunodeficiencies. Clin Immunol 2022; 236:108938. [PMID: 35121105 DOI: 10.1016/j.clim.2022.108938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/23/2022]
Abstract
Many patients with immunodeficiencies require lifelong immunoglobulin replacement therapy (IgRT). In a multicenter, randomized, open-label, crossover, non-inferiority 3-month-trial, we compared the impact of the subcutaneous immunoglobulin Gammanorm® administered via pump or syringe (rapid push). Primary endpoint was the life quality index (LQI), secondary endpoints were QoL (SF36v2), satisfaction (TSQM-11), disease and treatment burden (PRISM), incidence of infections and adverse events (AE), treatment costs, and IgG levels. 28/30 patients completed the study. Most of the endpoints were comparable. Drug administrations with rapid push were more frequent, but reduced total time expenditure and some costs. Of the TSQM-11/LQI/SF36 components only "treatment interference with daily activities" was superior with pump and two QoL domains with rapid push. Both delivery devices showed favorable safety. Rapid push was preferred by 34.5% of patients. It proved to be an efficacious and cost-effective alternative to pumps adding to patient choice and increasing flexibility during long-term IgRT.
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Herrick AL, Griffiths-Jones DJ, Ryder WD, Mason JC, Denton CP. Clinical trial protocol: PRednisolone in early diffuse cutaneous Systemic Sclerosis (PRedSS). JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2020; 6:146-153. [PMID: 34222671 PMCID: PMC8216311 DOI: 10.1177/2397198320957552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/16/2020] [Indexed: 11/17/2022]
Abstract
Background: Many of the painful, disabling features of early diffuse cutaneous systemic
sclerosis have an inflammatory component and are potentially treatable with
corticosteroid therapy. These features include painful and itchy skin,
fatigue and musculoskeletal involvement. Yet many clinicians are
understandably reluctant to prescribe corticosteroids because of the concern
that these are a risk factor for scleroderma renal crisis. The aim of PRedSS
(PRednisolone in early diffuse cutaneous Systemic Sclerosis) is to evaluate
the efficacy and safety of moderate dose prednisolone in patients with early
diffuse cutaneous systemic sclerosis, specifically whether moderate dose
prednisolone is (a) effective in terms of reducing pain and disability, and
improving skin score and (b) safe, with particular reference to renal
function. Methods: PRedSS is a Phase II, multicentre, double-blind randomised controlled trial
which aims to recruit 72 patients with early diffuse cutaneous systemic
sclerosis. Patients are randomised to receive either prednisolone (dosage
approximately 0.3 mg/kg) or placebo therapy for 6 months. The two co-primary
outcome measures are the difference in mean Health Assessment Questionnaire
Disability Index at 3 months and the difference in modified Rodnan skin
score at 3 months. Secondary outcome measures include patient reported
outcome measures of itch, hand function, anxiety and depression, and
helplessness. Results: Recruitment commenced in December 2017 and after a slow start (due to delays
in opening centres) 25 patients have now been recruited. Conclusion: PRedSS should help to answer the question as to whether clinicians should or
should not prescribe prednisolone in early diffuse cutaneous systemic
sclerosis.
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Affiliation(s)
- Ariane L Herrick
- Division of Musculoskeletal and
Dermatological Sciences, Salford Royal NHS Foundation Trust, Manchester Academic
Health Science Centre, The University of Manchester, Manchester, UK
- Ariane L Herrick, Clinical Sciences
Building, Salford Royal Hospital, Stott Lane, Salford M6 8HD, UK.
| | - Deborah J Griffiths-Jones
- Division of Musculoskeletal and
Dermatological Sciences, Salford Royal NHS Foundation Trust, Manchester Academic
Health Science Centre, The University of Manchester, Manchester, UK
| | - W David Ryder
- Manchester Clinical Trials Unit, Jean
McFarlane Building, The University of Manchester, Manchester, UK
| | - Justin C Mason
- National Heart and Lung Institute,
Imperial College London, Hammersmith Hospital, London, UK
| | - Christopher P Denton
- Centre for Rheumatology and Connective
Tissue Diseases, University College London Division of Medicine, Royal Free Campus,
London, UK
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5
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O'Malley L, Druce KL, Chanouzas D, Morgan MD, Jones R, Jayne DRW, Basu N, Harper L. The Longitudinal Course of Fatigue in Antineutrophil Cytoplasmic Antibody-associated Vasculitis. J Rheumatol 2019; 47:572-579. [PMID: 31263068 DOI: 10.3899/jrheum.190113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Fatigue is common and burdensome in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). This study aimed to understand how fatigue changes over time following treatment initiation and to determine whether individuals with the poorest prognosis can be robustly identified. METHODS One hundred forty-nine patients with AAV and new-onset disease recruited to 2 clinical trials (RITUXVAS and MYCYC) were followed for 18 months. Fatigue was measured at baseline and 6-month intervals using the vitality domain of the Medical Outcomes Study Short Form-36 quality of life questionnaire and compared to a cohort of 470 controls. Group-based trajectory modeling (GBTM) determined trajectories of the symptom to which baseline characteristics and ongoing fatigue scores were compared. RESULTS Fatigue levels at diagnosis were worse in patients than controls [median (interquartile range; IQR) 30 (10-48) vs 70 (55-80); p < 0.001], with 46% of patients reporting severe fatigue. Fatigue improved after 6 months of treatment but remained worse than in controls (p < 0.001). GBTM revealed varied trajectories of fatigue: low fatigue stable (n = 23), moderate baseline fatigue improvers (n = 29), high baseline fatigue improvers (n = 61), and stable baseline high fatigue (n = 37). Participants who followed stable high fatigue trajectories had lower vasculitis activity compared to improvers, but no other demographic or clinical variables differed. CONCLUSION This study longitudinally measured fatigue levels in patients with AAV. Although most patients improved following treatment, an important subgroup of patients reported persistently high levels of fatigue that did not change. Few clinical or laboratory markers distinguished these patients, suggesting alternative interventions specific for fatigue are required. [clinicaltrialsregister.eu, RITUXVAS EudraCT number: 2005-003610-15; MYCYC EudraCT number: 2006-001663-33].
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Affiliation(s)
- Lucy O'Malley
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma.,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham
| | - Katie L Druce
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma.,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham
| | - Dimitrios Chanouzas
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma.,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham
| | - Matthew D Morgan
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma.,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham
| | - Rachel Jones
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma.,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham
| | - David R W Jayne
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma.,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham
| | - Neil Basu
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma.,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham
| | - Lorraine Harper
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK. .,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma. .,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham.
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6
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Abstract
Patient-reported outcome measures are widely used to assess patient experiences, well-being, and treatment response in clinical trials and cohort-based observational studies. However, patients may be asked to respond to many different measures in order to provide researchers and clinicians with a wide array of information regarding their experiences. Collecting such long and cumbersome patient-reported outcome measures may burden patients, increase research costs, and potentially reduce the quality of the data collected. Nonetheless, little research has been conducted on replicable, and reproducible methods to shorten these instruments that result in shortened forms of minimal length. This manuscript proposes the use of mixed integer programming through Optimal Test Assembly as a method to shorten patient-reported outcome measures. This method is compared to the existing standard in the field, which is selecting items based on having high discrimination parameters from an item response theory model. The method is then illustrated in an application to a fatigue scale for patients with Systemic Sclerosis.
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Affiliation(s)
- Daphna Harel
- Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY, USA
| | - Murray Baron
- Division of Rheumatology, Sir Mortimer B, Davis Jewish General Hospital, Montreal, Canada
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7
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Herrick AL, Pan X, Peytrignet S, Lunt M, Hesselstrand R, Mouthon L, Silman A, Brown E, Czirják L, Distler JHW, Distler O, Fligelstone K, Gregory WJ, Ochiel R, Vonk M, Ancuţa C, Ong VH, Farge D, Hudson M, Matucci-Cerinic M, Balbir-Gurman A, Midtvedt Ø, Jordan AC, Jobanputra P, Stevens W, Moinzadeh P, Hall FC, Agard C, Anderson ME, Diot E, Madhok R, Akil M, Buch MH, Chung L, Damjanov N, Gunawardena H, Lanyon P, Ahmad Y, Chakravarty K, Jacobsen S, MacGregor AJ, McHugh N, Müller-Ladner U, Riemekasten G, Becker M, Roddy J, Carreira PE, Fauchais AL, Hachulla E, Hamilton J, İnanç M, McLaren JS, van Laar JM, Pathare S, Proudman S, Rudin A, Sahhar J, Coppere B, Serratrice C, Sheeran T, Veale DJ, Grange C, Trad GS, Denton CP. Treatment outcome in early diffuse cutaneous systemic sclerosis: the European Scleroderma Observational Study (ESOS). Ann Rheum Dis 2017; 76:1207-1218. [PMID: 28188239 PMCID: PMC5530354 DOI: 10.1136/annrheumdis-2016-210503] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 12/30/2022]
Abstract
Objectives The rarity of early diffuse cutaneous systemic sclerosis (dcSSc) makes randomised controlled trials very difficult. We aimed to use an observational approach to compare effectiveness of currently used treatment approaches. Methods This was a prospective, observational cohort study of early dcSSc (within three years of onset of skin thickening). Clinicians selected one of four protocols for each patient: methotrexate, mycophenolate mofetil (MMF), cyclophosphamide or ‘no immunosuppressant’. Patients were assessed three-monthly for up to 24 months. The primary outcome was the change in modified Rodnan skin score (mRSS). Confounding by indication at baseline was accounted for using inverse probability of treatment (IPT) weights. As a secondary outcome, an IPT-weighted Cox model was used to test for differences in survival. Results Of 326 patients recruited from 50 centres, 65 were prescribed methotrexate, 118 MMF, 87 cyclophosphamide and 56 no immunosuppressant. 276 (84.7%) patients completed 12 and 234 (71.7%) 24 months follow-up (or reached last visit date). There were statistically significant reductions in mRSS at 12 months in all groups: −4.0 (−5.2 to −2.7) units for methotrexate, −4.1 (−5.3 to −2.9) for MMF, −3.3 (−4.9 to −1.7) for cyclophosphamide and −2.2 (−4.0 to −0.3) for no immunosuppressant (p value for between-group differences=0.346). There were no statistically significant differences in survival between protocols before (p=0.389) or after weighting (p=0.440), but survival was poorest in the no immunosuppressant group (84.0%) at 24 months. Conclusions These findings may support using immunosuppressants for early dcSSc but suggest that overall benefit is modest over 12 months and that better treatments are needed. Trial registration number NCT02339441.
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Affiliation(s)
- Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Xiaoyan Pan
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sébastien Peytrignet
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Mark Lunt
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence pour les Vascularites Nécrosantes et la Sclérodermie Systémique, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alan Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences,University of Oxford, Oxford, UK
| | - Edith Brown
- Member of Steering Committee, contact via Professor Herrick, The University of Manchester, Manchester, UK
| | - László Czirják
- Department of Rheumatology and Immunology, Medical Center, University of Pécs, Pecs, Hungary
| | - Jörg H W Distler
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Oliver Distler
- Department of Rheumatology, University of Zurich, Zurich, Switzerland
| | | | - William J Gregory
- Rehabilitation Services, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Madelon Vonk
- Department of the Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Codrina Ancuţa
- Rheumatology 2 Department, "Grigore T. Popa" University of Medicine and Pharmacy, Clinical Rehabilitation Hospital, Iași, Romania
| | - Voon H Ong
- UCL Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
| | - Dominique Farge
- Unité Clinique de Médecine Interne, Maladies Auto-immunes et Pathologie Vasculaire, UF 04, Hôpital Saint-Louis, AP-HP Assistance Publique des Hôpitaux de Paris, INSERM UMRS 1160, Paris Denis Diderot University, France
| | - Marie Hudson
- Jewish General Hospital, Lady Davis Institute and McGill University, Montreal, Canada
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Alexandra Balbir-Gurman
- Shine Rheumatology Unit, Rambam Heath Care Campus; Rappaport Faculty of Medicine, Haifa, Israel
| | - Øyvind Midtvedt
- Rheumatology Unit, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Alison C Jordan
- Queen Elizabeth Hospital Birmingham, UHB Foundation Trust, Birmingham, UK
| | - Paresh Jobanputra
- Queen Elizabeth Hospital Birmingham, UHB Foundation Trust, Birmingham, UK
| | | | - Pia Moinzadeh
- Department for Dermatology, University of Cologne Kerpenerstr. 62, Köln, Germany
| | - Frances C Hall
- Cambridge University NHS Hospital Foundation Trust, Cambridge, UK
| | - Christian Agard
- Department of Internal Medicine, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | | | - Elisabeth Diot
- Service de Médecine Interne, Hôpital Bretonneau Tours Cedex, France
| | - Rajan Madhok
- Centre for Rheumatic Diseases, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, UK
| | | | - Nemanja Damjanov
- University of Belgrade School of Medicine, Institute of Rheumatology, Belgrade, Serbia
| | - Harsha Gunawardena
- Clinical and Academic Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Peter Lanyon
- Nottingham University Hospitals NHS Trust, and Nottingham NHS Treatment Centre, Nottingham, UK
| | | | | | - Søren Jacobsen
- University of Copenhagen, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Nauheim, Germany
| | | | - Michael Becker
- Department of Rheumatology and Clinical Immunology, University Hospital Charité Berlin, Berlin, Germany
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Patricia E Carreira
- Servicio de Reumatologia. Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre National de Référence Maladies Systémiques etAuto-immunes Rares, Université de Lille, Inserm, U995, FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies, Lille, France
| | | | - Murat İnanç
- Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - John S McLaren
- Fife Rheumatic Diseases Unit, Whyteman's Brae Hospital, Kirkcaldy, UK
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Susannah Proudman
- Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, University of Adelaide, Adelaide, South Australia
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Joanne Sahhar
- Monash Centre for Inflammatory Diseases, Monash University, Clayton, Melbourne, Australia
| | - Brigitte Coppere
- Department of Internal Medicine, Hôpital Edouard Herriot, Lyon, France
| | - Christine Serratrice
- Department of Internal Medicine, Foundation Hospital Saint Joseph, Marseille, France
| | | | | | - Claire Grange
- Department of Internal Medicine, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | | | - Christopher P Denton
- UCL Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
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The association of sociodemographic and objectively-assessed disease variables with fatigue in systemic sclerosis: an analysis of 785 Canadian Scleroderma Research Group Registry patients. Clin Rheumatol 2016; 36:373-379. [DOI: 10.1007/s10067-016-3501-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
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Racine M, Hudson M, Baron M, Nielson WR. The Impact of Pain and Itch on Functioning and Health-Related Quality of Life in Systemic Sclerosis: An Exploratory Study. J Pain Symptom Manage 2016; 52:43-53. [PMID: 26876159 DOI: 10.1016/j.jpainsymman.2015.12.314] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 12/30/2015] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
Abstract
CONTEXT Pain and itch are common symptoms reported by patients with systemic sclerosis (SSc; scleroderma), which can markedly diminish function and health-related quality of life (HRQL). OBJECTIVES The aim of this exploratory study was to examine the impact that pain, itch, and the interaction of both have on function (depressive symptoms, overall disability, fatigue, sleep disturbance) and HRQL in patients with SSc. METHODS A total of 964 patients from the Canadian Scleroderma Reserch Group Registry completed questionnaires measuring itch and pain severity, function, and HRQL. Multiple regression analyses were performed to examine the impact that pain, itch, and pain × itch interaction have on each outcome variable while controlling for demographic measures. A P-value of ≤0.01 was required for a difference to be deemed statistically significant. RESULTS Our results revealed that patients with SSc who reported higher pain and itch severity were also more likely to have greater depressive symptoms, overall disability, sleep and fatigue problems, even when demographic measures were controlled for (P-values ≤0.001). Similar results were obtained for HRQL, regardless of the domains (P-values ≤0.001). A significant association between pain × itch interaction and sleep (P = 0.002), physical functioning (P = 0.003), and general health (P ≤ 0.001) variables also was found. Further investigation of the nature of the pain × itch interaction showed that the effect of pain severity on outcome variables diminishes as itch severity increases. CONCLUSION Both pain and itch appear to have a detrimental impact on functioning and HRQL in patients with SSc, suggesting that more targeted approaches to symptom management are warranted.
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Affiliation(s)
- Mélanie Racine
- Lawson Health Research Institute, London, Ontario, Canada; Department of Clinical and Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Marie Hudson
- Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada
| | - Murray Baron
- Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada
| | - Warren R Nielson
- Lawson Health Research Institute, London, Ontario, Canada; Department of Psychology, Western University, London, Ontario, Canada.
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The Turkish Version of Multidimensional Assessment of Fatigue and Fatigue Severity Scale is Reproducible and Correlated With Other Outcome Measures in Patients With Systemic Sclerosis. Arch Rheumatol 2016; 31:329-332. [PMID: 30375564 DOI: 10.5606/archrheumatol.2016.5909] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/16/2016] [Indexed: 01/30/2023] Open
Abstract
Objectives This study aims to evaluate the reproducibility of Turkish versions of multidimensional assessment of fatigue (MAF) and fatigue severity scales (FSS) and the relationship between health related quality of life, disability, and psychological status in patients with systemic sclerosis (SSc). Patients and methods A total of 21 female patients (mean age 47.14±10.39 years; range 18 to 75 years) who met 2013 American College of Rheumatology/European League Against Rheumatism criteria for SSc were evaluated for severity of organ involvement and symptoms. Turkish version of MAF, FSS, and visual analog scale of fatigue were assessed at baseline and after two to three weeks. Level of dyspnea was noted and disability, functional limitation, and quality of life were assessed by health assessment questionnaire, 6-minute walking distance, and short-form 36, respectively. Results Ten patients had diffuse and 11 had limited SSc. MAF subscales and FSS had significant correlations with short-form 36-vitality subscale and 6-minute walking distance. Intraclass correlation coefficients for FSS and visual analog scale of fatigue were 0.824 (95% confidence interval, 0.566- 0.929) and 0.932 (95% confidence interval, 0.832-0.972), respectively. The intraclass correlation coefficients for MAF subscales changed between 0.916 and 0.968, except for MAF-timing (intraclass correlation coefficient, 0.404). Conclusion Our results revealed that FSS and MAF subscales had high reproducibility and correlated well with quality of life and disability scales which, to some extent, may suggest convergent validity of MAF subscales and FSS in SSc. The incompatible nature and four-choice answering in two items of MAF-timing may be the underlying reason for trivial relationship with other parameters. The Turkish version of MAF and FSS may be used to assess fatigue in patients with SSc.
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Botterman J, Bode C, Siemons L, van de Laar MA, Dekker J. Exploring Fatigue Trajectories in Early Symptomatic Knee and Hip Osteoarthritis: 6-year Results from the CHECK Study. J Rheumatol 2016; 43:1413-20. [DOI: 10.3899/jrheum.150820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2016] [Indexed: 01/24/2023]
Abstract
Objective.To examine whether different groups of fatigue trajectories can be identified among patients with early symptomatic osteoarthritis (OA) of the knee or hip, to describe the level of fatigue severity within each of these fatigue groups, and to investigate the involvement of age, sex, use of medication, comorbidity, and OA severity in relation to group membership.Methods.Six years of followup data on fatigue (Medical Outcomes Study Short Form-36 Vitality scale) came from the Cohort Hip and Cohort Knee (CHECK) cohort. Growth mixture modeling was applied to identify distinct fatigue trajectories as well as to take into account the effects of the patient characteristics.Results.Three fatigue trajectories were identified: low fatigue, low-to-high fatigue, and high fatigue. Latter trajectories showed considerable overlap from years 2 to 6, but differed in some patient characteristics in comparison with each other and in comparison with the low fatigue group. Comorbidity, medication use, and sex were significantly associated with the identified trajectories. Women, individuals with a comorbid disease, and those who used medication were more likely to follow a high fatigue trajectory.Conclusion.These findings suggest heterogeneous development of fatigue in the early OA population associated with varying patient characteristics. Further, this study shows that a considerable number of patients with OA already experience elevated levels of fatigue at an early stage of OA. While these findings need to be replicated, the identification of these trajectories with differing patient characteristics may warrant tailored psychosocial interventions for patients with elevated levels of fatigue.
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Sandıkçı SC, Özbalkan Z. Fatigue in rheumatic diseases. Eur J Rheumatol 2015; 2:109-113. [PMID: 27708942 DOI: 10.5152/eurjrheum.2015.0029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/15/2015] [Indexed: 12/24/2022] Open
Abstract
Fatigue is a common and important problem in many diseases including rheumatologic illnesses, and it has a negative impact on health-related quality of life. Fatigue is described as having an impact on multiple aspects of a patient's life. There is a need for knowledge about causes of and treatments for fatigue to ensure that patient outcomes are improved. There are several effective treatment strategies available for fatigue including pharmacological and non-pharmacological therapies. We aim to provide an overview of fatigue in rheumatologic disorders and some recommendations on its optimal management.
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Affiliation(s)
- Sevinç Can Sandıkçı
- Clinic of Rheumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Zeynep Özbalkan
- Clinic of Rheumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Systematic content evaluation and review of measurement properties of questionnaires for measuring self-reported fatigue among older people. Qual Life Res 2015; 24:2239-55. [PMID: 25778536 DOI: 10.1007/s11136-015-0963-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The assessment of fatigue in older people requires simple and user-friendly questionnaires that capture the phenomenon, yet are free from items indistinguishable from other disorders and experiences. This study aimed to evaluate the content, and systematically review and rate the measurement properties of self-report questionnaires for measuring fatigue, in order to identify the most suitable questionnaires for older people. METHODS This study firstly involved identification of questionnaires that purport to measure self-reported fatigue, and evaluation of the content using a rating scale developed for the purpose from contemporary understanding of the construct. Secondly, for the questionnaires that had acceptable content, we identified studies reporting measurement properties and rated the methodological quality of those studies according to the COSMIN system. Finally, we extracted and synthesised the results of the studies to give an overall rating for each questionnaire for each measurement property. The protocol was registered with PROSPERO (CRD42013005589). RESULTS Of the 77 identified questionnaires, twelve were selected for review after content evaluation. Methodological quality varied, and there was a lack of information on measurement error and responsiveness. CONCLUSIONS The PROMIS-Fatigue item bank and short forms perform the best. The FACIT-Fatigue scale, Parkinsons Fatigue Scale, Perform Questionnaire, and Uni-dimensional Fatigue Impact Scale also perform well and can be recommended. Minor modifications to improve performance are suggested. Further evaluation of unresolved measurement properties, particularly with samples including older people, is needed for all the recommended questionnaires.
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Oude Voshaar MA, ten Klooster PM, Bode C, Vonkeman HE, Glas CA, Jansen T, van Albada-Kuipers I, van Riel PL, van de Laar MA. Assessment of Fatigue in Rheumatoid Arthritis: A Psychometric Comparison of Single-item, Multiitem, and Multidimensional Measures. J Rheumatol 2015; 42:413-20. [DOI: 10.3899/jrheum.140389] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To compare the psychometric functioning of multidimensional disease-specific, multiitem generic, and single-item measures of fatigue in patients with rheumatoid arthritis (RA).Methods.Confirmatory factor analysis (CFA) and longitudinal item response theory (IRT) modeling were used to evaluate the measurement structure and local reliability of the Bristol RA Fatigue Multi-Dimensional Questionnaire (BRAF-MDQ), the Medical Outcomes Study Short Form-36 (SF-36) vitality scale, and the BRAF Numerical Rating Scales (BRAF-NRS) in a sample of 588 patients with RA.Results.A 1-factor CFA model yielded a similar fit to a 5-factor model with subscale-specific dimensions, and the items from the different instruments adequately fit the IRT model, suggesting essential unidimensionality in measurement. The SF-36 vitality scale outperformed the BRAF-MDQ at lower levels of fatigue, but was less precise at moderate to higher levels of fatigue. At these levels of fatigue, the living, cognition, and emotion subscales of the BRAF-MDQ provide additional precision. The BRAF-NRS showed a limited measurement range with its highest precision centered on average levels of fatigue.Conclusion.The different instruments appear to access a common underlying domain of fatigue severity, but differ considerably in their measurement precision along the continuum. The SF-36 vitality scale can be used to measure fatigue severity in samples with relatively mild fatigue. For samples expected to have higher levels of fatigue, the multidimensional BRAF-MDQ appears to be a better choice. The BRAF-NRS are not recommended if precise assessment is required, for instance in longitudinal settings.
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The comparability of English, French and Dutch scores on the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F): an assessment of differential item functioning in patients with systemic sclerosis. PLoS One 2014; 9:e91979. [PMID: 24638101 PMCID: PMC3956818 DOI: 10.1371/journal.pone.0091979] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 02/16/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) is commonly used to assess fatigue in rheumatic diseases, and has shown to discriminate better across levels of the fatigue spectrum than other commonly used measures. The aim of this study was to assess the cross-language measurement equivalence of the English, French, and Dutch versions of the FACIT-F in systemic sclerosis (SSc) patients. METHODS The FACIT-F was completed by 871 English-speaking Canadian, 238 French-speaking Canadian and 230 Dutch SSc patients. Confirmatory factor analysis was used to assess the factor structure in the three samples. The Multiple-Indicator Multiple-Cause (MIMIC) model was utilized to assess differential item functioning (DIF), comparing English versus French and versus Dutch patient responses separately. RESULTS A unidimensional factor model showed good fit in all samples. Comparing French versus English patients, statistically significant, but small-magnitude DIF was found for 3 of 13 items. French patients had 0.04 of a standard deviation (SD) lower latent fatigue scores than English patients and there was an increase of only 0.03 SD after accounting for DIF. For the Dutch versus English comparison, 4 items showed small, but statistically significant, DIF. Dutch patients had 0.20 SD lower latent fatigue scores than English patients. After correcting for DIF, there was a reduction of 0.16 SD in this difference. CONCLUSIONS There was statistically significant DIF in several items, but the overall effect on fatigue scores was minimal. English, French and Dutch versions of the FACIT-F can be reasonably treated as having equivalent scoring metrics.
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Park SK, Larson JL. Symptom cluster, healthcare use and mortality in patients with severe chronic obstructive pulmonary disease. J Clin Nurs 2014; 23:2658-71. [PMID: 24460846 DOI: 10.1111/jocn.12526] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2013] [Indexed: 12/26/2022]
Abstract
AIMS AND OBJECTIVES To examine how subgroups of patients with chronic obstructive pulmonary disease, identified by ratings of symptoms (dyspnoea, anxiety, depression and fatigue), affect healthcare use and mortality. BACKGROUND People with chronic obstructive pulmonary disease often experience multiple symptoms. The importance of multiple symptoms and symptom clusters has received increased attention. However, little is known about symptom clusters and their effect on healthcare use and mortality in this population. DESIGN Descriptive cross-sectional study. METHODS This secondary data analysis used data from the National Emphysema Treatment Trial. Participants (n = 597) had severe chronic obstructive pulmonary disease. Descriptive and inferential statistics were used to analyse the data that were drawn from structured interviews, questionnaires and clinical measures. RESULTS Three subgroup clusters emerged based on four symptom ratings. Mean age, proportion with higher education, proportion using oxygen, disease severity, exercise capacity and quality of life differed significantly between subgroups. Participants with high levels of symptoms used healthcare services more and were more likely to have died at the five-year follow-up than those with low levels of symptoms. Symptom cluster subgroups had more significant relationship with mortality than single symptoms. CONCLUSION Patients with high levels of symptoms require greater clinical attention. RELEVANCE TO CLINICAL PRACTICE Understanding subgroups of patients, based on symptom ratings and their adverse effect on outcomes, may enable healthcare providers to assess multiple symptoms and identify subgroups of patients at risk of increased healthcare use and mortality. Targeting modifiable symptoms within the cluster may be more beneficial than focusing on a single symptom for certain health-related outcome.
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Evaluating systemic sclerosis patients, which measures to use? INDIAN JOURNAL OF RHEUMATOLOGY 2013. [DOI: 10.1016/j.injr.2013.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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