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Silva CG, Santulhão M, Serrado A, Soares M, Morais N. Disability, Physical Activity, and Their Correlates in Patients With Inflammatory Bowel Disease: A Portuguese Cross-Sectional Survey. Gastroenterol Nurs 2024; 47:265-276. [PMID: 39087992 DOI: 10.1097/sga.0000000000000809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/16/2023] [Indexed: 08/02/2024] Open
Abstract
Knowledge about disability and physical activity is critical for enhancing self- and clinical management of inflammatory bowel disease, but the interplay between the two is unknown. This study aimed to explore the correlates of disability and physical activity in patients with inflammatory bowel disease. A cross-sectional online survey was conducted in 2019 in Portuguese patients (n = 108) capturing disability, clinical factors including disease status and comorbidities, physical activity habits, and barriers. The magnitude of disability was moderate (mean [95% confidence interval] = 41.85 [38.39, 45.31]). Disease activity and comorbidities were the most important predictors of disability (Model 2, F(102) = 20.285, p < .001, R2 = 0.499, R2adj = 0.443). About 62% of the participants engaged in moderate (31.5%) to vigorous (30.6%) physical activities. Perceived effort to engage in physical activities was the sole predictor of total weekly physical activity (R2 = 0.070, R2adj = 0.044, p = .006). The amount of disability and physical activity were poorly associated (ρ = -0.144, p = .068). Findings encourage gastroenterology nurses and other healthcare providers involved in the comprehensive care of patients with gastrointestinal disorders to recommend regular physical activity to these patients as part of an overall health enhancement strategy. Disability and back pain should be given further attention.
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Affiliation(s)
- Cândida G Silva
- Cândida G. Silva, PhD, is Associate Professor, ciTechCare-Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal; ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
- Mariana Santulhão, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; Condomínio Residencial Sénior-Montepio Rainha Dona Leonor, Caldas da Rainha, Portugal
- Alícia Serrado, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; ConMeFis-Consultório Médico de Fisiatria, Peniche, Portugal
- Mariana Soares, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; Centro Hospitalar do Oeste, E.P.E.-Unidade de Caldas da Rainha, Caldas da Rainha, Portugal
- Nuno Morais, MSc, PT, is Associate Professor, ciTechCare-Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal; ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; CDRSP-Centre for Rapid and Sustainable Product Development, Polytechnic of Leiria, Leiria, Portugal; Saúde Positiva, Clínica de Saúde Física e Mental, Aveiro, Portugal
| | - Mariana Santulhão
- Cândida G. Silva, PhD, is Associate Professor, ciTechCare-Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal; ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
- Mariana Santulhão, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; Condomínio Residencial Sénior-Montepio Rainha Dona Leonor, Caldas da Rainha, Portugal
- Alícia Serrado, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; ConMeFis-Consultório Médico de Fisiatria, Peniche, Portugal
- Mariana Soares, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; Centro Hospitalar do Oeste, E.P.E.-Unidade de Caldas da Rainha, Caldas da Rainha, Portugal
- Nuno Morais, MSc, PT, is Associate Professor, ciTechCare-Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal; ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; CDRSP-Centre for Rapid and Sustainable Product Development, Polytechnic of Leiria, Leiria, Portugal; Saúde Positiva, Clínica de Saúde Física e Mental, Aveiro, Portugal
| | - Alícia Serrado
- Cândida G. Silva, PhD, is Associate Professor, ciTechCare-Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal; ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
- Mariana Santulhão, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; Condomínio Residencial Sénior-Montepio Rainha Dona Leonor, Caldas da Rainha, Portugal
- Alícia Serrado, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; ConMeFis-Consultório Médico de Fisiatria, Peniche, Portugal
- Mariana Soares, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; Centro Hospitalar do Oeste, E.P.E.-Unidade de Caldas da Rainha, Caldas da Rainha, Portugal
- Nuno Morais, MSc, PT, is Associate Professor, ciTechCare-Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal; ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; CDRSP-Centre for Rapid and Sustainable Product Development, Polytechnic of Leiria, Leiria, Portugal; Saúde Positiva, Clínica de Saúde Física e Mental, Aveiro, Portugal
| | - Mariana Soares
- Cândida G. Silva, PhD, is Associate Professor, ciTechCare-Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal; ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
- Mariana Santulhão, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; Condomínio Residencial Sénior-Montepio Rainha Dona Leonor, Caldas da Rainha, Portugal
- Alícia Serrado, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; ConMeFis-Consultório Médico de Fisiatria, Peniche, Portugal
- Mariana Soares, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; Centro Hospitalar do Oeste, E.P.E.-Unidade de Caldas da Rainha, Caldas da Rainha, Portugal
- Nuno Morais, MSc, PT, is Associate Professor, ciTechCare-Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal; ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; CDRSP-Centre for Rapid and Sustainable Product Development, Polytechnic of Leiria, Leiria, Portugal; Saúde Positiva, Clínica de Saúde Física e Mental, Aveiro, Portugal
| | - Nuno Morais
- Cândida G. Silva, PhD, is Associate Professor, ciTechCare-Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal; ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
- Mariana Santulhão, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; Condomínio Residencial Sénior-Montepio Rainha Dona Leonor, Caldas da Rainha, Portugal
- Alícia Serrado, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; ConMeFis-Consultório Médico de Fisiatria, Peniche, Portugal
- Mariana Soares, PT, is Clinical Researcher, ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; Centro Hospitalar do Oeste, E.P.E.-Unidade de Caldas da Rainha, Caldas da Rainha, Portugal
- Nuno Morais, MSc, PT, is Associate Professor, ciTechCare-Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal; ESSLei-School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal; CDRSP-Centre for Rapid and Sustainable Product Development, Polytechnic of Leiria, Leiria, Portugal; Saúde Positiva, Clínica de Saúde Física e Mental, Aveiro, Portugal
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van Linschoten RCA, Huberts AS, van Leeuwen N, Hazelzet JA, van der Woude J, West RL, van Noord D. Validity of the self-administered comorbidity questionnaire in patients with inflammatory bowel disease. Therap Adv Gastroenterol 2023; 16:17562848231202159. [PMID: 37877105 PMCID: PMC10591493 DOI: 10.1177/17562848231202159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/01/2023] [Indexed: 10/26/2023] Open
Abstract
Background The International Consortium for Health Outcomes Measurement has selected the self-administered comorbidity questionnaire (SCQ) to adjust case-mix when comparing outcomes of inflammatory bowel disease (IBD) treatment between healthcare providers. However, the SCQ has not been validated for use in IBD patients. Objectives We assessed the validity of the SCQ for measuring comorbidities in IBD patients. Design Cohort study. Methods We assessed the criterion validity of the SCQ for IBD patients by comparing patient-reported and clinician-reported comorbidities (as noted in the electronic health record) of the 13 diseases of the SCQ using Cohen's kappa. Construct validity was assessed using the Spearman correlation coefficient between the SCQ and the Charlson Comorbidity Index (CCI), clinician-reported SCQ, quality of life, IBD-related healthcare and productivity costs, prevalence of disability, and IBD disease activity. We assessed responsiveness by correlating changes in the SCQ with changes in healthcare costs, productivity costs, quality of life, and disease activity after 15 months. Results We included 613 patients. At least fair agreement (κ > 0.20) was found for most comorbidities, but the agreement was slight (κ < 0.20) for stomach disease [κ = 0.19, 95% CI (-0.03; 0.41)], blood disease [κ = 0.02, 95% CI (-0.06; 0.11)], and back pain [κ = 0.18, 95% CI (0.11; 0.25)]. Correlations were found between the SCQ and the clinician-reported SCQ [ρ = 0.60, 95% CI (0.55; 0.66)], CCI [ρ = 0.39, 95% CI (0.31; 0.45)], the prevalence of disability [ρ = 0.23, 95% CI (0.15; 0.32)], and quality of life [ρ = -0.30, 95% CI (-0.37; -0.22)], but not between the SCQ and healthcare or productivity costs or disease activity (|ρ| ⩽ 0.2). A change in the SCQ after 15 months was not correlated with a change in any of the outcomes. Conclusion The SCQ is a valid tool for measuring comorbidity in IBD patients, but face and content validity should be improved before being used to correct case-mix differences.
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Affiliation(s)
- Reinier Cornelis Anthonius van Linschoten
- Department of Gastroenterology & Hepatology, Franciscus Gasthuis & Vlietland, P.O Box 10900, Rotterdam 3004BA, Netherlands
- Department of Gastroenterology & Hepatology, Erasmus MC, Rotterdam, Netherlands
| | - Anouk Sjoukje Huberts
- Department of Quality and Patientcare, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | - Nikki van Leeuwen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Jan Antonius Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | | | - Rachel Louise West
- Department of Gastroenterology & Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | - Desirée van Noord
- Department of Gastroenterology & Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
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Vigdal ØN, Storheim K, Killingmo RM, Småstuen MC, Grotle M. The one-year clinical course of back-related disability and the prognostic value of comorbidity among older adults with back pain in primary care. Pain 2023; 164:e207-e216. [PMID: 36083174 DOI: 10.1097/j.pain.0000000000002779] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Back pain and comorbidity are common in older adults. Comorbidity is a promising prognostic factor for the clinical course of back-related disability, but confirmatory studies assessing its prognostic value are needed. Thus, the aims of this study were to describe the clinical course of back-related disability during 1-year follow-up in patients aged ≥55 years visiting primary care (general practitioner, physiotherapist, or chiropractor) with a new episode of back pain and assess the prognostic value of comorbidity on back-related disability during 1-year follow-up. A prospective cohort study was conducted, including 452 patients. The outcome measure was Roland-Morris Disability Questionnaire (RMDQ, range 0-24) measured at baseline and at 3-, 6-, and 12-month follow-up. The Self-Administered Comorbidity Questionnaire was used to assess comorbidity count (CC, range 0-15) and comorbidity burden (CB, range 0-45). The RMDQ scores improved from median (interquartile range) 9 (4-13) at baseline to 4 (1-9), 4 (0-9), and 3 (0-9) at 3, 6, and 12 months, respectively. Using linear mixed-effects models, we found that CC and CB were independently associated with RMDQ scores. A 1-point increase in CC was associated with an increase in RMDQ score of 0.76 points (95% confidence interval [0.48-1.04]) over the follow-up year, adjusted for known prognostic factors. A 1-point increase in CB was associated with an increased RMDQ score of 0.47 points (95% confidence interval [0.33-0.61]). In conclusion, the clinical course of back-related disability for older adults presenting in primary care was favorable, and increased comorbidity was an independent prognostic factor for increased disability levels.
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Affiliation(s)
- Ørjan Nesse Vigdal
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Kjersti Storheim
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Rikke Munk Killingmo
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Margreth Grotle
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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Zeschick N, Warkentin L, Kühlein T, Steininger P, Überla K, Hueber S, Sebastião M. Active monitoring of adverse reactions following COVID-19 and other vaccinations: a feasibility study as part of the CoVaKo project. Pilot Feasibility Stud 2022; 8:134. [PMID: 35780172 PMCID: PMC9250275 DOI: 10.1186/s40814-022-01088-y] [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] [Received: 10/22/2021] [Accepted: 06/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background The Corona-Vakzin-Konsortium project (CoVaKo) analyses the efficacy and safety of COVID-19 vaccines in a real-world setting, as well as breakthrough infections in Bavaria, Germany. A subproject of CoVaKo aims to identify adverse reactions of the COVID-19 vaccine and compare these to adverse reactions of other vaccines in an online survey. In a preceding feasibility study, the study materials were tested for comprehensibility, visual design, and motivation to participate, as well as for their ability to be implemented and carried out in primary care practices and vaccination centres. Methods We used a mixed-methods research design. First, three focus groups consisting of general population participants were organised to evaluate the study materials and survey. Second, a test roll-out was conducted in vaccination centres and primary care practices that involved implementing and quantitatively evaluating the online survey. Third, interviews were conducted with participating general practitioners and heads of vaccination centres four weeks after the test roll-out. Results Parts of the information and registration form proved incomprehensible, specifically regarding the recruitment material and/or online survey. For example, headings were misleading given that, relative to other vaccinations, the COVID-19 vaccination was overemphasised in the title. Participants requested additional information regarding the procedure and completion time. Within 31 days, 2199 participants, who received either a COVID-19 vaccination (99%) or at least one of the control vaccinations (1%), registered for the study. Participants (strongly) agreed that the registration process was easy to understand, that the completion time was reasonable, and that the technical setup was straightforward. Physicians and heads of the vaccination centres perceived the study as easy to integrate into their workflow. The majority expressed willingness to participate in the main study. Conclusions Our study indicated that identifying and documenting adverse reactions following vaccinations using an online survey is feasible. Testing materials and surveys provided valuable insight, enabling subsequent improvements. Participation from health professionals proved essential in ensuring the practicality of procedures. Lastly, adapting the study’s organisation to external fluctuating structures and requirements confirmed necessary for a successful implementation, especially due to dynamic changes in the nation’s COVID-19 vaccination strategies. Trial registration The trial was retrospectively registered at the “Deutsches Register Klinischer Studien” (DRKS-ID: DRKS00025881) on Oct 14, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01088-y.
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Affiliation(s)
- Nikoletta Zeschick
- Institute of General Practice, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany.
| | - Lisette Warkentin
- Institute of General Practice, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Thomas Kühlein
- Institute of General Practice, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Philipp Steininger
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Klaus Überla
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Susann Hueber
- Institute of General Practice, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Maria Sebastião
- Institute of General Practice, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
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Roland-Morris Disability Questionnaire, Oswestry Disability Index, and Quebec Back Pain Disability Scale: Which Has Superior Measurement Properties in Older Adults With Low Back Pain? J Orthop Sports Phys Ther 2022; 52:457-469. [PMID: 35584027 DOI: 10.2519/jospt.2022.10802] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine the validity, reliability, and responsiveness of 3 commonly used questionnaires for assessing physical function (ie, Oswestry Disability Index [ODI], Quebec Back Pain Disability Scale [QBPDS], and Roland-Morris Disability Questionnaire [RMDQ]) in older patients undergoing chiropractic care for low back pain (LBP). DESIGN Head-to-head clinimetric comparison. METHODS Patients completed the ODI, QBPDS, and RMDQ at baseline and after 2 weeks of treatment. Reliability was evaluated for internal consistency (Cronbach α), test-retest reliability (interclass correlation coefficient [ICC]), and measurement error (standard error of measurement and smallest detectable change [SDC]). Structural validity was evaluated through unidimensional confirmatory factor analysis, and construct validity was investigated by a priori hypotheses with other measures. Responsiveness was evaluated by testing a priori hypotheses using data at baseline and at 2-week follow-up. RESULTS Two hundred fourteen patients (53% males and 47% females) with a mean age of 66.2 years (standard deviation = 7.8 years) were included, of which 193 patients completed the 2-week follow-up for our responsiveness analysis. The RMDQ, ODI, and QBPDS showed sufficient internal consistency (Cronbach α of .89, .86, and .94, respectively) and test-retest reliability (ICC[2,1] of 0.85, 0.89, and 0.84, respectively). The SDC for the RMDQ was 6.9, for the ODI was 19.1, and for the QBPDS was 23.6, which are values larger than the minimal important change. None of the measures met all criteria for sufficient structural validity, but the RMDQ and ODI exhibited a partial unidimensional fit. The questionnaires had sufficient construct validity and responsiveness. CONCLUSION The ODI, QBPDS, and RMDQ have similar measurement properties in older adults with LBP. J Orthop Sports Phys Ther 2022;52(7):457-469. Epub: 18 May 2022. doi:10.2519/jospt.2022.10802.
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Validity and psychometric characteristics of the self-administered comorbidity questionnaire in patients with psoriatic arthritis. Rheumatol Int 2022; 42:2061-2067. [PMID: 35648189 DOI: 10.1007/s00296-022-05150-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
The study aimed to translate and cross-culturally adapt the self-comorbidity questionnaire (SCQ) into Turkish and investigate the validity and reliability of SCQ and its modified version (mSCQ) in psoriatic arthritis (PsA). Psoriatic arthritis quality of life (PsAQoL) and short form 36 (SF-36) were used to assess the quality of life. The physical disability was evaluated with the health assessment questionnaire (HAQ). The reliability of the SCQ scale was assessed by test-retest reliability. For construct validity, the correlations of SCQ with the HAQ, SF-36, PsAQoL, age, body mass index (BMI), disease duration, disease activity in psa (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index (PASI), dactylitis and enthesitis were evaluated. The mSCQ was also used by removing the items related to rheumatic conditions. For the test-retest reliability of the Turkish version of SCQ, the intraclass correlation coefficient was 0.965, p < 0.001. The SCQ and mSCQ had significant correlations with HAQ, PsAQoL, some subscales of SF-36, and age (p < 0.05), but not with disease duration, BASDAI, PASI and dactylitis (p > 0.05). Although SCQ had a low correlation with DAPSA (rho = 0.262, p = 0.031), mSCQ was not correlated with DAPSA (p > 0.05). mSCQ was significantly correlated with BMI (rho = 0.233, p = 0.016), but SCQ was not (p > 0.05). The Turkish version of SCQ had adequate reliability and validity, and the mSCQ improved the validity of the scale in patients with PsA.
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Ma S, Zhang L, Man S, Bian T, Li H, Li W, Ma Z, He D. Patient-reported adherence to physical exercises of patients with ankylosing spondylitis. Clin Rheumatol 2022; 41:2423-2429. [PMID: 35505263 PMCID: PMC9287216 DOI: 10.1007/s10067-022-06189-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/27/2022] [Accepted: 04/24/2022] [Indexed: 11/27/2022]
Abstract
Introduction Studies on adherence to exercise therapy of patients with ankylosing spondylitis (AS) are rare, and the criteria for adherence to exercise are inconsistent. This study aimed to quantify patient-reported adherence to exercise therapy of Chinese outpatients with AS and investigate the factors related to poor adherence. Methods The subjects’ sociodemographic, disease-related, radiographic, and laboratory parameters were collected. Patients’ adherence to exercise therapy was assessed using the Exercise Attitude Questionnaire (EAQ) with a 4-point Likert scale. All cases were grouped as good adherence and poor adherence using a cutoff score of 60, according to a previous study. Univariate analysis was conducted to assess the intergroup differences. Then, we built a multivariate logistic regression model to identify possible significant factors related to poor adherence to exercise therapy. Results A total of 185 outpatients completed the questionnaire. The mean EAQ score was 49.4 (IQR, 40.7–59.3) and 146 patients (78.9%) were considered to have poor adherence, and 39 patients (21.1%) were considered to have good adherence. The rates of current nonsteroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and tumor necrosis factor-α inhibitor (TNF-i) use were significantly higher in the poor adherence group (p=0.001, p=0.027, p=0.018, respectively). Our multivariate logistic regression model revealed that the only significant associated factor was current use of NSAIDs (OR=3.517; p=0.016; 95% CI, 1.259–9.827). Conclusions Outpatients with AS had an unacceptable level of adherence to exercise therapy, and current use of NSAIDs was a significantly associated factor.Key Points • Outpatients with AS had an unacceptable level of adherence to exercise therapy. • Current use of NSAIDs exerted a negative impact on patients’ adherence to exercise therapy. |
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Affiliation(s)
- Sai Ma
- Department of Spine Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Liang Zhang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Siliang Man
- Department of Rheumatology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Tao Bian
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Hongchao Li
- Department of Rheumatology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Weiyi Li
- Department of Physical Therapy and Rehabilitation, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Zhuyi Ma
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
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Lin CMA, Ng N, Orman A, Clement ND, Deehan DJ. Reliability of patient-reported comorbidities: a systematic review and meta-analysis. Postgrad Med J 2021; 99:postgradmedj-2021-140857. [PMID: 34645695 DOI: 10.1136/postgradmedj-2021-140857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/18/2021] [Indexed: 11/04/2022]
Abstract
Self-reported questionnaires have become a widely adopted method of reviewing patients in clinical practice. This systematic review aimed to determine the reliability of patient-reported comorbidities and to identify which patient factors influence the reliability. Included studies assessed the reliability of at least one patient-reported comorbidity against their medical record or clinical assessment as gold standard. Twenty-four eligible studies were included in the meta-analysis. Only endocrine diseases (Cohen's Kappa Coefficient (CKC) 0.81 (95% CI 0.76 to 0.85)), consisting of diabetes mellitus (CKC 0.83 (95% CI 0.80 to 0.86)) and thyroid disease (CKC 0.68 (95% CI 0.50 to 0.86)), showed good-to-excellent reliability. Factors most frequently reported to influence concordance included age, sex and educational level.This systematic review demonstrated poor-to-moderate reliability for most systems, except for endocrine which showed good-to-excellent reliability. Although patient self-reporting can be a useful guide to clinical management, several patient factors were demonstrated to affect reliability therefore it should be avoided as a standalone measure.
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Affiliation(s)
| | - Nathan Ng
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alexander Orman
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nicholas D Clement
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Musculoskeletal Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - David J Deehan
- Musculoskeletal Department, Freeman Hospital, Newcastle upon Tyne, UK
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9
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Zhao SS, Robertson S, Reich T, Harrison NL, Moots RJ, Goodson NJ. Prevalence and impact of comorbidities in axial spondyloarthritis: systematic review and meta-analysis. Rheumatology (Oxford) 2020; 59:iv47-iv57. [PMID: 33053193 PMCID: PMC7566561 DOI: 10.1093/rheumatology/keaa246] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/09/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Comorbidities are common in people with axial spondyloarthritis (axSpA). In this systematic review and meta-analysis, we aimed to: (i) describe the prevalence of commonly reported comorbidities, (ii) compare comorbidities between axSpA and control populations, and (iii) examine the impact of comorbidity burden on axSpA outcomes. METHODS We systematically searched Medline, PubMed, Scopus and Web of Science using a predefined protocol in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We excluded studies of only one comorbid condition or a few closely related diseases within one organ system. Where possible, meta-analysis was performed using random-effects models. RESULTS A total of 40 studies were included for analysis. 36 studies reported prevalence of comorbidities, amounting to a combined sample size of 119 427 patients. The number of comorbidities studied ranged from 3 to 43. The most prevalent individual comorbidities were hypertension (pooled prevalence 23%), hyperlipidaemia (17%) and obesity (14%). Eleven studies consistently showed higher prevalence of comorbidities in axSpA than controls, particularly large differences were seen for depression [pooled odds ratio (OR) 1.80] and heart failure (OR 1.84). Comorbidities (total number of and individual conditions) were also associated with axSpA disease activity, functional impairment, quality of life, work productivity and mortality. CONCLUSIONS Comorbidities are common in axSpA, particularly cardiovascular diseases and risk factors. Most comorbidities were more prevalent in axSpA patients than in control populations. Overall comorbidity burden, and many individual conditions, were associated with axSpA outcomes including worse disease severity, work productivity and mortality.
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Affiliation(s)
- Sizheng Steven Zhao
- Musculoskeletal Biology, Institute of Lifecourse and Medical Sciences, University of Liverpool
- Department of Academic Rheumatology, Liverpool University Hospitals
| | | | - Tzvi Reich
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | - Robert J Moots
- Musculoskeletal Biology, Institute of Lifecourse and Medical Sciences, University of Liverpool
- Department of Academic Rheumatology, Liverpool University Hospitals
| | - Nicola J Goodson
- Musculoskeletal Biology, Institute of Lifecourse and Medical Sciences, University of Liverpool
- Department of Academic Rheumatology, Liverpool University Hospitals
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10
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Sheriffdeen A, Millar JL, Martin C, Evans M, Tikellis G, Evans SM. (Dis)concordance of comorbidity data and cancer status across administrative datasets, medical charts, and self-reports. BMC Health Serv Res 2020; 20:858. [PMID: 32917193 PMCID: PMC7488579 DOI: 10.1186/s12913-020-05713-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/03/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Benchmarking outcomes across settings commonly requires risk-adjustment for co-morbidities that must be derived from extant sources that were designed for other purposes. A question arises as to the extent to which differing available sources for health data will be concordant when inferring the type and severity of co-morbidities, how close are these to the "truth". We studied the level of concordance for same-patient comorbidity data extracted from administrative data (coded from International Classification of Diseases, Australian modification,10th edition [ICD-10 AM]), from the medical chart audit, and data self-reported by men with prostate cancer who had undergone a radical prostatectomy. METHODS We included six hospitals (5 public and 1 private) contributing to the Prostate Cancer Outcomes Registry-Victoria (PCOR-Vic) in the study. Eligible patients from the PCOR-Vic underwent a radical prostatectomy between January 2017 and April 2018.Health Information Manager's in each hospital, provided each patient's associated administrative ICD-10 AM comorbidity codes. Medical charts were reviewed to extract comorbidity data. The self-reported comorbidity questionnaire (SCQ) was distributed through PCOR-Vic to eligible men. RESULTS The percentage agreement between the administrative data, medical charts and self-reports ranged from 92 to 99% in the 122 patients from the 217 eligible participants who responded to the questionnaire. The presence of comorbidities showed a poor level of agreement between data sources. CONCLUSION Relying on a single data source to generate comorbidity indices for risk-modelling purposes may fail to capture the reality of a patient's disease profile. There does not appear to be a 'gold-standard' data source for the collection of data on comorbidities.
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Affiliation(s)
- A Sheriffdeen
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
| | - J L Millar
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
- William Buckland Radiotherapy Centre, The Alfred, Melbourne, Australia
| | - C Martin
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
| | - M Evans
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
| | - G Tikellis
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
| | - S M Evans
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.
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11
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Stolwijk C, Essers I, van den Bosch F, Dougados M, Etcheto A, van der Heijde D, Landewé R, Molto A, van Tubergen A, Boonen A. Validation of the self-administered comorbidity questionnaire adjusted for spondyloarthritis: results from the ASAS-COMOSPA study. Rheumatology (Oxford) 2020; 59:1632-1639. [PMID: 31665462 PMCID: PMC7310090 DOI: 10.1093/rheumatology/kez482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/17/2019] [Indexed: 12/21/2022] Open
Abstract
Objective To confirm validity of the Self-administered Comorbidity Questionnaire modified for patients with SpA (mSCQ), and assess whether validity improves when adding items on extra-articular manifestations (EAMs), i.e. uveitis, psoriasis, and IBD, and osteoporosis and fractures. Methods Data from the Assessment in SpondyloArthritis international Society COMOrbidities in SPondyloArthritis study were used. Criterion validity of presence of EAMs, osteoporosis and fractures was assessed as agreement (kappa) between patients’ self-reported and physician-confirmed disease. Construct validity of the mSCQ including EAMs, osteoporosis and/or fractures (SpA-SCQ) was assessed by testing hypotheses about correlations with demographics, physical function, work ability, health utility and disease activity, and was compared with construct validity of the rheumatic disease comorbidity index. Results In total, 3984 patients contributed to the analyses. Agreement between patient-reported and physician-reported EAMs was substantial to almost perfect (uveitis ĸ = 0.81, IBD ĸ = 0.73, psoriasis ĸ = 0.86). Agreement for osteoporosis (ĸ = 0.38) and fractures (ĸ = 0.39) was fair. As hypothesized, the mSCQ correlated moderately to weakly with age, physical function, work limitations and health utility, and very weakly with disease activity. In contrast to our hypothesis, adding EAMs, osteoporosis and/or fractures to the mSCQ decreased correlations with several external constructs, especially among patients with peripheral SpA. Correlations with the different constructs were stronger for the both mSCQ and SpA-SCQ (rBASFI = 0.34; rEQ-5D = −0.33) compared with the rheumatic disease comorbidity index (rBASFI = 0.24; rEQ-5D = −0.21). Conclusion The mSCQ is a valid self-report instrument to assess the influence of comorbidities on health outcomes in patients with SpA. Adding EAMs and/or osteoporosis or fractures does not improve validity of the mSCQ.
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Affiliation(s)
- Carmen Stolwijk
- Department of Rheumatology, Maastricht University Medical Center.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht.,Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ivette Essers
- Department of Rheumatology, Maastricht University Medical Center.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht
| | - Filip van den Bosch
- Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium
| | - Maxime Dougados
- Department of Rheumatology, Paris Descartes University and Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Adrien Etcheto
- Department of Rheumatology, Paris Descartes University and Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Robert Landewé
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology & Immunology Centre, Amsterdam, The Netherlands
| | - Anna Molto
- Department of Rheumatology, Paris Descartes University and Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Astrid van Tubergen
- Department of Rheumatology, Maastricht University Medical Center.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht
| | - Annelies Boonen
- Department of Rheumatology, Maastricht University Medical Center.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht
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12
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Oemrawsingh A, Swami N, Valderas JM, Hazelzet JA, Pusic AL, Gliklich RE, Bergmark RW. Patient-Reported Morbidity Instruments: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:791-811. [PMID: 32540238 DOI: 10.1016/j.jval.2020.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/27/2020] [Accepted: 02/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Although comorbidities play an essential role in risk adjustment and outcomes measurement, there is little consensus regarding the best source of this data. The aim of this study was to identify general patient-reported morbidity instruments and their measurement properties. METHODS A systematic review was conducted using multiple electronic databases (Embase, Medline, Cochrane Central, and Web of Science) from inception to March 2018. Articles focusing primarily on the development or subsequent validation of a patient-reported morbidity instrument were included. After including relevant articles, the measurement properties of each morbidity instrument were extracted by 2 investigators for narrative synthesis. RESULTS A total of 1005 articles were screened, of which 34 eligible articles were ultimately included. The most widely assessed instruments were the Self-Reported Charlson Comorbidity Index (n = 7), the Self-Administered Comorbidity Questionnaire (n = 3), and the Disease Burden Morbidity Assessment (n = 3). The most commonly included conditions were diabetes, hypertension, and myocardial infarction. Studies demonstrated substantial variability in item-level reliability versus the gold standard medical record review (κ range 0.66-0.86), meaning that the accuracy of the self-reported comorbidity data is dependent on the selected morbidity. CONCLUSIONS The Self-Reported Charlson Comorbidity Index and the Self-Administered Comorbidity Questionnaire were the most frequently cited instruments. Significant variability was observed in reliability per comorbid condition of patient-reported morbidity questionnaires. Further research is needed to determine whether patient-reported morbidity data should be used to bolster medical records data or serve as a stand-alone entity when risk adjusting observational outcomes data.
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Affiliation(s)
- Arvind Oemrawsingh
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Nishwant Swami
- University of Massachusetts Medical School, Worcester, MA, USA
| | - José M Valderas
- International Society for Quality of Life Research, Health Services & Policy Research, University of Exeter Medical School, Exeter, England, UK
| | - Jan A Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Patient Reported Outcomes, Value, and Experience Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Richard E Gliklich
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Regan W Bergmark
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Patient Reported Outcomes, Value and Experience Center, Brigham and Women's Hospital, Boston, MA, USA
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13
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Hendry GJ, Fenocchi L, Mason H, Steultjens M. The impact of multimorbidity on foot health outcomes in podiatry patients with musculoskeletal foot pain: a prospective observational study. J Foot Ankle Res 2019; 12:36. [PMID: 31312257 PMCID: PMC6609344 DOI: 10.1186/s13047-019-0346-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/24/2019] [Indexed: 12/28/2022] Open
Abstract
Background Multimorbidity is prevalent and adversely affects health outcomes. Foot pain is common and one of the primary reasons for utilisation of podiatry services. At present, little is known about the impact of multimorbidity on foot health and related outcomes following podiatric intervention. The aims of this study were to evaluate whether there is a difference in foot health outcomes following exposure to podiatric foot care for people with and without multimorbidity; and ii) to evaluate whether the presence or absence of multimorbidity affects patients’ perceptions of change in foot pain. Methods The PROMFoot study is a prospective cohort study of adults with a new episode of foot pain attending the podiatry service within the NHS Greater Glasgow and Clyde health board. Baseline medical comorbidity status (no condition, single condition, multiple conditions), longitudinal data on foot health measured using the Foot Health Status Questionnaire (FHSQ), and patient rating of change scores for foot pain were obtained from the PROMFoot study at baseline, and 3 and 6 months after podiatric intervention. Foot health scores (pain, function, footwear and general foot health) and perceptions of change for foot pain were compared between comorbidity groups. Results A total of 115 participants (59% female) with a mean age of 55 years were included. Multimorbidity was common, affecting 61 participants (53%); while 28 (24.3%) and 26 (22.6%) reported single or no medical comorbidities respectively. Significantly worse foot health scores for all FHSQ domains were observed for the multimorbidity group at baseline, 3 and 6 months. Change scores for foot pain were similar between groups and demonstrate modest improvements, however multimorbidity group membership was strongly associated with a perceptions of change in foot pain. Multimorbidity was independently associated with poorer foot function outcomes at 3 months, and poorer foot pain and foot function outcomes at 6 months. Conclusions Multimorbidity was associated with poor foot health outcomes and lower rates of self-perceived improvement in foot pain over 6 months following podiatric intervention in a sample of patients attending podiatric biomechanics clinics for a new episode of foot pain. Electronic supplementary material The online version of this article (10.1186/s13047-019-0346-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gordon J Hendry
- 1Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA Scotland UK
| | - Linda Fenocchi
- 1Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA Scotland UK.,2Yunus Centre for Social Business and Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA Scotland UK
| | - Helen Mason
- 2Yunus Centre for Social Business and Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA Scotland UK
| | - Martijn Steultjens
- 1Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA Scotland UK
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14
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Larsen M, Strumse Y, Borge C, Osborne R, Andersen M, Wahl A. Health literacy: a new piece of the puzzle in psoriasis care? A cross‐sectional study. Br J Dermatol 2019; 180:1506-1516. [DOI: 10.1111/bjd.17595] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2018] [Indexed: 12/26/2022]
Affiliation(s)
- M.H. Larsen
- Department of Health Sciences Institute of Health and Society Faculty of Medicine University of Oslo OsloNorway
| | - Y.A.S. Strumse
- Section for Climate Therapy Oslo University Hospital Oslo Norway
| | - C.R. Borge
- Department of Health Sciences Institute of Health and Society Faculty of Medicine University of Oslo OsloNorway
- Department of Patient Safety and Research at Lovisenberg Diaconal Hospital OsloNorway
| | - R. Osborne
- Deakin University Faculty of Health School of Health and Social Development Geelong VICAustralia
| | - M.H. Andersen
- Department of Health Sciences Institute of Health and Society Faculty of Medicine University of Oslo OsloNorway
- Department of Transplantation Medicine Oslo University Hospital Oslo Norway
| | - A.K. Wahl
- Department of Health Sciences Institute of Health and Society Faculty of Medicine University of Oslo OsloNorway
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15
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Essers I, Hiligsmann M, Kiltz U, Bansback N, Braun J, van der Heijde D, Boonen A. Development of one general and six country-specific algorithms to assess societal health utilities based on ASAS HI. RMD Open 2019; 5:e000872. [PMID: 31245046 PMCID: PMC6560676 DOI: 10.1136/rmdopen-2018-000872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 04/29/2019] [Indexed: 01/24/2023] Open
Abstract
Objective Health utilities represent preference values that persons attach to health states. This study aims to develop one general and six country-specific algorithms to calculate societal preference values for health of patients with spondyloarthritis (SpA), as assessed by the disease-specific Assessment of SpondyloArthritis international Society Health Index (ASAS HI). Methods A survey was performed in random population samples from six European countries. In a best-worst choice experiment, subjects were asked to indicate repeatedly which of 4 random aspects of the 17-item ASAS HI was were most and least important. Bayesian analysis provided the relative importance of each of the 17 items. To rescale the relative importance scores on the absolute utility scale between 0 and 1, participants additionally completed two lead time trade-off experiments, one for 'severe SpA' and one for 'best health' without SpA. Six country-specific algorithms and one general algorithm were derived. The general algorithm was tested in 199 patients with axial SpA (axSpA). Results 3039 subjects, mean age 47 years (SD 15) and 52% female completed the experiments. The population's health utility value for SpA varied between - 0.24 for 'worst' SpA (country range -0.35 to 0.03), and 0.88 for 'best' health (country range 0.81 to 0.90). Among 199 patients with axSpA, the mean utility was 0.36 (SD 0.30, range -0.24 to 0.88) and discriminated well between patients having high (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4) or low (BASDAI < 4) disease activity (0.18 (SD 0.24) vs 0.51(SD 0.27), p<0.01). Conclusion One general and six country-specific algorithms are available to convert scores from the ASAS HI into disease-specific societal utility values.
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Affiliation(s)
- Ivette Essers
- Rheumatology, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Mickael Hiligsmann
- Department of Health Services Research, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and the Caphri Research Institute Maastricht University, Maastricht, The Netherlands
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16
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Weiland TJ, De Livera AM, Brown CR, Jelinek GA, Aitken Z, Simpson SL, Neate SL, Taylor KL, O'Kearney E, Bevens W, Marck CH. Health Outcomes and Lifestyle in a Sample of People With Multiple Sclerosis (HOLISM): Longitudinal and Validation Cohorts. Front Neurol 2018; 9:1074. [PMID: 30619037 PMCID: PMC6299875 DOI: 10.3389/fneur.2018.01074] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/26/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: To report the methodology and summary data of the Health Outcomes and Lifestyle In a Sample of people with Multiple sclerosis (HOLISM) longitudinal and validation cohorts. We report (1) data on participation, socio-demographics, disease characteristics, medication use, modifiable lifestyle risk factor exposures, and health outcomes of the HOLISM longitudinal cohort 2.5-years post enrolment; (2) attrition at this 2.5-year wave; and (3) baseline characteristics of the associated HOLISM validation cohort. Methods: The HOLISM longitudinal study recruited people internationally with self-reported diagnosed multiple sclerosis (MS) through web 2.0 platforms and MS society newsletters. Participants, first recruited in 2012, were invited 2.5-years later to participate in a follow-up survey. At both time points, participants completed a comprehensive online questionnaire of socio-demographics, modifiable lifestyle exposures, and health outcomes using validated and researcher-designed tools. The same methodology was used to recruit a new sample: the HOLISM validation cohort. Characteristics were explored using summary measures. Results: Of 2,466 people with MS at baseline, 1,401 (56.8%) provided data at 2.5-year follow-up. Attrition was high, likely due to limited amount of contact information collected at baseline. Completion of the 2.5-year wave was associated with healthier lifestyle, and better health outcomes. Participants completing follow-up had diverse geographical location, were predominantly female, married, unemployed or retired. At 2.5-year follow-up, nearly 40% were overweight or obese, most were physically active, non-smokers, consumed little alcohol, used vitamin D/omega-3 supplements, and 42% reported current disease-modifying drug use. Thirty percentage of reported cane or gait disability, while 13% relied on major mobility supports (Patient Determined Disease Steps). Approximately half the respondents reported a comorbidity, 63% screened positive for clinically significant fatigue (Fatigue Severity Scale), and 22% screened positive for depression (Patient Health Questionnaire-9). The validation cohort's characteristics were mostly consistent with previously reported HOLISM baseline data. Conclusions: Exploring prospective associations of modifiable environmental/behavioral risk factors with health outcomes in this international longitudinal sample of people with MS will be beneficial to MS research. Impacts of attrition and selection bias will require consideration. The validation cohort provides opportunity for replication of previous findings, and also for temporal validation of predictive models derived from the HOLISM cohort.
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Affiliation(s)
- Tracey J. Weiland
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alysha M. De Livera
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Biostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Chelsea R. Brown
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - George A. Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Zoe Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Steve L. Simpson
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sandra L. Neate
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Keryn L. Taylor
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Emily O'Kearney
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - William Bevens
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Claudia H. Marck
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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17
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Webers C, Ramiro S, Landewé R, van der Heijde D, van den Bosch F, Dougados M, van Tubergen A, Boonen A. Sick leave and its predictors in ankylosing spondylitis: long-term results from the Outcome in Ankylosing Spondylitis International Study. RMD Open 2018; 4:e000766. [PMID: 30564453 PMCID: PMC6269643 DOI: 10.1136/rmdopen-2018-000766] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/26/2018] [Accepted: 10/23/2018] [Indexed: 12/26/2022] Open
Abstract
Objective To investigate the occurrence of ankylosing spondylitis (AS)-related sick leave (SL) over 6 12 years and explore factors predicting first and recurrent SL. Methods Data from employed patients from the Outcome in Ankylosing Spondylitis International Study were used. At each visit, patients indicated the occurrence of SL (yes/no) in the previous inter-assessment period. Cox regressions predicted a first episode of SL. Generalised estimating equations (GEE) explored the association between SL and (time-lagged) predictors. To investigate whether SL predicts new SL, SL in the first year was included as covariate in a separate analysis. Results 139 patients (76% males, mean (SD) age 38.7 (10.0) years) were at risk for SL for an average period of 7.9 years, of whom 88 (63%) reported any SL. In both the Cox baseline predictors model (HR (95% CI)) and the time-varying GEE models (OR (95% CI)), AS Disease Activity Score (1.67, 1.23 to 2.28 (HR); 1.48, 1.07 to 2.03 (OR)); Bath AS Disease Activity Index (1.33, 1.18 to 1.51 (HR); 1.31, 1.15 to 1.49 (OR)), Bath AS Functional Index (1.17, 1.02 to 1.34 (HR); 1.31, 1.16 to 1.47 (OR)) and comorbidity at baseline (GEE only, 1.52, 1.00 to 2.29 (OR)) were associated with SL in separate models, but only in patients with low educational attainment. SL in the first year was an independent predictor of SL over time (OR: 2.62 to 8.37 in different models, all p<0.05). Conclusion Disease activity and physical function predicted first and recurrent SL, but only in patients with low educational attainment. Prior SL results in future SL, and SL should therefore be a signal for support to prevent future adverse work outcome.
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Affiliation(s)
- Casper Webers
- Division of Rheumatology, Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert Landewé
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands.,Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Filip van den Bosch
- Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium
| | - Maxime Dougados
- Department of Rheumatology, Paris Descartes University and Cochin Hospital, AP-HP, Paris, France.,Department of INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Astrid van Tubergen
- Division of Rheumatology, Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Annelies Boonen
- Division of Rheumatology, Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Rodrigues Manica S, Sepriano A, Ramiro S, Pimentel Santos F, Putrik P, Nikiphorou E, Norton S, Molto A, Dougados M, van der Heijde D, Landewé RBM, van den Bosch FE, Boonen A. Work participation in spondyloarthritis across countries: analysis from the ASAS-COMOSPA study. Ann Rheum Dis 2018; 77:1303-1310. [PMID: 29860232 DOI: 10.1136/annrheumdis-2018-213464] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To explore the role of individual and country level socioeconomic (SE) factors on employment, absenteeism and presenteeism in patients with spondyloarthritis (SpA) across 22 countries worldwide. METHODS Patients with a clinical diagnosis of SpA fulfilling the ASAS classification criteria and in working age (≤65 years) from COMOSPA were included. Outcomes of interest were employment status, absenteeism and presenteeism, assessed by the Work Productivity and Activity Impairment Specific General Health questionnaire. Three multivariable models were built (one per outcome) using mixed-effects binomial (for work status) or ordinal regressions (for absenteeism and presenteeism), with country as random effect. The contribution of SE factors at the individual-level (eg, gender, education, marital status) and country-level (healthcare expenditure (HCE) per capita, Human Development Index (HDI) and gross domestic product per capita) SE factors, independent of clinical factors, was assessed. RESULTS In total, 3114 patients with SpA were included of which 1943 (62%) were employed. Physical function and comorbidities were related to all work outcomes in expected directions and disease activity also with absenteeism and presenteeism. Higher education (OR 4.2 (95% CI 3.1 to 5.6)) or living in a country with higher HCE (OR 2.3 (1.5 to 3.6)) or HDI (OR 1.9 (1.2 to 3.3)) was positively associated with being employed. Higher disease activity was associated with higher odds for absenteeism (OR 1.5 (1.3 to 1.7)) and presenteeism (OR 2.1 (1.8 to 2.4)). No significant association between individual-level and country-level SE factors and absenteeism or presenteeism was found. CONCLUSIONS Higher education level and higher country SE welfare are associated with a higher likelihood of keeping patients with SpA employed. Absenteeism and presenteeism are only associated with clinical but not with individual-level or country-level SE factors.
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Affiliation(s)
- Santiago Rodrigues Manica
- Department of Rheumatology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Alexandre Sepriano
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sofia Ramiro
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fernando Pimentel Santos
- Department of Rheumatology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - Elena Nikiphorou
- Academic Rheumatology, King's College of London (KCL), London, UK
| | - Sam Norton
- Academic Rheumatology, King's College of London (KCL), London, UK.,Psychology Department, King's College of London (KCL), London, UK
| | - Anna Molto
- Rheumatology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.,INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Maxime Dougados
- Rheumatology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.,INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | | | | | - Filip E van den Bosch
- Department of Internal Medicine, VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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19
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O'Leary H, Smart KM, Moloney NA, Blake C, Doody CM. Pain sensitization associated with nonresponse after physiotherapy in people with knee osteoarthritis. Pain 2018; 159:1877-1886. [DOI: 10.1097/j.pain.0000000000001288] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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20
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Castillo-Ortiz JD, Ramiro S, Landewé R, van der Heijde D, Dougados M, van den Bosch F, Boonen A. Work Outcome in Patients With Ankylosing Spondylitis: Results From a 12-Year Followup of an International Study. Arthritis Care Res (Hoboken) 2016; 68:544-52. [PMID: 26414460 DOI: 10.1002/acr.22730] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 08/11/2015] [Accepted: 09/08/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To understand the impact of ankylosing spondylitis (AS) on work disability (WD) over 12 years compared with the general population, and explore factors predicting adverse work outcome, defined as new partial WD or reduction in working hours. METHODS Source of data was the Outcome Assessments in Ankylosing Spondylitis International Study, which includes patients from The Netherlands, France, and Belgium. Standardized WD rates over time compared to the general population were calculated using indirect standardization (Dutch patients only). Cox survival analyses identified baseline predictors as well as time-varying factors influencing adverse work outcome over 12 years. RESULTS Of 215 patients, 55 (26%) were full WD at baseline and 139 (65%) were at risk for adverse work outcome during followup. When compared to the general population, WD over 12 years continued to be increased in Dutch men (incidence rate [IR] 2.9 [95% confidence interval (95% CI) 1.2, 4.6]), but less clearly for women (IR 1.2 [95% CI -0.4, 2.9]). Within the entire sample, baseline predictors of adverse work outcome over 12 years were residence in The Netherlands (versus France or Belgium) (hazard ratio [HR] 3.4 [95% CI 1.4, 8.4]) and worse Bath Ankylosing Spondylitis Functional Index (BASFI) (HR 1.2 [95% CI 1.0, 1.4]). Time-varying predictors over 12 years were residence in The Netherlands, uveitis, and either BASFI or Bath Ankylosing Spondylitis Disease Activity Index with age and inflammatory bowel disease. CONCLUSION Although WD was already prevalent at inclusion in the cohort, a substantial proportion of patients incurred further adverse work outcome over 12 years. In addition to country of residence, uveitis, age, and self-reported physical function or disease activity predicted long-term adverse work outcome.
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Affiliation(s)
- J D Castillo-Ortiz
- Maastricht University, Maastricht, The Netherlands, and Unidad de Investigacion en Enfermedades Cronico Degenerativas, Guadalajara, Jalisco, Mexico
| | - S Ramiro
- Amsterdam Rheumatology Center, Amsterdam, The Netherlands, and Hospital Garcia de Orta, Almada, Portugal
| | - R Landewé
- Hospital Garcia de Orta, Almada, Portugal, and Atrium Medical Center, Heerlen, The Netherlands
| | | | | | | | - A Boonen
- Maastricht University, Maastricht, The Netherlands
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21
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Robinski M, Strich F, Mau W, Girndt M. Validating a Patient-Reported Comorbidity Measure with Respect to Quality of Life in End-Stage Renal Disease. PLoS One 2016; 11:e0157506. [PMID: 27294867 PMCID: PMC4905653 DOI: 10.1371/journal.pone.0157506] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/31/2016] [Indexed: 12/26/2022] Open
Abstract
Purpose Medical record-derived comorbidity measures such as the Charlson Comorbidity Index (CCI) do not predict functional limitations or quality of life (QoL) in the chronically ill. Although these shortcomings are known since the 1980s, they have been largely ignored by the international literature. Recently, QoL has received growing interest as an end-point of interventional trials in Nephrology. The aim of this study is to compare a patient-reported comorbidity measure and the CCI with respect to its validity regarding QoL. Methods The German Self-Administered Comorbidity Questionnaire (SCQ-G) was completed by 780 adult end-stage renal disease-patients recruited from 55 dialysis units throughout Germany. Acceptance was evaluated via response rates. Content validity was examined by comparing the typical comorbidity pattern in dialysis patients and the pattern retrieved from our data. Convergent validity was assessed via kappa statistics. Data was compared to the CCI. Linear associations with QoL were examined (criterion validity). Results The SCQ-G was very well accepted by dialysis patients of all ages (response rate: 99%). Content validity can be interpreted as high (corresponding comorbidity items: 73.7%). Convergent validity was rather weak (.27≤ρ≤.29) but increased when comparing only concordant items (.39≤ρ≤.43). With respect to criterion validity, the SCQ-G performed better than the CCI regarding the correlation with QoL (e.g., SF-12-physical: SCQ-G total score: ρ = -.49 vs. CCI: ρ = -.36). Conclusions The patient-reported measure proved to be more valid than the external assessment when aiming at insights on QoL. Due to the inclusion of subjective limitations, the SCQ-G is more substantial with respect to patient-centered outcomes and might be used as additional measure in clinical trials.
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Affiliation(s)
- Maxi Robinski
- Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Center for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- * E-mail:
| | - Franz Strich
- Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Center for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Wilfried Mau
- Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Center for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Girndt
- Department of Internal Medicine II, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Center for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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22
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Weiss SJ, Simeonova DI, Kimmel MC, Battle CL, Maki PM, Flynn HA. Anxiety and physical health problems increase the odds of women having more severe symptoms of depression. Arch Womens Ment Health 2016; 19:491-9. [PMID: 26403982 DOI: 10.1007/s00737-015-0575-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 09/13/2015] [Indexed: 01/04/2023]
Abstract
Severely depressed women incur substantial disability and suicide risk, necessitating an understanding of factors that may contribute to severe depression. The purpose of this research was to determine the degree to which age, physical morbidity, anxiety, and hormonal status predict the likelihood of severe depression among women with mood disorders (n = 298). Data arose from a standardized battery of measures in a multi-center clinical registry of patients with mood disorders. The women were being treated at 17 participating sites of the National Network of Depression Centers. Results of logistic regression analyses indicate that a woman's level of anxiety was the strongest predictor of her likelihood of having severe depression (Exp(B) = 1.33, p = .000), including thoughts of death or suicide. The number of physical health problems that a woman reported was also a significant predictor (Exp(B) = 1.09, p = .04). Neither age nor hormonal status was significant in the final model, although a trend was observed for women with surgically induced menopause to have more severe depression. Findings support the need to work closely with medical practitioners to address physical health problems as part of the treatment plan for depression and to give comorbid anxiety and depression equal priority in symptom management.
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Affiliation(s)
- Sandra J Weiss
- Department of Community Health Systems, University of California, San Francisco, 9 Koret Way, Box 0608, San Francisco, CA, 94143, USA.
| | - Diana I Simeonova
- Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Drive, NE, Atlanta, GA, 30329, USA
| | - Mary C Kimmel
- Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Cynthia L Battle
- Department of Psychiatry and Human Behavior, Brown University and Butler Hospital Psychosocial Research Program, 345 Blackstone Blvd, Providence, RI, 02906, USA
| | - Pauline M Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, 912 South Wood Street, Chicago, IL, 60612, USA
| | - Heather A Flynn
- Department of Behavioral Science and Social Medicine, Florida State University, 115 West Call Street, Tallahasse, FL, 32306, USA
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23
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Maas F, Arends S, van der Veer E, Wink F, Efde M, Bootsma H, Brouwer E, Spoorenberg A. Obesity Is Common in Axial Spondyloarthritis and Is Associated with Poor Clinical Outcome. J Rheumatol 2015; 43:383-7. [PMID: 26669924 DOI: 10.3899/jrheum.150648] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the prevalence of overweight and obesity in a large cohort of patients with axial spondyloarthritis (axSpA) in comparison with the general population. To explore the relationship of body mass index (BMI) with clinical outcome in axSpA. METHODS Patients from the Groningen Leeuwarden Axial SpA cohort who visited the outpatient clinic in 2011/2012 were included in this cross-sectional analysis. Body weight, height, disease activity, physical function, and quality of life (QoL) were assessed. Patients were divided into normal weight (BMI < 25 kg/m(2)), overweight (BMI ≥ 25 to < 30 kg/m(2)), and obese (BMI ≥ 30 kg/m(2)). BMI data for the general population in the same demographic region, matched for age and sex, were obtained from the LifeLines Cohort Study. RESULTS Of the 461 patients with axSpA, 37% were overweight and 22% were obese. In the LifeLines cohort (n = 136,577), 43% were overweight and 15% were obese. Overweight and obese patients were older, had longer symptom duration, and had more comorbidities, especially hypertension. Further, obese patients had significantly higher disease activity, worse physical function, and worse QoL than overweight and normal weight patients (mean Bath Ankylosing Spondylitis Disease Activity Index 4.5, 3.5, 3.8; mean Ankylosing Spondylitis Disease Activity Score 2.8, 2.2, 2.3; median C-reactive protein 5, 3, 3 mg/l; median erythrocyte sedimentation rate 13, 8, 8 mm/h; median Bath Ankylosing Spondylitis Functional Index 5.2, 2.9, 2.9; median Ankylosing Spondylitis QoL Questionnaire 8, 4, 5, respectively). After adjustment for potential confounders, obesity proved to be an independent predictor of worse clinical outcome. CONCLUSION In this large observational cohort study, obesity is more common in axSpA than in the general population and it is associated with worse clinical outcome.
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Affiliation(s)
- Fiona Maas
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden.
| | - Suzanne Arends
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
| | - Eveline van der Veer
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
| | - Freke Wink
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
| | - Monique Efde
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
| | - Hendrika Bootsma
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
| | - Elisabeth Brouwer
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
| | - Anneke Spoorenberg
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
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Stolwijk C, Castillo‐Ortiz J, Gignac M, Luime J, Boonen A, Lacaille D, Fautrel B, Tang K, Verstappen S, Escorpizo R, Tugwell P, Beaton D. Importance of Contextual Factors When Measuring Work Outcome in Ankylosing Spondylitis: A Systematic Review by the OMERACT Worker Productivity Group. Arthritis Care Res (Hoboken) 2015; 67:1316-1327. [DOI: 10.1002/acr.22573] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 02/07/2015] [Accepted: 02/24/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Carmen Stolwijk
- Maastricht University Medical CenterMaastricht The Netherlands
| | - José‐Dionisio Castillo‐Ortiz
- Maastricht University Medical Center, Maastricht, The Netherlands, and Unidad de Investigación en Enfermedades Cronico‐DegenerativasGuadalajara Mexico
| | - Monique Gignac
- Institute for Work and Health, University of Toronto, and University Health NetworkToronto, Ontario Canada
| | - Jolanda Luime
- Erasmus Medical Center and University Medical CenterRotterdam The Netherlands
| | - A. Boonen
- Maastricht University Medical CenterMaastricht The Netherlands
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25
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Turabián JL, Pérez Franco B. [A way of helping "Mr. Minotaur" and "Ms. Ariadne" to exit from the multiple morbidity labyrinth: the "master problems"]. Semergen 2015; 42:38-48. [PMID: 25817854 DOI: 10.1016/j.semerg.2015.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/07/2015] [Accepted: 02/09/2015] [Indexed: 11/24/2022]
Abstract
Multiple morbidity seems to be "infinite" and so is not easy to make useful decisions. A new concept is introduced: the "master problems", as a qualitative method to facilitate the exit from this maze of multiple morbidity. Metaphors from the art world have been used to teach this concept. These "master problems" generally remain hidden and can only "unravel" between the interstices of multiple morbidity, when the details of the system that defines the problem are explained. A problem with "energy" or a "master problem" is complex, multiple and dramatic or theatrical--everything in the clinical history history make us look into that particular question. It is what gives us a blow to the stomach, which causes our hearts to beat faster, that moves us on many levels, which has a high "density of emotions", human elements, social symbols, and opens solutions in a patient.
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Affiliation(s)
- J L Turabián
- Medicina de Familia y Comunitaria, Centro de Salud Polígono Industrial, Toledo, España.
| | - B Pérez Franco
- Medicina de Familia y Comunitaria, Centro de Salud La Estación, Talavera de la Reina, Toledo, España
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26
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