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Pain CE, Torok KS. Challenges and complications in juvenile localized scleroderma: A practical approach. Best Pract Res Clin Rheumatol 2024; 38:101987. [PMID: 39294014 DOI: 10.1016/j.berh.2024.101987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/09/2024] [Accepted: 07/15/2024] [Indexed: 09/20/2024]
Abstract
Juvenile localized scleroderma is characterised by inflammation which drives fibrosis in skin and soft tissues. The more severe subtypes of localized scleroderma such as linear and craniofacial are more common in children. Additionally, extracutaneous involvement is seen in half of all children and is associated with poorer treatment outcomes and health-related quality of life. Evidence for the management of craniofacial and extracutaneous involvement is lacking and therefore poses a challenge to clinicians. This review aims to provide a practical approach to management of these most challenging features of juvenile localized scleroderma through case studies where we present the available evidence, current recommendations and considerations for management.
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Affiliation(s)
- Clare E Pain
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, UK; Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | - Kathryn S Torok
- Division of Pediatric Rheumatology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA; Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Scleroderma Center, 4401 Penn Ave Pittsburgh, Pennsylvania, USA, 15224.
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Hernandez A, Zapata Leiva L, Mutka M, Torok KS, Ledbetter L, Zigler CK. Endpoints and outcomes for localized scleroderma/morphea: a scoping literature review. Pediatr Rheumatol Online J 2024; 22:77. [PMID: 39169409 PMCID: PMC11337887 DOI: 10.1186/s12969-024-01014-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 08/01/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Current treatment for localized scleroderma (LS) has been shown to halt disease activity, but little is still known about patient experiences with these treatments, nor is there consensus about optimal measurement strategies for future clinical trials. OBJECTIVE Conduct a scoping review of the literature for the types of outcomes and measures (i.e. clinician-, patient-, and caregiver-reported) utilized in published treatment studies of LS. METHODS Online databases were searched for articles related to the evaluation of treatment efficacy in LS with a special focus on pediatrics. RESULTS Of the 168 studies, the most common outcomes used were cutaneous disease activity and damage measured via clinician-reported assessments. The most frequently cited measure was the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT). Few patient-reported outcome measures (PROMs) were used. LIMITATIONS Some studies only vaguely reported the measures utilized, and the review yielded a low number of clinical trials. CONCLUSION In addition to evaluating disease activity with clinician-reported measures, the field could obtain critical knowledge on the patient experience by including high-quality PROMs of symptoms and functioning. More clinical trials using a variety of outcomes and measures are necessary to determine the most suitable course of treatment for LS patients.
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Affiliation(s)
- Alexy Hernandez
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Leslie Zapata Leiva
- Center for Communication Science, RTI International, Research Triangle Park, USA
| | | | - Kathryn S Torok
- Division of Rheumatology, Department of Pediatrics, University of Pittsburgh Medical Center - Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Leila Ledbetter
- Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, USA
| | - Christina K Zigler
- Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, 15224, United States.
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Ghazal S, Zhang Huang H, Gabrielli S, Khoury L, Pehr K, Veilleux M, Chédeville G, McCuaig C, Piram M, Netchiporouk E. Localized Scleroderma Burden: A Scoping Review Focusing on the Health-Related Quality of Life, Mental Health, and Productivity. J Cutan Med Surg 2024:12034754241260018. [PMID: 38864167 DOI: 10.1177/12034754241260018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Affiliation(s)
- Stephanie Ghazal
- Division of Dermatology, McGill University Health Center, Montreal, QC, Canada
| | - Han Zhang Huang
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Lauren Khoury
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Kevin Pehr
- Division of Dermatology, Jewish General Hospital, Montreal, QC, Canada
| | - Mylene Veilleux
- Division of Dermatology, Centre Hospitalier Universitaire Sherbrooke, Montreal, QC, Canada
| | - Gaëlle Chédeville
- Division of Pediatric Rheumatology, McGill University Health Center, Montreal, QC, Canada
| | - Catherine McCuaig
- Division of Dermatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Montréal, QC, Canada
| | - Maryam Piram
- Division of Dermatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Montréal, QC, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Center, Montreal, QC, Canada
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Stubbs LA, Ferry AM, Guffey D, Loccke C, Wade EM, Pour P, Ardalan K, Chira P, Ganske IM, Glaser D, Higgins G, Luca N, Moore KF, Sivaraman V, Stewart K, Vasquez-Canizares N, Hunt RD, Maricevich RS, Torok KS, Li SC. Barriers to care in juvenile localized and systemic scleroderma: an exploratory survey study of caregivers' perspectives. Pediatr Rheumatol Online J 2023; 21:39. [PMID: 37098622 PMCID: PMC10131373 DOI: 10.1186/s12969-023-00819-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/12/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Juvenile localized scleroderma (LS) and systemic sclerosis (SSc) are rare pediatric conditions often associated with severe morbidities. Delays in diagnosis are common, increasing the risk for permanent damage and worse outcomes. This study explored caregiver perspectives on barriers they encountered while navigating diagnosis and care for their child's scleroderma. METHODS In this cross-sectional study, caregivers of juvenile LS or SSc patients were recruited from a virtual family scleroderma educational conference and a juvenile scleroderma online interest group. The survey queried respondents about their child's condition and factors affecting diagnosis and treatment. RESULTS The response rate was 61% (73/120), with 38 parents of LS patients and 31 parents of SSc patients. Most patients were female (80%) and over half were non-Hispanic white (55%). Most families had at least one person with a college education or higher (87%), traveled ≤ 2 h to see their rheumatologist (83%), and had private insurance (75%). Almost half had an annual household income ≥ $100,000 (46%). Families identified the following factors as barriers to care: lack of knowledge about scleroderma in the medical community, finding reliable information about pediatric scleroderma, long wait times/distances for a rheumatology/specialist appointment, balance of school/work and child's healthcare needs, medication side effects, and identifying effective medications. The barrier most identified as a major problem was the lack of knowledge about juvenile scleroderma in the medical community. Public insurance, household income less than $100,000, and Hispanic ethnicity were associated with specific barriers to care. Lower socioeconomic status was associated with longer travel times to see the rheumatologist/specialist. Diagnosis and systemic treatment initiation occurred at greater than one year from initial presentation for approximately 28% and 36% of patients, respectively. Families of LS patients were commonly given erroneous information about the disease, including on the need and importance of treating active disease with systemic immunosuppressants in patients with deep tissue or rapidly progressive disease. CONCLUSION Caregivers of children with LS or SSc reported numerous common barriers to the diagnosis, treatment, and ongoing care of juvenile scleroderma. The major problem highlighted was the lack of knowledge of scleroderma within the general medical community. Given that most of the caregiver respondents to the survey had relatively high socioeconomic status, additional studies are needed to reach a broader audience, including caregivers with limited English proficiency, geographical limitations, and financial constraints, to determine if the identified problems are generalizable. Identifying key care barriers will help direct efforts to address needs, reduce disparities in care, and improve patient outcomes.
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Affiliation(s)
- Leigh A Stubbs
- Department of Pediatrics, Division of Rheumatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Andrew M Ferry
- Department of Plastic Surgery, Division of Pediatric Plastic Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Danielle Guffey
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Christina Loccke
- Board of Directors, National Scleroderma Foundation, Danvers, MA, USA
| | | | - Pamela Pour
- Advisory Board Member, Scleroderma Foundation Michigan Chapter, Southfield, MI, USA
| | - Kaveh Ardalan
- Department of Pediatrics, Division of Rheumatology, Duke University School of Medicine, Durham, NC, USA
| | - Peter Chira
- Department of Pediatrics, Division of Rheumatology, University of California San Diego, San Diego, CA, USA
| | - Ingrid M Ganske
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel Glaser
- Department of Pediatrics, Section of General Pediatrics, Yale University, New Haven, CT, USA
| | - Gloria Higgins
- Department of Pediatrics, Division of Rheumatology, Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA
| | - Nadia Luca
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Katharine F Moore
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Vidya Sivaraman
- Department of Pediatrics, Division of Rheumatology, Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA
| | - Katie Stewart
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Texas Southwestern, Dallas, TX, USA
| | - Natalia Vasquez-Canizares
- Department of Pediatrics, Division of Pediatric Rheumatology, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, NY, USA
| | - Raegan D Hunt
- Department of Dermatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Renata S Maricevich
- Department of Plastic Surgery, Division of Pediatric Plastic Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Kathryn S Torok
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Pittsburgh and Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Suzanne C Li
- Department of Pediatrics, Division of Pediatric Rheumatology, Joseph M. Sanzari Children's Hospital, Hackensack Meridian School of Medicine, 30 Prospect Avenue, Hackensack, NJ, 07601, USA.
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Current Utilization of Qualitative Methodologies in Dermatology: A Scoping Review. JID INNOVATIONS 2023; 3:100172. [PMID: 36891031 PMCID: PMC9986021 DOI: 10.1016/j.xjidi.2022.100172] [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: 04/30/2022] [Revised: 08/27/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022] Open
Abstract
The focus of this review was to determine how qualitative methods are used in dermatology research and whether published manuscripts meet current standards for qualitative research. A scoping review of manuscripts published in English between January 1, 2016 and September 22, 2021 was conducted. A coding document was developed to collect information on authors, methodology, participants, research theme, and the presence of quality criteria as outlined by the Standards for Reporting Qualitative Research. Manuscripts were included if they described original qualitative research about dermatologic conditions or topics of primary interest to dermatology. An adjacency search yielded 372 manuscripts, and after screening, 134 met the inclusion criteria. Most studies utilized interviews or focus groups, and researchers predominantly selected participants on the basis of disease status, including over 30 common and rare dermatologic conditions. Research themes frequently included patient experience of disease, development of patient-reported outcomes, and descriptions of provider and caregiver experiences. Although most authors explained their analysis and sampling strategy and included empirical data, few referenced qualitative data reporting standards. Missed opportunities for qualitative methods in dermatology include examination of health disparities, exploration of surgical and cosmetic dermatology experiences, and determination of the lived experience of and provider attitudes toward diverse patient populations.
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Zigler CK, Randell RL, Reeve BB. Assessing Patient-Reported Outcomes in Pediatric Rheumatic Diseases: Considerations and Future Directions. Rheum Dis Clin North Am 2022; 48:15-29. [PMID: 34798944 PMCID: PMC9311483 DOI: 10.1016/j.rdc.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
For children with pediatric rheumatic diseases (PRDs), the inclusion of patient-reported outcomes (PROs) is critical to inform decision making in health care delivery and research settings. PROs are direct reports from a child on their health status, without interpretation by anyone else. PROs improve understanding of the patient experience, allow clinicians to provide patient-centered care, and add value to clinical trials. When PROs cannot be collected directly from the patient, caregiver-proxy reports can provide important information on the child's more observable symptoms and functioning. In this article, we describe the current use of PROs in specific PRDs, align current research with best practice recommendations for both clinical care and research settings, highlight exciting new developments, and identify areas for future research.
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Affiliation(s)
- Christina K. Zigler
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Rachel L. Randell
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Bryce B. Reeve
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Pediatrics, Duke University School of Medicine, Durham, North Carolina
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Li SC, Higgins GC, Chen M, Torok KS, Rabinovich CE, Stewart K, Laxer RM, Pope E, Haines KA, Punaro M, O'Neil KM. Extracutaneous involvement is common and associated with prolonged disease activity and greater impact in juvenile localized scleroderma. Rheumatology (Oxford) 2021; 60:5724-5733. [PMID: 33711155 DOI: 10.1093/rheumatology/keab238] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate factors associated with extracutaneous involvement (ECI) in juvenile localized scleroderma (jLS). METHODS A prospective, multicentre, 6-month observational study was performed. The data collected included disease features, global assessments, and subject symptoms. Bivariate and linear multilevel regression analyses were performed. RESULTS A total of 86 jLS subjects (80% female, 80% Caucasian), median age of disease onset 7.7 years, were evaluated. Most had linear scleroderma or mixed morphea. Of the 86 subjects, 49 (57%) had 125 extracutaneous problems {median 2 [interquartile range (IQR) 1, 3] per subject} from nine organ systems. Most of these subjects had multiple musculoskeletal problems. ECI was associated with more extensive cutaneous involvement, higher number of symptoms, family history of autoimmunity, and ANA and RF positivity. Subjects with ECI had higher scores for physician global assessment of damage (PGA-D), and parental global assessment of disease impact, but not baseline physician global assessment of disease activity (PGA-A). Although subjects with ECI received more MTX and glucocorticoid treatment, they had a slower reduction in PGA-A scores and symptoms over time, suggesting a poorer response to treatment. In logistic regression modelling, female sex had the largest effect on parental impact scores. CONCLUSION ECI occurred in the majority of subjects with jLS, and was associated with more medication use, longer treatment duration, higher PGA-D scores, and higher parental assessment of disease impact. Our findings suggest that jLS subjects with ECI have greater overall disease burden, both cutaneous and extracutaneous, and poorer response to treatment. More study of the treatment needs of this population is warranted.
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Affiliation(s)
- Suzanne C Li
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Gloria C Higgins
- Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, OH
| | - Mallory Chen
- Department of Psychology, Williams College, Williamstown, MA
| | - Kathryn S Torok
- Department of Pediatrics, University of Pittsburgh Clinical and Translational Science Institute, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | | | - Katie Stewart
- Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, TX, USA
| | | | - Elena Pope
- Department of Pediatrics, The University of Toronto, The Hospital for Sick Kids, Toronto, Canada
| | - Kathleen A Haines
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Marilynn Punaro
- Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, TX, USA
| | - Kathleen M O'Neil
- Department of Pediatrics, University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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Desai Y, Jaki T, Beresford MW, Burnett T, Eleftheriou D, Jacobe H, Leone V, Li S, Mozgunov P, Ramanan AV, Torok KS, Anderson ME, Anton J, Avcin T, Felton J, Foeldvari I, Laguda B, McErlane F, Shaw L, Zulian F, Pain CE. Prior elicitation of the efficacy and tolerability of Methotrexate and Mycophenolate Mofetil in Juvenile Localised Scleroderma. AMRC OPEN RESEARCH 2021; 3:20. [PMID: 38708070 PMCID: PMC11064983 DOI: 10.12688/amrcopenres.13008.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 05/07/2024]
Abstract
Background Evidence is lacking for safe and effective treatments for juvenile localised scleroderma (JLS). Methotrexate (MTX) is commonly used first line and mycophenolate mofetil (MMF) second line, despite a limited evidence base. A head to head trial of these two medications would provide data on relative efficacy and tolerability. However, a frequentist approach is difficult to deliver in JLS, because of the numbers needed to sufficiently power a trial. A Bayesian approach could be considered. Methods An international consensus meeting was convened including an elicitation exercise where opinion was sought on the relative efficacy and tolerability of MTX compared to MMF to produce prior distributions for a future Bayesian trial. Secondary aims were to achieve consensus agreement on critical aspects of a future trial. Results An international group of 12 clinical experts participated. Opinion suggested superior efficacy and tolerability of MMF compared to MTX; where most likely value of efficacy of MMF was 0.70 (95% confidence interval (CI) 0.34-0.90) and of MTX was 0.68 (95% CI 0.41-0.8). The most likely value of tolerability of MMF was 0.77 (95% CI 0.3-0.94) and of MTX was 0.62 (95% CI 0.32-0.84). The wider CI for MMF highlights that experts were less sure about relative efficacy and tolerability of MMF compared to MTX. Despite using a Bayesian approach, power calculations still produced a total sample size of 240 participants, reflecting the uncertainty amongst experts about the performance of MMF. Conclusions Key factors have been defined regarding the design of a future Bayesian approach clinical trial including elicitation of prior opinion of the efficacy and tolerability of MTX and MMF in JLS. Combining further efficacy data on MTX and MMF with prior opinion could potentially reduce the pre-trial uncertainty so that, when combined with smaller trial sample sizes a compelling evidence base is available.
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Affiliation(s)
- Yasin Desai
- MPS Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, LA1 4YF, UK
| | - Thomas Jaki
- MPS Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, LA1 4YF, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, L12 2AP, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Thomas Burnett
- MPS Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, LA1 4YF, UK
| | - Despina Eleftheriou
- University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Paediatric Rheumatology, Great Ormond St Hospital NHS Foundation Trust, London, WC1N 3JH, UK
| | - Heidi Jacobe
- UT Southwestern Medical Center, Dallas, Texas, TX 75390, USA
| | - Valentina Leone
- Paediatric Rheumatology Department, Leeds Children Hospital (Leeds Teaching Hospitals) and University of Leeds, Leeds, LS1 3EX, UK
| | - Suzanne Li
- Department of Pediatrics, Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center & Hackensack Meridian School of Medicine, Hackensack, New Jersey, NJ 07601, USA
| | - Pavel Mozgunov
- MPS Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, LA1 4YF, UK
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Translational Health Sciences, Bristol, BS1 3NU, UK
| | - Kathryn S Torok
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Marina E Anderson
- Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L9 7AL, UK
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YF, UK
| | - Jordi Anton
- Pediatric Rheumatology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Barcelona, 08007, UK
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre, Ljubljana, 1000 Ljubljana, Slovenia
| | - Jessie Felton
- Department of Dermatology, Brighton and Sussex University Hospitals & Royal Alexandra Children’s Hospital, Brighton, BN2 1DH, UK
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescence Rheumatology, Hamburg, 22081 Hamburg, Germany
| | - Bisola Laguda
- Department of Paediatric Dermatology, Chelsea and Westminster Hospital, London, SW10 9NH, UK
| | - Flora McErlane
- Department of Paediatric Rheumatology, Great North Children's Hospital, Newcastle, NE1 4LP, UK
| | - Lindsay Shaw
- Department of Paediatric Rheumatology, Great Ormond St Hospital NHS Foundation Trust, London, WC1N 3JH, UK
- University Hospitals Bristol NHS Foundation Trust & Translational Health Sciences, Bristol, BS1 3NU, UK
| | - Francesco Zulian
- Department of Woman's and Child's Health, University of Padova, Padua, 35122 Padua, Italy
| | - Clare E Pain
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, L12 2AP, UK
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The importance of development standards for anchoring vignettes: an illustrative example from pediatric localized scleroderma quality of life. Qual Life Res 2020; 29:3263-3272. [PMID: 32654054 DOI: 10.1007/s11136-020-02575-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Anchoring vignettes (AVs) are a promising measurement technique to reduce bias in patient-reported outcome (PRO) measures by helping researchers understand differences in how individuals and groups interpret response options. However, little attention has been paid to ensure quality development of AVs, and their performance has not been well assessed in pediatric populations. In this study, we explore the application of a rigorous development process for AVs based upon current standards for PROs, as well as feasibility of AVs when administered to children and adolescents. METHODS We developed AVs using a rigorous, patient-centered mixed methods process including three phases: (1) development, (2) a pilot study, and (3) a field test. Our proposed process included the generation of a conceptual framework based on the PRO, the Localized Scleroderma Quality of Life Instrument, and numerous vignette-specific considerations. We qualitatively explored readability and comprehension of the AVs (pilot study) and then analyzed ranking patterns within vignette sets (field test). RESULTS Four sets of four vignettes were developed. Revisions were suggested at each phase of development. The pilot study demonstrated that children ≥ 10 years had no trouble indicating understanding of the AVs. In the field test, although appropriate rankings of vignettes were generally demonstrated by participants, the percentage of tied rankings was higher than expected in this pediatric group. CONCLUSIONS This work supports the need for rigorous developmental standards for AVs, as each stage of development suggested revisions. Additionally, AVs showed initial promise for use with pediatric populations; general feasibility and understanding were supported.
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Quality of Life in Patients with Morphea: A Cross-Sectional Study and a Review of the Current Literature. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9186274. [PMID: 32258158 PMCID: PMC7094194 DOI: 10.1155/2020/9186274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 11/23/2022]
Abstract
Objective The aim of the study was to evaluate QoL in patients suffering from morphea. Material and Methods. Sixty-five patients with morphea were recruited into this cross-sectional, prospective parallel study. QoL among adult patients was assessed with the Dermatology Life Quality Index (DLQI) and Euro-QoL-5D questionnaire; patients aged <17 years used the Children's Dermatology Life Quality Index (CDLQI). The severity of morphea was assessed using the Localized Scleroderma Cutaneous Assessment Tool. The results of QoL and its association with disease severity were compared between patients with various morphea subtypes. Results The mean DLQI scoring was 3.8 ± 4.1 points and the CDLQI was 2.3 ± 3.0. The mean value of Visual Analogue Scale thermometer (EQ VAS) was 66.9 ± 17.5 points. The disease activity of morphea based on mLoSSI correlated significantly with QoL impairment according to the DLQI (R = 0.41, p = 0.001). No significant correlation was observed between morphea-induced damage and QoL (p = 0.99). Conclusions Evaluation of QoL in patients with morphea is still challenging due to lack of good assessment tools dedicated specifically for morphea patients. In general, QoL in morphea patients is significantly correlated with the disease activity, but not with disease-induced skin damage.
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11
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Nelson P. Good practice in dermatological patient‐reported outcome measure development: an example from localized scleroderma. Br J Dermatol 2020; 182:529. [DOI: 10.1111/bjd.18613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P.A. Nelson
- School of Health Sciences Faculty of Biology, Medicine & Health University of Manchester Manchester U.K
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