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Sharpe L, Menzies RE, Richmond B, Todd J, MacCann C, Shaw J. The development and validation of the Worries About Recurrence or Progression Scale (WARPS). Br J Health Psychol 2024; 29:454-467. [PMID: 38040446 DOI: 10.1111/bjhp.12707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/07/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES Worry about recurrence or progression is a common concern among people with chronic physical illnesses. Although there are options to measure the fear of cancer recurrence and other illness-specific measures, there is only one transdiagnostic measure of fear of progression, which does not assess the fear of recurrence or relapse. DESIGN A multi-phase study outlining the development and validation of a novel transdiagnostic measure of fear of recurrence or progression, the Worries About Recurrence and Progression Scale (WARPS). METHOD From a prior systematic review, we used quotes from people with lived experience to generate 55 items. Next, we piloted the items with 10 people with a range of chronic conditions, leading to a final total of 57 items. We then recruited four groups of people with cardiac disease, rheumatic disease, diabetes and respiratory disease (n = 804). An exploratory factor analysis in a randomly split sample resulted in an 18 item, single factor scale. We then performed confirmatory factor analysis on these 18 items in the remaining sample. RESULTS The 18-item WARPS demonstrated good construct validity, internal consistency and test-retest reliability. Specifically, the WARPS was strongly correlated with the Fear of Progression Questionnaire, and with illness-specific fears. Significant, moderate correlations were observed with depression, anxiety, stress, and death anxiety. The WARPS demonstrated the validity and reliability amongst people with four of the most common chronic conditions and the factor structure was invariant across genders. CONCLUSION The WARPS is a valid and reliable tool to measure transdiagnostic worries about recurrence and progression.
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Affiliation(s)
- Louise Sharpe
- The School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel E Menzies
- The School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Bethany Richmond
- The School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Jemma Todd
- The School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Carolyn MacCann
- The School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanne Shaw
- The School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
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Association of fear assessment in inflammatory rheumatic diseases (FAIR) questionnaire with ankylosing spondylitis quality of life and disease activity in patients with ankylosing spondylitis. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1119839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background/Aim: Fear against disease course, treatment, and limitations in family, work, and social life are commonly seen but mostly overlooked by physicians of patients with chronic inflammatory rheumatic diseases. Ankylosing spondylitis (AS) is a chronic inflammatory disease in young adults characterized by limitations in spinal mobility. The Fear Assessment (FAIR) Questionnaire was designed especially for patients with rheumatoid arthritis and spondyloarthritis to assess the level of fear from the patient’s perspective. Here we evaluate the FAIR score in AS patients and its association with disease activity, AS quality of life (ASQoL), depression, anxiety, and fatigue levels.
Methods: This cross-sectional study included 79 patients with AS, and disease activity was assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), AS-Disease Activity Score-C reactive protein, and functional status was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI). Patient global assessment of disease and pain were scored on 0–10 cm visual analog scores. All patients completed FAIR and ASQoL questionnaires. The depression and anxiety were evaluated by Hospital Anxiety and Depression Scale (HADS), and fatigue was assessed by Fatigue Severity Scale (FSS).
Results: The mean age of AS patients (62% male) was 41.7 (11.3) years. Most of the patients were on biological disease-modifying anti-rheumatic drugs (bDMARDs). The patients’ median BASDAI, ASDAS-CRP, and BASFI were 5.4 (range, 3.8–7.4), 3.83 (1.4), and 4.0 (range, 2.3–6.2), respectively. The overall FAIR, ASQoL, FSS, HADS-depression, and HADS-anxiety scores were 75 (range, 52–91), 9.6 (5.2), 5.4 (range, 4.1–7), 7.7 (4.4) and 9.6 (5.2), respectively. There were statistically significant correlations between disease activity indices and FAIR, ASQoL, FSS, and HADS scores. The FAIR scores significantly correlated with ASQoL, FSS, and HADS scores. The patients with active disease (BASDAI ≥ 4) had significantly higher levels of FAIR, ASQoL, FSS, and HADS. The best cut-off value for the FAIR score of AS patients with moderate to severe disease activity was 50 (AUC: 0.734, 95% CI [0.599–0.870], P = 0.002), with a sensitivity of 89.8%, specificity of 55%, positive likelihood ratio of 1.99, and Youden index of 0.45.
Conclusion: This study shows that AS patients face a high level of fear which is associated with higher disease activity, higher risk of mood disorders, and lower quality of life. Physicians should not only focus on the physical improvement of the patient but also handle the fear of patients against their diseases and their treatment. This holistic approach will improve the dialogue between the physician and the patient, which will result in increased compliance with treatment and will raise the quality of care.
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Lee TH, Koo BS, Nam B, Kim YJ, Son D, Lee S, Joo KB, Kim TH. Age-stratified trends in the progression of spinal radiographic damage in patients with ankylosing spondylitis: a longitudinal study. Ther Adv Musculoskelet Dis 2022; 14:1759720X221100301. [PMID: 35634353 PMCID: PMC9131377 DOI: 10.1177/1759720x221100301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/26/2022] [Indexed: 12/17/2022] Open
Abstract
Objective: The objective of this study was to investigate spinal radiographic progression in specific age ranges of ankylosing spondylitis (AS) patients. Methods: Longitudinal data for 1125 AS patients at a single hospital from 2000 to 2018 were retrospectively reviewed. Radiographic intervals were obtained from patients with consecutive spinal radiographs. The radiographic progression rate was defined as the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) change per year within each interval. Using generalized estimating equations (GEEs), estimated marginal means were calculated for the mSASSS progression rate across age groups after adjusting for potential confounders. Results: We obtained 4016 radiographic intervals and stratified them into five groups based on patient age at the interval start: <20 (n = 122); 20–29 (n = 1124); 30–39 (n = 1690); 40–49 (n = 794); and ⩾50 years (n = 286). The mean (SD) mSASSS progression rate for all the intervals was 0.8 (1.9). The GEE-estimated mean mSASSS progression rate increased with age, peaking in the 30–39 age group with a value of 1.15 [95% confidence interval (CI) 1.03, 1.27], and decreased slightly thereafter. In the presence of risk factors, rapid progression occurred at earlier ages: the GEE-estimated mean mSASSS progression rate in those with elevated C-reactive protein levels and preexisting syndesmophytes was 2.82 (95% CI 1.93, 3.71) in the 20–29 age group. Conclusion: Spinal structural damage in AS seems to progress most rapidly when patients are age 30–39 years. An awareness of the trends in radiographic progression with advancing age could improve understanding of the natural course of AS.
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Affiliation(s)
- Tae-Han Lee
- Department of Rheumatology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Bon San Koo
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul, South Korea
| | - Bora Nam
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Yun Jin Kim
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, South Korea
| | - Donghee Son
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, South Korea
| | - Seunghun Lee
- Department of Radiology, Hanyang University Hospital, Seoul, South Korea
| | - Kyung Bin Joo
- Department of Radiology, Hanyang University Hospital, Seoul, South Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1, Wangsimni-ro, Seongdong-gu, Seoul 04763, South Korea
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Lucasson F, Kiltz U, Kalyoncu U, Leung YY, Palominos P, Cañete JD, Scrivo R, Balanescu A, Dernis E, Meisalu S, Ryussen-Witrand A, Soubrier M, Aydin SZ, Eder L, Gaydukova I, Lubrano E, Richette P, Husni E, Coates LC, de Wit M, Smolen JS, Orbai AM, Gossec L. Disparities in healthcare in psoriatic arthritis: an analysis of 439 patients from 13 countries. RMD Open 2022; 8:e002031. [PMID: 35523519 PMCID: PMC9083399 DOI: 10.1136/rmdopen-2021-002031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/14/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Patient care can vary substantially by country. The objective was to explore differences in psoriatic arthritis (PsA) across countries for disease activity, impact and treatments. METHODS A cross-sectional analysis of 13 countries from the Remission/Flare in PsA study (NCT03119805) of consecutive adult patients with definite PsA was performed. Countries were classified into tertiles by gross domestic product (GDP)/capita. Disease activity (Disease Activity in PsA, DAPSA and Minimal Disease Activity, MDA) and their components, disease impact (patient-reported outcomes) and biological disease-modifying antirheumatic drugs (bDMARDs) were analysed per country and compared between the three tertiles of GDP/capita by parametric and non-parametric tests. We also explored the percentage of patients with significant disease activity (DAPSA >14) and no ongoing bDMARD prescription. RESULTS In 439 patients (50.6% male, mean age 52.3 years, mean disease duration 10.1 years), disease activity and disease impact were higher in the lowest GDP/capita countries. DAPSA remission and MDA were attained in the lowest tertile in 7.0% and 18.4% patients, vs 29.1% and 49.5% in the middle tertile and 16.8% and 41.3% in the high tertile, respectively (all p<0.001). bDMARDs use was similar in the tertiles (overall mean 61%). The overall rate of patients with DAPSA >14 and no bDMARDs was 18.5%, and was higher in lower GDP/capita countries (p=0.004). CONCLUSION PsA patients from countries with the lowest GDP/capita, despite similar use of bDMARDs, were more likely to have high disease activity and worse disease impact. There is a need for more equity in healthcare.
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Affiliation(s)
- Florian Lucasson
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Uta Kiltz
- Herne and Ruhr-Universität, Rheumazentrum Ruhrgebiet, Bochum, Germany
| | - Umut Kalyoncu
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ying Ying Leung
- Duke-NUS Medical School, Singapore General Hospital, Singapore
| | - Penélope Palominos
- Rheumatology Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Juan D Cañete
- Servicio de Reumatología, Hospital Clínic and IDIBAPS, Barcelona, Spain
| | - Rossana Scrivo
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza Università di Roma, Roma, Italy
| | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, "Sf. Maria" Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Adeline Ryussen-Witrand
- Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, Paul Sabatier University, Toulouse University Hospital, Toulouse, France
| | | | - Sibel Zehra Aydin
- The Ottawa Hospital Research Institute, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Lihi Eder
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Inna Gaydukova
- North-western State Medical University, St.Petersburg, Russian Federation
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Pascal Richette
- Service de Rhumatologie, Hopital Lariboisiere Centre Viggo Petersen, Paris, France
- Inserm UMR1132 Bioscar, Universite Paris Diderot UFR de Medecine, Paris, France
| | - Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Maarten de Wit
- Patient Research Partner, EULAR, Zaltbommel, The Netherlands
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Wien, Austria
| | - Ana-Maria Orbai
- Division of Rheumatology, Psoriatic Arthritis Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
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Mosor E, Studenic P, Alunno A, Padjen I, Olsder W, Ramiro S, Bini I, Caeyers N, Gossec L, Kouloumas M, Nikiphorou E, Stones S, Wilhelmer TC, Stamm TA. Young people's perspectives on patient-reported outcome measures in inflammatory arthritis: results of a multicentre European qualitative study from a EULAR task force. RMD Open 2021; 7:rmdopen-2020-001517. [PMID: 33514672 PMCID: PMC7849893 DOI: 10.1136/rmdopen-2020-001517] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/24/2020] [Accepted: 01/14/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Although patient-reported outcome measures (PROMs) are increasingly used in clinical practice and research, it is unclear whether these instruments cover the perspective of young people with inflammatory arthritis (IA). The aims of this study were to explore whether PROMs commonly used in IA adequately cover the perspective of young people from different European countries. METHODS A multinational qualitative study was conducted in Austria, Croatia, Italy and the Netherlands. Young people with either rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), Still's disease, psoriatic arthritis (PsA) or spondyloarthritis (SpA), aged 18-35 years, participated in semistructured focus group interviews. Thematic analysis was used and data saturation was defined as no new emergent concepts in at least three subsequent focus groups. RESULTS Fifty-three patients (21 with RA/JIA/Still's, 17 with PsA, 15 with SpA; 72% women) participated in 12 focus groups. Participants expressed a general positive attitude towards PROMs and emphasised their importance in clinical practice. In addition, 48 lower level concepts were extracted and summarised into 6 higher level concepts describing potential issues for improvement. These included: need for lay-term information regarding the purpose of using PROMs; updates of certain outdated items and using digital technology for data acquisition. Some participants admitted their tendency to rate pain, fatigue or disease activity differently from what they actually felt for various reasons. CONCLUSIONS Despite their general positive attitude, young people with IA suggested areas for PROM development to ensure that important concepts are included, making PROMs relevant over the entire course of a chronic disease.
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Affiliation(s)
- Erika Mosor
- Section for Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Wien, Austria
| | - Paul Studenic
- Internal Medicine 3, Division of Rheumatology, Medical University Vienna, Wien, Austria.,Department of Medicine (Solna), Division of Rheumatology, Karolinska Institute, Stockholm, Sweden
| | - Alessia Alunno
- Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Umbria, Italy
| | - Ivan Padjen
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.,University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Wendy Olsder
- EULAR Young PARE, Zürich, Switzerland.,Youth-R-Well, Nieuwegein, The Netherlands
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, South Holland, The Netherlands.,Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Ilaria Bini
- EULAR Young PARE, Zürich, Switzerland.,Anmar Young, Rome, Italy
| | - Nele Caeyers
- EULAR PARE, Zurich, Switzerland.,ReumaNET, Leuven, Belgium
| | - Laure Gossec
- Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, Paris, France.,APHP, Rheumatology Department, Pitie Salpetriere University Hospital, Paris, France
| | | | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK.,Rheumatology Department, King's College Hospital NHS Trust, London, UK
| | - Simon Stones
- EULAR Patient Research Partner, Manchester, UK.,University of Leeds, Leeds, West Yorkshire, UK
| | | | - Tanja A Stamm
- Section for Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Wien, Austria
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Contreras-Yáñez I, Lavielle P, Clark P, Pascual-Ramos V. Markers of disease severity and positive family history are associated to significant risk perception in rheumatoid arthritis, while compliance with therapy is not: a cross-sectional study in 415 Mexican outpatients. Arthritis Res Ther 2021; 23:61. [PMID: 33618752 PMCID: PMC7898444 DOI: 10.1186/s13075-021-02440-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 02/10/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Assessing risk perception (RP) helps explain how rheumatoid arthritis (RA) patients integrate their ideas concerning the disease and how this understanding affects their self-care management. Compliance with treatment impacts disease-related outcomes and could be associated with RP to variable degrees and at different levels. The primary objective was to determine a potential association between RP and compliance with therapy in RA outpatients and to identify additional factors. The secondary objective was to identify factors associated with judgment bias such as unrealistic RP. PATIENTS AND METHODS Between January 2018 and June 2019, 450 consecutive outpatients who received RA-related treatment were invited to a face-to-face interview to obtain socio-demographic data, RA-related information, comorbidities, and the following outcomes: adherence, persistence, and concordance with medications assessed with a questionnaire locally designed; RP with the RP questionnaire (RPQ); disease activity with the Routine Assessment of Patient Index Data-3 (RAPID-3); disability with the Health Assessment Questionnaire Disability Index (HAQ-DI); quality of life with Medical Outcomes Study Short Form-36 (SF-36) instrument; pain and overall disease with the respective visual analogue scale (VAS); and health literacy assessed with 3 questions. Significant RP was defined according to a cut-off based on the 75th percentile value of the sample in which the RPQ was validated. Unrealistic RP was defined based on the coincidence of the presence/absence of significant RP and less/more than 7 unfavorable medical criteria. Multiple logistic regression analysis was used. Patients provided written informed consent and the study received Internal Review Board approval. RESULTS There were 415 patients included, primarily middle-aged women with long-standing disease and moderate disease activity. Almost half of the patients were receiving corticosteroids and 15.9% intensive RA-related treatment. There were 44.1% of the patients concordant with treatment and 22.6% had significant RP. The patients' treatment behavior was not retained in the regression analysis; meanwhile, rheumatoid nodes, surgical joint replacement, family history of RA, and higher RAPID-3 score were associated with significant RP. There were 56 patients with unrealistic RP; significant RP and more unfavorable medical criteria were associated with unrealistic RP. CONCLUSIONS Compliance with therapy was not associated with significant RP in RA outpatients.
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Affiliation(s)
- Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez, Sección XVI, 14080 Mexico City, Mexico
| | - Pilar Lavielle
- Clinical Epidemiology Unit, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Mexico City, Mexico
| | - Patricia Clark
- Head of the Clinical Epidemiology Unit, Hospital Infantil de México Federico Gómez and Facultad de Medicina UNAM, Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez, Sección XVI, 14080 Mexico City, Mexico
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Psychological Distress in Patients with Autoimmune Arthritis during the COVID-19 Induced Lockdown in Italy. Microorganisms 2020; 8:microorganisms8111818. [PMID: 33218124 PMCID: PMC7698862 DOI: 10.3390/microorganisms8111818] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 11/14/2020] [Indexed: 01/14/2023] Open
Abstract
Lockdowns imposed by governments worldwide as a way to limit the spread of severe atypical respiratory syndrome-coronavirus-2 (SARS-CoV2) have had heavy psychological and economic consequences. Arthritis patients are a vulnerable population at an increased risk of peritraumatic stress. This could be due to several reasons, including the fear of shortage of medicine and difficulty receiving periodical medical checks. In the present case-control study, psychological distress in patients with autoimmune arthritis during the coronavirus disease 2019 (COVID-19) pandemic were investigated. An electronic survey was conducted to gather information on the perceived change in the emotional state, general health (GH), fatigue, joint pain, and disease activity during the lockdown, in 100 patients with autoimmune arthritis and 100 controls. Mental health status was measured using the Depression, Anxiety and Stress Scale (DASS-21). The COVID-19 Peritraumatic Distress Index (CPDI) was used to assess the frequency of peritraumatic stress disorders related to COVID-19. Patients reported a significant worsening of perceived GH (36% vs. 7%; p < 0.001), a significantly higher mean CPDI score (p < 0.001) than controls. Using multivariate analysis, arthritis patients had significantly higher CPDI scores (+3.67 points; p = 0.019), independent of depression, anxiety, and stress symptoms, comorbidities, and sociodemographic and lifestyle characteristics. Logistic regression analysis showed that the risk of reporting worsened GH was 9-fold higher in patients than controls (p < 0.001). Patients with autoimmune arthritis are at higher risk of psychological distress related to COVID-19 pandemic; thus targeted intervention should be designed to strengthen coping capacity in this vulnerable population.
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Boeri M, Szegvari B, Hauber B, Mange B, Mountian I, Schiff M, Maniadakis N. From drug-delivery device to disease management tool: a study of preferences for enhanced features in next-generation self-injection devices. Patient Prefer Adherence 2019; 13:1093-1110. [PMID: 31371927 PMCID: PMC6636455 DOI: 10.2147/ppa.s203775] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/08/2019] [Indexed: 12/02/2022] Open
Abstract
PURPOSE To quantify rheumatology patient preferences and willingness to pay (WTP) for features differentiating enhanced from standard self-injection devices and to investigate differences among subgroups. PATIENTS AND METHODS Patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) were recruited in the UK. A discrete-choice experiment was used to elicit preferences; respondents were presented with 10 choices between 3 different devices: a free standard disposable device, and 2 hypothetical reusable devices characterized by presence/absence of skin sensor, injection speed control, on-screen instructions, injection reminders, electronic log, and large grip. Every hypothetical device included a cost component to assess WTP for each enhanced feature. A random-parameters logit model was used to estimate preference weights and WTP. RESULTS Data were collected from 323 respondents by electronic survey (15/11/2017-15/02/2018; RA: 108; PsA: 103; axSpA: 112). On average, the skin sensor was the most preferred feature (£30), followed by injection speed control, injection reminders, electronic log (~£20 each), on-screen instructions (~£12), and a device with a small, rather than large grip (~£7). Similar preferences for attributes were observed across condition subgroups except for grip size: axSpA patients preferred small grip (~£27); PsA patients preferred large grip (~£19). Overall, respondents preferred reusable devices with all enhanced features (WTP value: £85) over the standard device. RA patients exhibited a higher WTP (£145) than PsA (£102) or axSpA (£62) for the same enhanced device. CONCLUSION Patients positively valued reusable self-injection devices with enhanced features, which may improve patient experience, potentially improving treatment adherence, clinical, and economic outcomes.
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Affiliation(s)
| | | | - Brett Hauber
- RTI Health Solutions
, Research Triangle Park, NC, USA
| | - Brennan Mange
- RTI Health Solutions
, Research Triangle Park, NC, USA
| | | | - Michael Schiff
- Rheumatology Division, University of Colorado School of Medicine, Denver, CO, USA
| | - Nikolaos Maniadakis
- Health Services Management, National School of Public Health, Athens, Greece
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Bergsten U, Almehed K, Baigi A, Jacobsson LTH. A randomized study comparing regular care with a nurse-led clinic based on tight disease activity control and person-centred care in patients with rheumatoid arthritis with moderate/high disease activity: A 6-month evaluation. Musculoskeletal Care 2019; 17:215-225. [PMID: 31219668 PMCID: PMC6852576 DOI: 10.1002/msc.1403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 11/20/2022]
Abstract
Introduction A recent survey showed that 27% of rheumatoid arthritis (RA) patients had inadequately controlled disease activity. Hence, there is a need for new strategies aiming at improving patient outcomes. The aim of the present study was to evaluate the effect of a nurse‐led clinic with frequent visits, treat‐to‐target and person‐centred care of patients with established RA and moderate‐to‐high disease activity compared with patients receiving regular care. Methods The study was a randomized, controlled trial over 26 weeks, with a nonrandomized extension to week 50. Patients were randomized to an intervention group (IG; nurse‐led clinic) based on person‐centred care, frequent visits and “treat to target”, or to a control group (CG) which visited the clinic according to care as usual. The primary outcome was the difference in the DAS28 change between the IG and the CG groups. Results A total of 332 patients were screened for eligibility, of which 70 were randomly assigned to either the IG (n = 36) or the CG (n = 34) group. The primary outcome was not met, although patients in the IG group tended to improve more than those in the CG group (difference: 0.43 (95% confidence interval [CI] –0.27, 1.13). In both the IG and CG groups, delta‐DAS28 improved significantly. The European League Against Rheumatology moderate or good response was achieved by 76% (95% CI 58, 89) in the IG and 49% (95% CI 32, 65) in the CG group. Conclusions Disease activity tended to improve more with the nurse‐led intervention compared with regular care, although the difference was not significant, probably partly due to the lack of statistical power.
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Affiliation(s)
- Ulrika Bergsten
- Research and Development Department at Region of Halland, Halmstad, Sweden
| | - Katarina Almehed
- Rheumatology Department, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Amir Baigi
- Research and Development Department at Region of Halland, Halmstad, Sweden
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Goteborg, Sweden
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Garrido-Cumbrera M, Poddubnyy D, Gossec L, Gálvez-Ruiz D, Bundy C, Mahapatra R, Makri S, Christen L, Delgado-Domínguez CJ, Sanz-Gómez S, Plazuelo-Ramos P, Navarro-Compán V. The European Map of Axial Spondyloarthritis: Capturing the Patient Perspective-an Analysis of 2846 Patients Across 13 Countries. Curr Rheumatol Rep 2019; 21:19. [PMID: 30868287 PMCID: PMC6449283 DOI: 10.1007/s11926-019-0819-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Scientific research in axial spondyloarthritis (axSpA) has grown significantly. Nevertheless, the patient perspective remains insufficiently explored. Using a cross-sectional survey, the European Map of Axial Spondyloarthritis (EMAS) describes how patients living with self-reported axSpA experience their disease physically, psychologically, and socially. RECENT FINDINGS 2846 patients participated: mean age 43.9 ± 12.3 years, 61.3% female, mean disease duration was 17.2 ± 12.4 years, and 71.3% were HLA-B27 positive. Mean diagnostic delay was 7.4 ± 8.4 years. Mean BASDAI score was 5.5 ± 2.0 and 75.7% reported moderate/severe spinal stiffness throughout the day. Daily life was substantially impaired: 74.1% reported difficulties finding a job due to the disease, and 61.5% reported psychological distress. EMAS results showed long diagnostic delay and substantial physical and psychological burden, indicating important unmet needs for patients. Furthermore, axSpA restricted patients' ability to participate in their daily routine and lead a productive work life. Understanding the patient's perspective can improve both health outcomes and shared decision-making between patient and rheumatologist.
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Affiliation(s)
- Marco Garrido-Cumbrera
- Universidad de Sevilla, Seville, Spain.
- Health & Territory Research (HTR), Centro de Investigación, Tecnología e Innovación Manuel Losada Villasante (CITIUS), Universidad de Sevilla, C/ Dr Rafael Martínez Domínguez s/n, 41013, Seville, Spain.
- Spanish Federation of Spondyloarthritis Patient Associations (CEADE), Madrid, Spain.
| | - Denis Poddubnyy
- Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Rheumatism Research Centre, Berlin, Germany
| | - Laure Gossec
- Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France
- Rheumatology Department, Pitié Salpêtrière hospital, AP-HP, Paris, France
| | - David Gálvez-Ruiz
- Universidad de Sevilla, Seville, Spain
- Health & Territory Research (HTR), Centro de Investigación, Tecnología e Innovación Manuel Losada Villasante (CITIUS), Universidad de Sevilla, C/ Dr Rafael Martínez Domínguez s/n, 41013, Seville, Spain
| | | | - Raj Mahapatra
- Ankylosing Spondylitis International Federation (ASIF), London, UK
| | - Souzi Makri
- Cyprus League Against Rheumatism, Nicosia, Cyprus
| | - Laura Christen
- Novartis Pharma AG, Patient Advocacy, Basel, Switzerland
| | - Carlos J Delgado-Domínguez
- Health & Territory Research (HTR), Centro de Investigación, Tecnología e Innovación Manuel Losada Villasante (CITIUS), Universidad de Sevilla, C/ Dr Rafael Martínez Domínguez s/n, 41013, Seville, Spain
| | - Sergio Sanz-Gómez
- Universidad de Sevilla, Seville, Spain
- Health & Territory Research (HTR), Centro de Investigación, Tecnología e Innovación Manuel Losada Villasante (CITIUS), Universidad de Sevilla, C/ Dr Rafael Martínez Domínguez s/n, 41013, Seville, Spain
| | - Pedro Plazuelo-Ramos
- Spanish Federation of Spondyloarthritis Patient Associations (CEADE), Madrid, Spain
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Sang Y, Dong C, Fu T, Zhao R, Ge X, Zhou W, Ji J, Gu Z. Associated factors with adherence to standard exercise therapy and health-related quality of life in Chinese patients with ankylosing spondylitis. Mod Rheumatol 2018; 30:149-154. [PMID: 30561239 DOI: 10.1080/14397595.2018.1559966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives: The aim of this study is to assess the current situations of standard exercise treatment and predictors of non-standard exercise in Chinese patients with ankylosing spondylitis (AS). An analysis of the effect of standard exercise on health-related quality of life (HR-QoL) was also conducted.Methods: In the cross-sectional study, a total of 259 AS patients were constantly invited to participate in this study and complete the questionnaire under the researchers' supervision in a clinical setting including sociodemographic variables, clinical variables, psychological variables, and HR-QoL. Data were analyzed by Mann-Whitney U test, Chi-square test as well as multivariable analysis of Binary Stepwise Logistic Regression.Results: The data showed that just 20.5% of them could complete the standard exercise. Exercise adherence was associated with employment, educational level, marital status, place of residence, treatment of Tumor Necrosis Factor-α inhibitor, knowledge about exercise, disease duration, clinical variables, and anxiety. The HR-QoL in the group of standard exercise was better than that in the non-standard exercise group. Logistic Regression Analysis showed that lower educational level, less knowledge about benefits of exercise treatment and higher score of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were the independent risk factors of exercise treatment non-adherence.Conclusion: AS patients educated less than 9 years or with higher BASDAI score were more likely not to adhere to standard exercise treatment. Non-adherence to exercise treatment among AS patients is exceedingly common, particularly in patients without knowledge about benefits of exercise treatment. Standard exercise treatment can also improve HR-QoL of AS patients.
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Affiliation(s)
- Yan Sang
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Chen Dong
- Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China.,Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Ting Fu
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Rui Zhao
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Xingyu Ge
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China
| | - Wei Zhou
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Juan Ji
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China
| | - Zhifeng Gu
- Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China.,Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
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12
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Küçükakkaş O, Rezvani A, Yurdakul OV, Tolu S, Kılıçoğlu MS, Aydın T. Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire: a cross-cultural adaptation and validation to the Turkish language. Clin Rheumatol 2018; 37:3247-3254. [PMID: 30054752 DOI: 10.1007/s10067-018-4239-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 02/05/2023]
Abstract
In chronic inflammatory rheumatic diseases (CIRD), it is important to understand patients' fears towards their disease in order to improve patient-physician dialog, to raise the quality of care offered, and to optimize treatment adherence. In this study, we aimed to translate the Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire into Turkish and evaluate its psychometric properties in patients with CIRD. One hundred fifteen patients filled the provided socio-demographic information form, FAIR-Tr questionnaire, Hospital Anxiety and Depression Scale (HADS), and Beck's Hopelessness Scale (BHS). For the analysis of short-term reliability, 50 patients re-filled the FAIR-Tr questionnaire 1 week later. Internal consistency was evaluated with Cronbach's α coefficient and test-retest reliability was evaluated with intraclass correlation coefficients (ICC). Construct validity analysis was investigated based on the correlation with HADS and BHS. All patients found FAIR-Tr easily understandable and acceptable. FAIR-Tr internal consistency (Cronbach's α = 0.93) and test-retest reliability (ICC = 0.91) were excellent. Psychometric validation was proved upon observing high correlation with HADS (Anxiety, r = 0.77; Depression, r = 0.70) and moderate correlation with BHS (r = 0.65). FAIR-Tr is a questionnaire that has excellent internal consistency and test-retest reliability. The successful correlation with HADS and BHS supported its psychometric validity in terms of evaluating the fear in CIRD cases. We think that FAIR-Tr is a specific scale that can help to evaluate the disease- and treatment-related fears of the Turkish patients with CIRD and may be useful in both routine practice and clinical studies.
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Affiliation(s)
- Okan Küçükakkaş
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, 34093, Istanbul, Turkey.
| | - Aylin Rezvani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Ozan Volkan Yurdakul
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, 34093, Istanbul, Turkey
| | - Sena Tolu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Mehmet Serkan Kılıçoğlu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, 34093, Istanbul, Turkey
| | - Teoman Aydın
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, 34093, Istanbul, Turkey
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Development and application of a questionnaire to assess patient beliefs in rheumatoid arthritis and axial spondyloarthritis. Clin Rheumatol 2018; 37:2649-2657. [PMID: 29948351 PMCID: PMC6154088 DOI: 10.1007/s10067-018-4172-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 12/04/2022]
Abstract
Misinterpretation of patient beliefs may complicate shared decision-making in rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA). The objective of this study was to develop a questionnaire to assess patients’ beliefs about their disease and its treatment, and to identify patient characteristics associated with these beliefs. All beliefs reported by > 5% of 50 patients in a previous study were reformulated with a partnering patient organization into statements with which participants could rate their agreement on a scale of 0–10 (totally disagree to totally agree). The resulting Questionnaire for Arthritis Dialogue (QuAD) was made available to patients with RA or axSpA. A score ≥ 7 was considered a strongly held belief. Associations between patient characteristics and individual lifestyle beliefs were assessed using multiple logistic regression. The 21-item QuAD was completed by 672 patients (432 RA, 240 axSpA; mean [±SD] age 54.2 [± 14.2]; 63.7% female). The most widely held beliefs were related to uncertainty about progression (n = 354, 54.0%), heredity (n = 309, 47.8%), and flare triggers (n = 283, 42.7%). The unwarranted belief that physical activity is deleterious to disease activity was associated with markers of psychological distress and lower educational levels. The beliefs of patients with RA or axSpA about their disease are wide-ranging. Since these may be unwarranted and may lead to inappropriate behaviors, physicians should discuss these beliefs with their patients. The QuAD may facilitate this dialogue, and may also be useful in population studies to standardize the assessment and evolution of beliefs over time. People with long-term inflammatory conditions such as rheumatoid arthritis (RA; inflammation of the joints) and axial spondyloarthritis (axSpA; inflammation of the spine) may hold a number of beliefs about their disease, including some that are not supported by current scientific evidence (e.g., “I think that my disease was triggered by a vaccination”). Some beliefs, especially those relating to the role of lifestyle factors (such as exercise, diet, smoking, and drinking alcohol), may encourage people living with severe diseases to change their behavior in a way that has an effect on their disease. Within this project, we developed a questionnaire to identify the most common beliefs held by people living with RA or axSpA, which is called the “Questionnaire for Arthritis Dialogue (QuAD).” We also examined whether certain characteristics (or traits) of people living with RA or axSpA are linked to beliefs not currently supported by scientific evidence. A total of 672 people living with RA or axSpA in France were asked to complete the questionnaire (QuAD). The questionnaire included 21 opinion statements that they scored from 0 (totally disagree) to 10 (totally agree). A score of more than 7 was interpreted to mean that the person significantly agreed with the opinion. Based on the responses to specific opinion statements in the questionnaire, we were able to identify possible links between beliefs that are not supported by scientific evidence (e.g., “I think that flare-ups of my disease are triggered by physical effort”), and characteristics of people living with severe diseases. Our findings suggested that beliefs about lifestyle and inflammatory diseases varied from person to person, were sometimes inconsistent (the most widely held beliefs were sometimes contradictory), and were often not supported by scientific evidence. The belief that physical activity had negative effects on the disease was linked to poor education and psychological issues (such as anxiety and helplessness). People living with axSpA were more likely to believe their disease was a result of their genetic make-up, whereas those with RA more often believed their disease was caused by emotional issues. People living with axSpA were also more likely to believe that physical activity could be beneficial for their disease, and less likely to believe that their disease was caused by smoking. Our results suggest that doctors need to discuss with their patients how they might believe lifestyle is associated with their disease. This will help to dispel any unnecessary concerns, and to encourage their patients to take up healthy lifestyles and habits that are beneficial for their disease management. It may also be beneficial for health care providers to discuss the beliefs identified in this study during educational programs about inflammatory diseases, for the benefit of people living with RA or axSpA.
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14
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Nikiphorou E, Aletaha D, Bukhari M. Are we failing patients in our assessment of treatment failure? Rheumatology (Oxford) 2018; 58:561-562. [DOI: 10.1093/rheumatology/key107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elena Nikiphorou
- Academic Rheumatology Department, King’s College London, London
- Department of Rheumatology, The Whittington Hospital, London, UK
| | - Daniel Aletaha
- Division of Rheumatology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Marwan Bukhari
- Department of Rheumatology, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
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