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Sutherland C, Gaffo AL. Investigating gout flares: beyond a definition. Curr Opin Rheumatol 2024; 36:309-313. [PMID: 38695425 DOI: 10.1097/bor.0000000000001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
PURPOSE OF REVIEW Gout flares are a paramount component of disease burden inflicted by gout onto the patient. Furthermore, they are included in the core domain set for long-term gout studies recognized by Outcome Measures in Rheumatology. Along with a validated classification criterion for gout, gout investigators have turned their efforts into defining and characterizing the gout flare. This brief review will summarize the efforts that have been done to define and characterize a gout flare in clinical studies. RECENT FINDINGS Recent findings include a validated definition of a gout flare that has been utilized in novel clinical studies, use of technology to monitor for gout flares and their effects on patient life, and qualitative analyses into the disease burden that a patient undergoes. SUMMARY Although guidelines for core outcome domains have been well established, there is question in methods of measuring and reporting gout flares in long-term trials. Furthermore, there is question as to the effectiveness of the agreed upon instruments' abilities to fully capture the disease burden experienced by patients with gout. A combination of outcome measurements including binary data (gout flare present or absent) along with a comprehensive measurement of disease burden over time would theoretically provide a more accurate description of the disease and serve as a basis for intervention development.
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Affiliation(s)
| | - Angelo L Gaffo
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
- Birmingham VA Medical Center, Birmingham, Alabama, USA
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2
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Morillon MB, Nørup A, Singh JA, Dalbeth N, Taylor WJ, Kennedy MA, Pedersen BM, Grainger R, Tugwell P, Perez-Ruiz F, Diaz-Torne C, Edwards NL, Shea B, Ellingsen TJ, Christensen R, Stamp LK. Outcome reporting in randomized trials in gout: A systematic scoping review from the OMERACT gout working group assessing the uptake of the core outcome set. Semin Arthritis Rheum 2023; 60:152191. [PMID: 36963128 DOI: 10.1016/j.semarthrit.2023.152191] [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: 10/10/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE The selection and reporting of core outcome measures in clinical trials is essential for patients, researchers, and healthcare providers for clinical research to have an impact on healthcare. In this systematic scoping review, we aimed to quantify the extent to which gout clinical trials are collecting and reporting data in accordance with the core outcome domains from Outcome Measures in Rheumatology (OMERACT) published in 2009 applicable for both acute and chronic trials and evaluate the reporting according to the core domains before and after the 2009 OMERACT endorsement. METHODS We searched multiple databases PubMed, EMBASE, the Cochrane Library including the Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews (CDSR) and www. CLINICALTRIALS gov for randomized controlled trials (RCTs) allocating people with gout versus an active pharmacological gout treatment or a control comparator (no date limitation). We extracted the data in accordance with the core outcome sets, focusing individually on core outcome domains and the core outcome measurements for acute and chronic trials, respectively. In this study 'Acute trials' reflect studies that describe interventions for short term management of gout flares, and 'chronic trials' describe interventions for long-term urate lowering therapy in the management of gout. RESULTS From 8,522 records identified in the database search, 134 full text papers were reviewed, and 71 trials were included, of which 36 were acute and 35 were chronic. Only 3 of 36 (8%) acute trials reported all five core domains and none of the 35 included chronic trials reported all 7 core domains. In the acute trials, twenty-seven unique measurement instruments across the 5 core domains were identified. For chronic trials there were 31 unique measurement instruments used across the 7 core domains. Serum urate was reported in 100% of the chronic trials and gout flares in 80%. However, other core domains were reported in <30% of chronic trials. In particular the patient-important domains such as HR-QOL, patient global assessment and activity limitations were rarely reported. A broad variety of different measurement instruments were used to assess each endorsed core domain, a minority of trials used the OMERACT endorsed instruments. For acute trials, the number reporting on all core domains was consistently low and no change was detected before and after the endorsement of the core domains in 2009. None of the included chronic trials reported on all 7 endorsed core domains at any time. CONCLUSION In this study we found a low adherence with the intended endorsed (i.e., core) outcome domains for acute and chronic gout studies which represents a poor uptake of the global OMERACT efforts for the minimum of what should be measured in clinical trials. In addition, there is a significant variation in how the OMERACT endorsed outcome domains have been measured. This systematic review demonstrates the need for continuous encouragement among gout researchers to adhere to OMERACT core domains as well as further guidance on outcome measurements reporting. REGISTRATION Prospero: CRD42019151316.
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Affiliation(s)
- Melanie B Morillon
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark & Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark; Department of Internal Medicine, Odense University Hospital, Svendborg, Denmark
| | - Alexander Nørup
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark & Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Jasvinder A Singh
- Birmingham Veterans Affairs (VA) Medical Center and University of Alabama, Birmingham, AL, United States
| | | | | | - Martin A Kennedy
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, Christchurch, New Zealand
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Fernando Perez-Ruiz
- Rheumatology Division, Osakidetza, OSI-EE Cruces, Cruces University Hospital, Barakaldo, Spain
| | - Cesar Diaz-Torne
- Rheumatology Department. Hospital de la Sant Pau. Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Beverley Shea
- Clinical Epidemiology program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Torkell J Ellingsen
- Department of Clinical Research, University of Southern Denmark; the Department of Rheumatology, Odense University Hospital, the Faculty of Health Sciences, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark & Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.
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Emergency department opioid discharge instructions: a multidisciplinary national Delphi study. CAN J EMERG MED 2022; 24:641-649. [PMID: 35969328 DOI: 10.1007/s43678-022-00352-7] [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: 12/13/2021] [Accepted: 06/21/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVES Currently, there are no Canadian guidelines for discharge instruction to be given to patients receiving an opioid prescription in the ED. This likely contributes to inadequate discharge instructions for these potentially dangerous medications. The principal goal of this study was to develop an interdisciplinary Canadian consensus regarding important concepts to be included in written opioid discharge instructions within the ED setting. METHODS We conducted a modified Delphi study between May and August 2021. The national multidisciplinary panel consisted of 23 healthcare professionals and one patient partner. The survey consisted of 19 initial concepts developed after a review of the literature and a meeting with local experts. The panel added four new concepts after the first survey round. Three rounds of online surveys were distributed in total. Panel consensus was defined a priori as a disagreement index score less than 1, in accordance with the RAND/UCLA Appropriateness Method. RESULTS We achieved a 100% response rate in round one and a 96% response rate in rounds two and three of our Delphi study. There was group consensus (disagreement index = 0.66, median importance = 9) that all patients receiving opioid prescriptions from the ED should receive written discharge instructions. The interdisciplinary panel arrived at a consensus on 21/23 concepts for ED opioid discharge instructions. The concepts with the highest level of agreement were related to minimizing the use of the prescribed opioid medication and opioid use safety (mixing with drugs/alcohol, storage, and impairment). CONCLUSION This Delphi study with a national, multidisciplinary panel achieved consensus on 21 concepts that should be included in written discharge instructions to patients receiving an opioid prescription upon discharge from the ED.
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Singh JA. Disease modification in gout: a qualitative study of gout expert rheumatologists. Rheumatol Adv Pract 2022; 6:rkab107. [PMID: 35028499 DOI: 10.1093/rap/rkab107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/17/2021] [Indexed: 01/21/2023] Open
Abstract
Objective The aim was to examine the views of health-care providers regarding disease modification in gout, with the potential to derive a provisional set of domains for disease modification in gout. Methods A qualitative nominal group study was performed with 20 gout experts (15 expert/expert panel members of the 2012 and/or 2020 ACR gout guidelines and/or 2015 ACR/EULAR gout classification criteria) about what constitutes disease modification in gout: 'What sorts of things do you think constitute a change in the course of disease in gout? (positive); what are all the ways in which gout as a disease can be modified?' Results Decrease in gout flares was rated number one rank in all six nominal groups as indicative of disease modification in gout, followed by serum urate lowering, which was rated number one rank in one of the six nominal groups (tied score with flares in one nominal group). Other components of gout disease modification were to improve quality of life/productivity; restore function; reduce/eliminate pain; reduce tophi burden; and joint preservation or resolution of joint damage. Potential additional components that were not ranked in the top three votes within each nominal group were: decreasing health-care cost/utilization; reducing cardiovascular/renal morbidity/mortality; and stopping formation of urate crystals. Conclusion This qualitative study provides a provisional set of domains for disease modification in gout. Future studies for the development of thresholds for disease modification domains and wider consensus on this definition are needed.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center.,Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, Birmingham, AL, USA
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Morillon MB, Christensen R, Singh JA, Dalbeth N, Saag K, Taylor WJ, Neogi T, Kennedy MA, Pedersen BM, McCarthy GM, Shea B, Diaz-Torne C, Tedeschi SK, Grainger R, Abhishek A, Gaffo A, Nielsen SM, Noerup A, Simon LS, Lassere M, Tugwell P, Stamp LK, Gout Working Group FTO. Serum urate as a proposed surrogate outcome measure in gout trials: From the OMERACT working group. Semin Arthritis Rheum 2021; 51:1378-1385. [PMID: 34839932 PMCID: PMC10401605 DOI: 10.1016/j.semarthrit.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 02/03/2023]
Abstract
Serum urate (SU) is the most common primary efficacy outcome in trials of urate-lowering therapies for gout. Despite this, it is not formally considered a validated surrogate outcome. In this paper we will outline the definitions of biomarkers and surrogate outcome measures, respectively as well as the available frameworks and challenges in the assessment of the validity of serum urate as a surrogate in gout (i.e. a reasonable replacement for gout symptoms).
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Affiliation(s)
- Melanie Birger Morillon
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark; Department of Medicine, Svendborg, Odense University Hospital, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Jasvinder A Singh
- Birmingham Veterans Affairs (VA) Medical Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Kenneth Saag
- Birmingham Veterans Affairs (VA) Medical Center, University of Alabama, Birmingham, AL, USA
| | | | | | | | | | - Geraldine M McCarthy
- Division of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Beverley Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Cesar Diaz-Torne
- Rheumatology Department. Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona. Barcelona
| | - Sara K Tedeschi
- Brigham and Women's Hospital, Division of Rheumatology, Inflammation and Immunity, Boston, USA
| | - Rebecca Grainger
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | | | - Angelo Gaffo
- Birmingham Veterans Affairs (VA) Medical Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sabrina Mai Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Alexander Noerup
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | | | - Marissa Lassere
- Department of Rheumatology, St George Hospital, University of NSW, Sydney, Australia
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand.
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Abstract
This review highlights outcomes for patients with calcium pyrophosphate deposition (CPPD) reported in prior studies and underscores challenges to assessing outcomes of this condition. Prior clinical studies of interventions for CPPD focused on joint damage and calcification on imaging tests, joint pain, swelling, and inflammatory biomarkers. Qualitative interviews with patients with CPPD and healthcare providers additionally identified flares, overall function, and use of analgesic medications as important outcomes. Imaging evidence of joint damage and calcification is likely to be outcomes in future clinical studies of CPPD, though reliability and sensitivity to change in CPPD require further testing for several imaging modalities. Challenges to outcome measurement in CPPD include questions of attribution of signs and symptoms to CPPD versus co-existing forms of arthritis, lack of therapies to prevent or dissolve calcium pyrophosphate crystal deposition, absence of validated patient- or physician-reported CPPD outcome measures, and scarcity of large cohorts in which to study outcomes of different clinical presentations of CPPD.
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Affiliation(s)
- Ken Cai
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Rheumatology, Westmead Hospital, Westmead, Australia
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA.
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Abstract
Gout flares are central to the patient experience of gout and are included in the Outcome Measures in Rheumatology (OMERACT) core outcome domain set for long-term gout studies. Although a valid definition for gout flare has been developed, there is no consensus around how flare outcomes are measured and reported in long-term clinical studies. Current methods of flare measurement, which are centered on measuring flares as a binary outcome (i.e., present vs absent), do not reflect the variable pattern of flares over time, nor the multidimensional patient experience of gout flares which include factors related to pain severity, functional disability, impact on family and social life, and psychological wellbeing. This review will discuss the importance and challenges of gout flare measurement.
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Affiliation(s)
- Sarah Stewart
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand.
| | - Angelo Gaffo
- Department of Medicine, University of Alabama and Birmingham, Alabama, United States.
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Kleiner G, Fernandez HH, Chou KL, Fasano A, Duque KR, Hengartner D, Law A, Margolius A, Poon Y, Sáenz Farret M, Saleh P, Vizcarra JA, Stebbins GT, Espay AJ. Non‐Motor Fluctuations in Parkinson's Disease: Validation of the Non‐Motor Fluctuation Assessment Questionnaire. Mov Disord 2021; 36:1392-1400. [DOI: 10.1002/mds.28507] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 12/16/2022] Open
Affiliation(s)
- Galit Kleiner
- Jeff and Diane Ross Movement Disorders Clinic/ATC Baycrest Center for Geriatric Health Toronto Toronto Ontario Canada
- Division of Neurology University of Toronto Toronto Ontario Canada
| | - Hubert H. Fernandez
- Department of Neurology and Center for Neurological Restoration Neurological Institute, Cleveland Clinic Lerner College of Medicine Cleveland Ohio USA
| | - Kelvin L. Chou
- Department of Neurology and Neurosurgery University of Michigan Medical School Ann Arbor Michigan USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital, UHN Toronto Ontario Canada
- Krembil Brain Institute Toronto Ontario Canada
| | - Kevin R. Duque
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders Department of Neurology University of Cincinnati Cincinnati Ohio USA
| | - Diana Hengartner
- Department of Neurology and Center for Neurological Restoration Neurological Institute, Cleveland Clinic Lerner College of Medicine Cleveland Ohio USA
| | - Albie Law
- Jeff and Diane Ross Movement Disorders Clinic/ATC Baycrest Center for Geriatric Health Toronto Toronto Ontario Canada
- Division of Neurology University of Toronto Toronto Ontario Canada
| | - Adam Margolius
- Department of Neurology and Center for Neurological Restoration Neurological Institute, Cleveland Clinic Lerner College of Medicine Cleveland Ohio USA
| | - Yu‐Yan Poon
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital, UHN Toronto Ontario Canada
| | - Michel Sáenz Farret
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital, UHN Toronto Ontario Canada
| | - Philip Saleh
- Jeff and Diane Ross Movement Disorders Clinic/ATC Baycrest Center for Geriatric Health Toronto Toronto Ontario Canada
- Division of Neurology University of Toronto Toronto Ontario Canada
| | - Joaquin A. Vizcarra
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders Department of Neurology University of Cincinnati Cincinnati Ohio USA
| | - Glenn T. Stebbins
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
| | - Alberto J. Espay
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders Department of Neurology University of Cincinnati Cincinnati Ohio USA
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Taylor W, Dalbeth N, Saag KG, Singh JA, Rahn EJ, Mudano AS, Chen YH, Lin CT, Tan P, Louthreno W, Vazquez-Mellado J, Hernández-Llinas H, Neogi T, Vargas-Santos AB, Castelar-Pinheiro G, Chaves-Amorim RB, Uhlig T, Hammer HB, Eliseev M, Perez-Ruiz F, Cavagna L, McCarthy GM, Stamp LK, Gerritsen M, Fana V, Sivera F, Gaffo AL. Flare Rate Thresholds for Patient Assessment of Disease Activity States in Gout. J Rheumatol 2021; 48:293-298. [PMID: 32358154 DOI: 10.3899/jrheum.191242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the relationship between gout flare rate and self-categorization into remission, low disease activity (LDA), and patient acceptable symptom state (PASS). METHODS Patients with gout self-categorized as remission, LDA, and PASS, and reported number of flares over the preceding 6 and 12 months. Multinomial logistic regression was used to determine the association between being in each disease state (LDA and PASS were combined) and flare count, and self-reported current flare. A distribution-based approach and extended Youden index identified possible flare count thresholds for each state. RESULTS Investigators from 17 countries recruited 512 participants. Remission was associated with a median recalled flare count of zero over both 6 and 12 months. Each recalled flare reduced the likelihood of self-perceived remission compared with being in higher disease activity than LDA/PASS, by 52% for 6 months and 23% for 12 months, and the likelihood of self-perceived LDA/PASS by 15% and 5% for 6 and 12 months, respectively. A threshold of 0 flares in preceding 6 and 12 months was associated with correct classification of self-perceived remission in 58% and 56% of cases, respectively. CONCLUSION Flares are significantly associated with perceptions of disease activity in gout, and no flares over the prior 6 or 12 months is necessary for most people to self-categorize as being in remission. However, recalled flare counts alone do not correctly classify all patients into self-categorized disease activity states, suggesting that other factors may also contribute to self-perceived gout disease activity.
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Affiliation(s)
- William Taylor
- W. Taylor, MBChB, PhD, FRACP, FAFRM, University of Otago, Wellington, New Zealand
| | - Nicola Dalbeth
- N. Dalbeth, MBChB, MD, FRACP, P. Tan, University of Auckland, Auckland, New Zealand
| | - Kenneth G Saag
- K.G. Saag, MD, MSc, E.J. Rahn, PhD, A.S. Mudano, MPH, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jasvinder A Singh
- J.A. Singh, MD, MPH, A.L. Gaffo, MD, MSPH, University of Alabama at Birmingham, and Birmingham VA Medical Center, Birmingham, Alabama, USA
| | - Elizabeth J Rahn
- K.G. Saag, MD, MSc, E.J. Rahn, PhD, A.S. Mudano, MPH, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amy S Mudano
- K.G. Saag, MD, MSc, E.J. Rahn, PhD, A.S. Mudano, MPH, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yi-Hsing Chen
- Y.H. Chen, MD, PhD, C.T. Lin, MD, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Tsai Lin
- Y.H. Chen, MD, PhD, C.T. Lin, MD, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Paul Tan
- N. Dalbeth, MBChB, MD, FRACP, P. Tan, University of Auckland, Auckland, New Zealand
| | | | - Janitzia Vazquez-Mellado
- J. Vazquez-Mellado, MD, PhD, H. Hernández-Llinas, MD, Hospital General de Mexico, Mexico City, Mexico
| | - Hansel Hernández-Llinas
- J. Vazquez-Mellado, MD, PhD, H. Hernández-Llinas, MD, Hospital General de Mexico, Mexico City, Mexico
| | - Tuhina Neogi
- T. Neogi, MD, PhD, FRCPC, A.B. Vargas-Santos, MD, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ana B Vargas-Santos
- T. Neogi, MD, PhD, FRCPC, A.B. Vargas-Santos, MD, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Geraldo Castelar-Pinheiro
- G. Castelar-Pinheiro, MD, PhD, R.B. Chaves-Amorim, MD, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo B Chaves-Amorim
- G. Castelar-Pinheiro, MD, PhD, R.B. Chaves-Amorim, MD, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tillman Uhlig
- T. Uhlig, MD, H.B. Hammer, MD, PhD, Diakonhjemmet Hospital, Oslo, Norway
| | - Hilde B Hammer
- T. Uhlig, MD, H.B. Hammer, MD, PhD, Diakonhjemmet Hospital, Oslo, Norway
| | - Maxim Eliseev
- M. Eliseev, PhD, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | | | - Lorenzo Cavagna
- L. Cavagna, MD, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Geraldine M McCarthy
- G.M. McCarthy, MD, FRCPI, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lisa K Stamp
- L.K. Stamp, MBChB, FRACP, PhD, University of Otago-Christchurch, Christchurch, New Zealand
| | | | - Viktoria Fana
- V. Fana, MD, Copenhagen Center for Artritis Reserch, Righospitalet Glostrup, Denmark
| | - Francisca Sivera
- F. Sivera, MD, PhD, Hospital General Universitario Elda, Elda, Spain
| | - Angelo L Gaffo
- J.A. Singh, MD, MPH, A.L. Gaffo, MD, MSPH, University of Alabama at Birmingham, and Birmingham VA Medical Center, Birmingham, Alabama, USA;
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10
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Chowalloor P, Raymond WD, Cheah P, Keen H. The burden of subclinical intra-articular inflammation in gout. Int J Rheum Dis 2020; 23:661-668. [PMID: 32107861 DOI: 10.1111/1756-185x.13811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/23/2019] [Accepted: 02/06/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the burden of subclinical intra-articular inflammation using ultrasound in people with gout. METHODS A pilot, prospective longitudinal cohort of 28 participants with gout were examined twice, once during a gout flare (n = 25) and then during an inter-critical phase (n = 27). At each visit, a 52 joint count was done followed by ultrasound examination for detection of intra-articular power Doppler (PD) signal. Clinically active joints were defined as tender and swollen. Data was collected on patient reported gout pain - visual analog scale (VAS) (painVAS), physician global VAS (physicianVAS), Health Assessment Questionnaire (HAQ), serum uric acid, erythrocyte sedimentation rate (ESR), and high-sensitivity C-reactive protein (HsCRP). RESULTS At the flare visit, participants had a median of 1 clinically active joint (interquartile range [IQR] 1-2), and a median of 5 joints with a PD score ≥ 2 (IQR 4-10, P < .001). At the inter-critical visit, participants reported an median of 0 clinically active joints (IQR 0-0), and a median of 4 joints with a PD score ≥ 2 (IQR 3-7, P < .001). Physician VAS (5.69 vs 3.40, P < .001), painVAS (6 vs 0, P < .001), HAQ (0.75 vs 0.12, P = .032), and ESR (29 vs 13.5 mm/h, P = .02) were higher at the acute visit, but HsCRP levels were similar (8.88 vs 5.15 mg/L, P = .062). CONCLUSION This pilot study established the presence of subclinical intra-articular inflammation in gout at both acute and inter-critical phases. Despite the apparent resolution of symptoms after an acute flare, a relatively high proportion of joints had subclinical inflammation in the inter-critical visit. The long-term implications of untreated subclinical joint inflammation are not clear.
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Affiliation(s)
- Priya Chowalloor
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Department of Internal Medicine, Royal Perth Hospital, Perth, WA, Australia
| | | | - Patrick Cheah
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Helen Keen
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Department of Rheumatology, Fiona Stanley Hospital, Perth, WA, Australia
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Schlesinger N, Edwards NL, Khanna PP, Yeo AE, Lipsky PE. Evaluation of Proposed Criteria for Remission and Evidence-Based Development of Criteria for Complete Response in Patients With Chronic Refractory Gout. ACR Open Rheumatol 2019; 1:236-243. [PMID: 31777799 PMCID: PMC6857961 DOI: 10.1002/acr2.1025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objective The objective of this study is to assess criteria for gout remission and to use the results to inform criteria for a complete response (CR). Methods A post hoc analysis of two clinical trials was undertaken to determine the frequency with which subjects with chronic refractory gout who were treated with pegloticase met remission criteria. Mixed modeling was then employed to identify the components that best correlated with time to maximum benefit. Results Of the 56 subjects treated with biweekly pegloticase for whom adequate data were collected, 48.2% met the remission criteria. When subjects with persistent lowering of urate levels were examined separately, 27 of 32 (84.4%) met the criteria for remission. In contrast, even when the requirement for lowering of serum urate levels was waived, only 2 of 24 (8.3%) subjects without persistent lowering of urate levels and 0 of 43 subjects receiving placebo met criteria. Mixed modeling indicated that in addition to urate levels, assessment of tophi, swollen joints, and tender joints and patient global assessment best correlated with time to maximum benefit. Using these criteria of CR, 23 of the responders (71.9%) met the criteria. All patients who achieved a CR maintained it for a mean duration of 507.4 days. Finally, 64% of persistent responders to monthly pegloticase also met criteria for CR. Conclusion These results have validated the proposed remission criteria for gout and have helped define criteria for CR in individuals with chronic gout treated with pegloticase. This composite CR index can serve as an evidence-based target to inform the design and end points of future clinical trials.
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Alvarado-de la Barrera C, López-López CO, Álvarez-Hernández E, Peláez-Ballestas I, Gómez-Ruiz C, Burgos-Vargas R, Vázquez-Mellado J. Are Target Urate and Remission Possible in Severe Gout? A Five-year Cohort Study. J Rheumatol 2019; 47:132-139. [PMID: 31043541 DOI: 10.3899/jrheum.181214] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Determine the proportion of patients achieving target serum urate (SU), defined as < 6 mg/dl for patients with non-severe gout and < 5 mg/dl for patients with severe gout, as well as the proportion of patients achieving remission after 5 years of followup. METHODS Patients from the Gout Study Group (GRESGO) cohort were evaluated at 6-month intervals. Demographic and clinical data were obtained at baseline. Visits included assessments of serum urate, flares, tophus burden, health-related quality of life using the EQ-5D, activity limitations using the Health Assessment Questionnaire adapted for gout, and pain level and patient's global assessment using visual analog scales. Treatment for gout and associated diseases was prescribed according to guidelines and available drugs. RESULTS Of 500 patients studied, 221 had severe gout (44%) and 279 had non-severe gout (56%) at baseline. No significant differences were observed across the study in percentages of severe gout versus non-severe gout patients achieving SU 6 mg/dl or 5 mg/dl. The highest proportion of patients achieving target SU (50-70%) and remission (39%) were found after 3-4 years of followup. In the fifth year, these proportions decreased and 28% of the patients were in remission, but only 40 patients remained in the study. None of the patients with severe gout achieved remission. CONCLUSION In patients with severe gout, target SU was hard to achieve and remission was not possible. The main obstacles for target SU and gout remission include poor medication adherence, persistent tophi, and loss to followup.
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Affiliation(s)
- Claudia Alvarado-de la Barrera
- From the Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; Servicio de Reumatología, Unidad 404, Hospital General de México, Mexico City, Mexico.,C. Alvarado-de la Barrera, PhD, Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; C.O. López-López, MD, PhD, Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; E. Álvarez-Hernández, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; I. Peláez-Ballestas, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México; C. Gómez-Ruiz, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; R. Burgos-Vargas, MD, Servicio de Medicina Física y Rehabilitación, Unidad 402, and Servicio de Reumatología, Unidad 404, Hospital General de México; J. Vázquez-Mellado, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México
| | - Carlos Omar López-López
- From the Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; Servicio de Reumatología, Unidad 404, Hospital General de México, Mexico City, Mexico.,C. Alvarado-de la Barrera, PhD, Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; C.O. López-López, MD, PhD, Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; E. Álvarez-Hernández, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; I. Peláez-Ballestas, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México; C. Gómez-Ruiz, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; R. Burgos-Vargas, MD, Servicio de Medicina Física y Rehabilitación, Unidad 402, and Servicio de Reumatología, Unidad 404, Hospital General de México; J. Vázquez-Mellado, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México
| | - Everardo Álvarez-Hernández
- From the Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; Servicio de Reumatología, Unidad 404, Hospital General de México, Mexico City, Mexico.,C. Alvarado-de la Barrera, PhD, Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; C.O. López-López, MD, PhD, Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; E. Álvarez-Hernández, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; I. Peláez-Ballestas, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México; C. Gómez-Ruiz, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; R. Burgos-Vargas, MD, Servicio de Medicina Física y Rehabilitación, Unidad 402, and Servicio de Reumatología, Unidad 404, Hospital General de México; J. Vázquez-Mellado, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México
| | - Ingris Peláez-Ballestas
- From the Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; Servicio de Reumatología, Unidad 404, Hospital General de México, Mexico City, Mexico.,C. Alvarado-de la Barrera, PhD, Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; C.O. López-López, MD, PhD, Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; E. Álvarez-Hernández, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; I. Peláez-Ballestas, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México; C. Gómez-Ruiz, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; R. Burgos-Vargas, MD, Servicio de Medicina Física y Rehabilitación, Unidad 402, and Servicio de Reumatología, Unidad 404, Hospital General de México; J. Vázquez-Mellado, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México
| | - Citlallyc Gómez-Ruiz
- From the Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; Servicio de Reumatología, Unidad 404, Hospital General de México, Mexico City, Mexico.,C. Alvarado-de la Barrera, PhD, Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; C.O. López-López, MD, PhD, Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; E. Álvarez-Hernández, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; I. Peláez-Ballestas, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México; C. Gómez-Ruiz, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; R. Burgos-Vargas, MD, Servicio de Medicina Física y Rehabilitación, Unidad 402, and Servicio de Reumatología, Unidad 404, Hospital General de México; J. Vázquez-Mellado, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México
| | - Rubén Burgos-Vargas
- From the Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; Servicio de Reumatología, Unidad 404, Hospital General de México, Mexico City, Mexico.,C. Alvarado-de la Barrera, PhD, Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; C.O. López-López, MD, PhD, Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; E. Álvarez-Hernández, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; I. Peláez-Ballestas, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México; C. Gómez-Ruiz, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; R. Burgos-Vargas, MD, Servicio de Medicina Física y Rehabilitación, Unidad 402, and Servicio de Reumatología, Unidad 404, Hospital General de México; J. Vázquez-Mellado, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México
| | - Janitzia Vázquez-Mellado
- From the Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; Servicio de Reumatología, Unidad 404, Hospital General de México, Mexico City, Mexico. .,C. Alvarado-de la Barrera, PhD, Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; C.O. López-López, MD, PhD, Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; E. Álvarez-Hernández, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; I. Peláez-Ballestas, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México; C. Gómez-Ruiz, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; R. Burgos-Vargas, MD, Servicio de Medicina Física y Rehabilitación, Unidad 402, and Servicio de Reumatología, Unidad 404, Hospital General de México; J. Vázquez-Mellado, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México.
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Janssen CA, Oude Voshaar MAH, Ten Klooster PM, Jansen TLTA, Vonkeman HE, van de Laar MAFJ. A systematic literature review of patient-reported outcome measures used in gout: an evaluation of their content and measurement properties. Health Qual Life Outcomes 2019; 17:63. [PMID: 30975212 PMCID: PMC6460780 DOI: 10.1186/s12955-019-1125-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/26/2019] [Indexed: 01/01/2023] Open
Abstract
Background Gout is a common, monosodium urate crystal-driven inflammatory arthritis. Besides its clinical manifestations, patients often also suffer from pain, physical impairment, emotional distress and work productivity loss, as a result of the disease. Patient-reported outcome measures (PROMs) are commonly used to assess these consequences of the disease. However, current instrument endorsements for measuring such outcomes in acute and chronic gout clinical settings are based on limited psychometric evidence. The objective of this systematic literature review was to identify currently available PROMs for gout, and to critically evaluate their content and psychometric properties, in order to evaluate the current status regarding PROMs for use in gout patients. Methods Systematic literature searches were performed in the PubMed and EMBASE databases. The methodological quality of included papers was appraised using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist, and evaluation of measurement properties (reliability, responsiveness, construct validity, floor and ceiling effects) was done in accordance with published quality criteria. Item content was appraised by linking health concepts to the International Classification of Functioning Disability and Health (ICF) framework. Results In total, 13 PROMs were identified, of which three were targeted specifically at gout patients. The majority of the PROMs were rated positively for content validity. For most instruments, limited evidence was available for construct validity and reliability. Instruments to assess pain scored well on responsiveness and floor and ceiling effects, but not much is known about their reliability in gout. Conclusions The physical functioning subscale of the SF-36v2 (Short Form-36 item version 2) is the only PROM that had sufficient supporting evidence for all its psychometric properties. Many of the commonly used PROMs in gout are currently not yet well supported and more studies on their measurement properties are needed among both acute and chronic gout populations. Electronic supplementary material The online version of this article (10.1186/s12955-019-1125-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carly A Janssen
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands.
| | - Martijn A H Oude Voshaar
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands
| | - Peter M Ten Klooster
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands
| | - Tim L Th A Jansen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
| | - Harald E Vonkeman
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Mart A F J van de Laar
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
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Mackenzie RM, Ells LJ, Simpson SA, Logue J. Development of a core outcome set for behavioural weight management programmes for adults with overweight and obesity: protocol for obtaining expert consensus using Delphi methodology. BMJ Open 2019; 9:e025193. [PMID: 30826797 PMCID: PMC6398651 DOI: 10.1136/bmjopen-2018-025193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Weight management interventions in research studies and in clinical practice differ in length, advice, frequency of meetings, staff and cost. Very few real-world programmes have published patient-related outcomes, and those that have published used different ways of reporting the information, making it impossible to compare interventions and further develop the evidence base. Developing a core outcome set for behavioural weight management programmes (BWMPs) for adults with overweight and obesity will allow different BWMPs to be compared and reveal which interventions work best for which members of the population. METHODS AND ANALYSIS An expert group, comprised of 40 people who work in, refer to, or attend BWMPs for adults with overweight and obesity, will be asked to decide which outcomes services should report. An online Delphi process will be employed to help the group reach consensus as to which outcomes should be measured and reported, and which definitions/instruments should be used in order to do so. The first stage of the Delphi process (three rounds of questionnaires) will focus on outcomes while the second stage (three additional rounds of questionnaires) will focus on definition/instrument selection. ETHICS AND DISSEMINATION Ethical approval for this study has been received from the University of Glasgow College of Medical, Veterinary and Life Sciences Ethics Committee. With regard to disseminating results, a report will be submitted to our funding body, the Chief Scientist Office of the Scottish Government Health Department. In addition, early findings will be shared with Public Health England and Health Scotland, and results communicated via conference presentations, peer review publication and our institutions' social media platforms.
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Affiliation(s)
- Ruth M Mackenzie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Louisa J Ells
- School of Health and Social Care, Teeside University, Middlesbrough, UK
| | | | - Jennifer Logue
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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15
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Wuytack F, Gutke A, Stuge B, Mørkved S, Olsson C, Robinson HS, Vøllestad NK, Öberg B, Wikmar LN, Mena JJS, Smith V. Protocol for the development of a core outcome set for pelvic girdle pain, including methods for measuring the outcomes: the PGP-COS study. BMC Med Res Methodol 2018; 18:158. [PMID: 30509216 PMCID: PMC6276248 DOI: 10.1186/s12874-018-0624-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 11/19/2018] [Indexed: 12/18/2022] Open
Abstract
Background Pelvic Girdle Pain (PGP) is an important cause of disability and economic cost worldwide. There is a need for effective preventative and management strategies. Emerging studies measure a variety of outcomes rendering synthesis and translation to clinical practice difficult. A Core Outcome Set (COS) can address this problem by ensuring that data are relevant, useful and usable for making well-informed healthcare choices. The aim of this study is to develop a consensus-based PGP-COS, including agreement on methods (e.g. instruments) for measuring the construct outcomes in the COS for use in research and clinical practice. Furthermore, as there is uncertainty as to whether incorporating stakeholder interviews in addition to conducting a systematic review to determine an initial list of outcomes for the Delphi survey, or, whether using different rating scales in a Delphi survey impacts on the final COS, we propose to embed two methodological studies within the PGP-COS development process to address these questions. Methods The PGP-COS study will include five phases: (1) A systematic review of the literature and semi-structured interviews with 15 patients (three countries) to form the initial list of outcomes for the Delphi survey; (2) A 3-round Delphi including patients, clinicians, researchers and service providers; (3) A systematic review of methods for measuring the outcomes in the preliminary PGP-COS identified in the Delphi survey; (4) A face-to-face consensus meeting to agree on the final PGP-COS and methods for measuring the COS; (5) Global dissemination. To address the methodological questions, we will assess the number and type of outcomes, in the final PGP-COS, that were exclusively derived from the interviews. Secondly, we will randomise Delphi survey participants to either a 5-point or 9-point importance rating scale, and examine potential differences in ‘important’ ratings between the groups. Discussion There is currently no COS for measuring/monitoring PGP in trials and clinical practice. A PGP-COS will ensure that relevant outcomes are measured using appropriate measurement instruments for patients with PGP globally. Core outcome set registration This PGP-COS was registered with COMET (Core Outcome Measures for Effectiveness Trials) in January 2017 (http://www.comet-initiative.org/studies/details/958). Electronic supplementary material The online version of this article (10.1186/s12874-018-0624-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francesca Wuytack
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Annelie Gutke
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Box 455, 40530, Göteborg, Sweden
| | - Britt Stuge
- Division for Neuroscience and Musculoskeletal Medicine, Oslo University Hospital, Oslo, Norway
| | - Siv Mørkved
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, N-7489, Trondheim, Norway
| | - Christina Olsson
- Mörby Academic Primary Healthcare Centre, Golfvägen 8, 182 31, Danderyd, Sweden
| | - Hilde Stendal Robinson
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Postboks 1089 Blindern, 0318, Oslo, Norway
| | - Nina K Vøllestad
- Institute of Health and Society, University of Oslo, Box 1133 Blindern, N-0318, Oslo, Norway
| | - Birgitta Öberg
- Department of Medicine and Health, Linköping University, 581 85, Linköping, Sweden
| | - Lena Nilsson Wikmar
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Juan Jose Saldaña Mena
- Universidad Estatal del Valle de Ecatepec, Calle León Guzmán #60 Col Valle de Anáhuac CP, 55210, Ecatepec de Morelos, Mexico
| | - Valerie Smith
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
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Stamp L, Morillon MB, Taylor WJ, Dalbeth N, Singh JA, Lassere M, Christensen R. Serum urate as surrogate endpoint for flares in people with gout: A systematic review and meta-regression analysis. Semin Arthritis Rheum 2018; 48:293-301. [PMID: 29566967 DOI: 10.1016/j.semarthrit.2018.02.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 01/17/2018] [Accepted: 02/16/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The primary efficacy outcome in trials of urate lowering therapy (ULT) for gout is serum urate (SU). The aim of this study was to examine the strength of the relationship between SU and patient-important outcomes to determine whether SU is an adequate surrogate endpoint for clinical trials. METHODS Multiple databases through October 2017 were searched. Randomized controlled trials comparing any ULT in people with gout with any control or placebo, ≥three months duration were included. Open label extension (OLE) trial data were included in secondary analyses. Standardized data elements were extracted independently by two reviewers. RESULTS Ten RCTs and 3 OLE studies were identified. From the RCTs (maximum duration 24 months) meta-regression did not reveal an association between the relative risk of a gout flare and the difference in proportions of individuals with SU < 6mg/dL (P = 0.47; R2 = 8%). In a post hoc analysis, the ratio of the time in months at which the proportion of individuals having a flare was reported/time in months at which the proportion of individuals with SU < 6mg/dL was reported was calculated and studies where the ratio was <2 were excluded. Using the remaining 6 studies there was an association between proportion of individuals achieving SU < 6mg/dL and gout flares (over patient years). Duration of ULT was inversely associated with the proportion of patients experiencing a flare. Study duration and variability in reporting of outcomes limited the analysis. Observational studies supported the trend of fewer flares in those with lower SU. CONCLUSIONS Based on aggregate clinical trial-level data an association between SU and gout flare could not be confirmed. However, based on observational ecological study design data-including longer duration extension studies-SU < 6mg/dL was associated with reduced gout flares.
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Affiliation(s)
- Lisa Stamp
- Department of Medicine, University of Otago, Christchurch, P.O. Box 4345, Christchurch, New Zealand.
| | - Melanie B Morillon
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Rheumatology, Odense University Hospital, Denmark; Department of Medicine, Vejle Hospital, Denmark
| | - William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, New Zealand
| | - Jasvinder A Singh
- Department of Medicine, University of Alabama at Birmingham & Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Marissa Lassere
- Department of Rheumatology, St George Hospital, University of NSW, Sydney, Australia
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Assessing Consensus Between UK Renal Clinicians on Listing for Kidney Transplantation: A Modified Delphi Study. Transplant Direct 2018; 4:e343. [PMID: 29796414 PMCID: PMC5959339 DOI: 10.1097/txd.0000000000000782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/12/2018] [Indexed: 11/27/2022] Open
Abstract
Background It is well recognized that there is significant variation between centers in access to kidney transplantation. In the absence of high-grade evidence, it is unclear whether variation is due to patient case mix, other center factors, or individual clinician decisions. This study sought consensus between UK clinicians on factors that should influence access to kidney transplantation. Methods As part of the Access to Transplantation and Transplant Outcome Measures project, consultant nephrologists and transplant surgeons in 71 centers were invited to participate in a Delphi study involving 2 rounds. During rounds 1 and 2, participants rated their agreement to 29 statements covering 8 topics regarding kidney transplantation. A stakeholder meeting was used to discuss statements of interest after the 2 rounds. Results In total, 122 nephrologists and 16 transplant surgeons from 45 units participated in rounds 1 and 2. After 2 rounds, 12 of 29 statements reached consensus. Fifty people participated in the stakeholder meeting. After the stakeholder meeting, a further 4 statements reached agreement. Of the 8 topics covered, consensus was reached in 6: use of a transplant protocol, patient age, body mass index, patient compliance with treatment, cardiac workup, and use of multidisciplinary meetings. Consensus was not reached on screening for malignancy and use of peripheral Doppler studies. Conclusions The Delphi process identified factors upon which clinicians agreed and areas where consensus could not be achieved. The findings should inform national guidelines to support decision making in the absence of high quality evidence and to guide areas that warrant future research.
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Kelly A, Tong A, Tymms K, March L, Craig JC, De Vera M, Evans V, Hassett G, Toupin-April K, van den Bemt B, Teixeira-Pinto A, Alten R, Bartlett SJ, Campbell W, Dawson T, Gill M, Hebing R, Meara A, Nieuwlaat R, Shaw Y, Singh JA, Suarez-Almazor M, Sumpton D, Wong P, Christensen R, Beaton D, de Wit M, Tugwell P. Outcome Measures in Rheumatology - Interventions for medication Adherence (OMERACT-Adherence) Core Domain Set for Trials of Interventions for Medication Adherence in Rheumatology: 5 Phase Study Protocol. Trials 2018; 19:204. [PMID: 29587864 PMCID: PMC5870260 DOI: 10.1186/s13063-018-2565-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/28/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Over the last 20 years, there have been marked improvements in the availability of effective medications for rheumatic conditions such as gout, osteoporosis and rheumatoid arthritis (RA), which have led to a reduction in disease flares and the risk of re-fracture in osteoporosis, and the slowing of disease progression in RA. However, medication adherence remains suboptimal, as treatment regimens can be complex and difficult to continue long term. Many trials have been conducted to improve adherence to medication. Core domains, which are the outcomes of most relevance to patients and clinicians, are a pivotal component of any trial. These core domains should be measured consistently, so that all relevant trials can be combined in systematic reviews and meta-analyses to reach conclusions that are more valid. Failure to do this severely limits the potential for trial-based evidence to inform decisions on how to support medication adherence. The Outcome Measures in Rheumatology (OMERACT) - Interventions for Medication Adherence study by the OMERACT-Adherence Group aims to develop a core domain set for interventions that aim to support medication adherence in rheumatology. METHODS/DESIGN This OMERACT-Adherence study has five phases: (1) a systematic review to identify outcome domains that have been reported in interventions focused on supporting medication adherence in rheumatology; (2) semi-structured stakeholder interviews with patients and caregivers to determine their views on the core domains; (3) focus groups using the nominal group technique with patients and caregivers to identify and rank domains that are relevant to them, including the reasons for their choices; (4) an international three-round modified Delphi survey involving patients with diverse rheumatic conditions, caregivers, health professionals, researchers and other stakeholders to develop a preliminary core domain set; and (5) a stakeholder workshop with OMERACT members to review, vote on and reach a consensus on the core domain set for interventions to support medication adherence in rheumatology. DISCUSSION Establishing a core domain set to be reported in all intervention studies undertaken to support patients with medication adherence will enhance the relevance and the impact of these results and improve the lives of people with rheumatic conditions.
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Affiliation(s)
- Ayano Kelly
- Canberra Rheumatology, Level 9, 40 Marcus Clarke St, Canberra City, ACT, 2606, Australia. .,Department of Rheumatology, Canberra Hospital, Canberra, ACT, Australia. .,College of Health and Medicine, Australian National University, Canberra, ACT, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kathleen Tymms
- Canberra Rheumatology, Level 9, 40 Marcus Clarke St, Canberra City, ACT, 2606, Australia.,Department of Rheumatology, Canberra Hospital, Canberra, ACT, Australia.,College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Lyn March
- Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia.,Institute of Bone and Joint Research, Kolling Institute of Medical Research, Sydney, NSW, Australia.,Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Mary De Vera
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.,Arthritis Research Centre of Canada, Richmond, BC, Canada
| | - Vicki Evans
- Patient Research Partner, Clear Vision Consulting, Canberra, ACT, Australia
| | - Geraldine Hassett
- Department of Rheumatology, Liverpool Hospital, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Karine Toupin-April
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Bart van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Ubbergen, Netherlands.,Radboud University Medical Centre, Nijmegen, Netherlands
| | - Armando Teixeira-Pinto
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Rieke Alten
- Department of Rheumatology, Clinical Immunology, Osteology, Physical therapy and Sports Medicine, Schlosspark Klinik, Charité University Medicine, Berlin, Germany
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Canada.,Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Willemina Campbell
- Patient Research Partner, Toronto Western Hospital, Toronto, Ottawa, Canada
| | - Therese Dawson
- Lord Street Specialist Centre, Port Macquarie, NSW, Australia.,Mayo Hospital Specialist Centre, Taree, NSW, Australia
| | - Michael Gill
- Patient Research Partner, Dragon Claw, Sydney, NSW, Australia
| | - Renske Hebing
- Amsterdam Rheumatology and Immunology Centre, Amsterdam, Netherlands
| | - Alexa Meara
- The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Robby Nieuwlaat
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Yomei Shaw
- National Data Bank for Rheumatic Diseases, Wichita, KS, USA
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, AL, USA.,Department of Medicine, School of Medicine, University of Alabama, Birmingham, AL, USA.,Division of Epidemiology, School of Public Health, University of Alabama, Birmingham, AL, USA
| | - Maria Suarez-Almazor
- Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel Sumpton
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Department of Rheumatology, Concord Hospital, Sydney, NSW, Australia
| | - Peter Wong
- Mid-North Coast Arthritis Clinic, Coffs Harbour, NSW, Australia.,University of New South Wales Rural Clinical School, Coffs Harbour, NSW, Australia
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Dorcas Beaton
- Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Institute for Work & Health, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy and the Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Maarten de Wit
- Metamedica, VU Medical Centre, Amsterdam, The Netherlands
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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19
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Improvement in OMERACT domains and renal function with regular treatment for gout: a 12-month follow-up cohort study. Clin Rheumatol 2018; 37:1885-1894. [DOI: 10.1007/s10067-018-4065-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
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20
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Stamp LK, Morillon MB, Taylor WJ, Dalbeth N, Singh JA, Lassere M, Christensen R. Variability in the Reporting of Serum Urate and Flares in Gout Clinical Trials: Need for Minimum Reporting Requirements. J Rheumatol 2017; 45:419-424. [DOI: 10.3899/jrheum.170911] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2017] [Indexed: 01/18/2023]
Abstract
Objective.To describe the ways in which serum urate (SU) and gout flares are reported in clinical trials, and to propose minimum reporting requirements.Methods.This analysis was done as part of a systematic review aiming to validate SU as a biomarker for gout. The ways in which SU and flares were reported were extracted from each study by 2 reviewers.Results.A total of 22 studies (10 randomized controlled trials, 3 open-label extension studies, and 9 observational studies) were identified. There were 3 broad categories of SU reporting: percentage at target SU, mean SU, and change in SU. A median of 2 (range 1–3) categories were reported across all studies. The most common method of reporting SU was percentage at target in 17/22 (77.3%) studies, with all studies reporting a target of SU < 6 mg/dl. There were 12/22 (54.5%) studies reporting mean SU at some time after study entry, with 7 (58.3%) of these reporting at more than just the final study visit. Two ways of reporting gout flares were identified: mean flare rate and percentage of participants with flares. There was variability in time periods over which flares rates were reported.Conclusion.There is inconsistent reporting of SU and flares in gout studies. Reporting the percentage of participants who achieve a target SU reflects international treatment guidelines. SU should also be reported as a continuous variable with a relevant central and dispersion estimate. Gout flares should be reported as both percentage of participants and mean flare rates at each timepoint.
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21
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Tallouzi MO, Mathers JM, Moore DJ, Murray PI, Bucknall N, Blazeby JM, Calvert M, Denniston AK. COSUMO: study protocol for the development of a core outcome set for efficacy and effectiveness trials in posterior segment-involving uveitis. Trials 2017; 18:576. [PMID: 29191216 PMCID: PMC5709828 DOI: 10.1186/s13063-017-2294-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 10/27/2017] [Indexed: 12/17/2022] Open
Abstract
Background Uveitis, a group of disorders characterised by intraocular inflammation, causes 10–15% of total blindness in the developed world. The most sight-threatening uveitis affects the posterior segment of the eye (posterior-segment involving uveitis (PSIU)). Numerous different outcomes have been used in clinical trials evaluating alternative treatments for uveitis, limiting inter-trial comparison and aggregation of data. We aim to develop a core outcome set (COS) that would provide a standardised set of outcomes to be measured and reported in all effectiveness trials for PSIU. Methods A three-phase design will be used informed by recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) initiative. Phase 1: a comprehensive list of outcomes will be identified through both a systematic review of effectiveness trials of PSIU and qualitative research with stakeholders. The qualitative study will comprise focus groups with patients and their carers in parallel with one-to-one telephone interviews with health professionals and policy-makers. In the focus groups, patients will be grouped according to whether or not their uveitis is complicated by the sight-threatening condition uveitic macular oedema (UMO) since it is hypothesised that the presence of UMO may significantly impact on patient experience of PSIU. Phase 2: Delphi methodology will be used to reduce the range of potential outcomes for the core set. Up to three Delphi rounds will be used through an online survey. Participants will be asked to rate the importance of each outcome on a 9-point Likert scale where 9 is most important. Phase 3: a consensus meeting will be held with key stakeholders to discuss the Delphi results and ratify the final outcomes to be included in the COS. Discussion The development of an agreed COS for PSIU would help ensure that outcomes which matter to key stakeholders are captured and reported in a consistent way. A COS for PSIU would allow greater comparison and aggregation of data across trials for the better evaluation of established and emerging therapies through evidence synthesis and meta-analysis to inform clinical guidelines and health policy. Trial registration COMET. http://comet-initiative.org/studies/details/640. August 2015.
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Affiliation(s)
- Mohammad O Tallouzi
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. .,Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Jonathan M Mathers
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Philip I Murray
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Nicholas Bucknall
- Patient Involvement Group in Uveitis (PInGU), Birmingham, B15 2TT, UK
| | - Jane M Blazeby
- Centre for Surgical Research, School of Social & Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK
| | - Melanie Calvert
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Alastair K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.,Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2WB, UK.,NIHR Biomedical Research Centre at Moorefield's Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
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22
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de Lautour H, Taylor WJ, Adebajo A, Alten R, Burgos-Vargas R, Chapman P, Cimmino MA, da Rocha Castelar Pinheiro G, Day R, Harrold LR, Helliwell P, Janssen M, Kerr G, Kavanaugh A, Khanna D, Khanna PP, Lin C, Louthrenoo W, McCarthy G, Vazquez-Mellado J, Mikuls TR, Neogi T, Ogdie A, Perez-Ruiz F, Schlesinger N, Ralph Schumacher H, Scirè CA, Singh JA, Sivera F, Slot O, Stamp LK, Tausche AK, Terkeltaub R, Uhlig T, van de Laar M, White D, Yamanaka H, Zeng X, Dalbeth N. Development of Preliminary Remission Criteria for Gout Using Delphi and 1000Minds Consensus Exercises. Arthritis Care Res (Hoboken) 2017; 68:667-72. [PMID: 26414176 DOI: 10.1002/acr.22741] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/09/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To establish consensus for potential remission criteria to use in clinical trials of gout. METHODS Experts (n = 88) in gout from multiple countries were invited to participate in a web-based questionnaire study. Three rounds of Delphi consensus exercises were conducted using SurveyMonkey, followed by a discrete-choice experiment using 1000Minds software. The exercises focused on identifying domains, definitions for each domain, and the timeframe over which remission should be defined. RESULTS There were 49 respondents (56% response) to the initial survey, with subsequent response rates ranging from 57% to 90%. Consensus was reached for the inclusion of serum urate (98% agreement), flares (96%), tophi (92%), pain (83%), and patient global assessment of disease activity (93%) as measurement domains in remission criteria. Consensus was also reached for domain definitions, including serum urate (<0.36 mm), pain (<2 on a 10-point scale), and patient global assessment (<2 on a 10-point scale), all of which should be measured at least twice over a set time interval. Consensus was not achieved in the Delphi exercise for the timeframe for remission, with equal responses for 6 months (51%) and 1 year (49%). In the discrete-choice experiment, there was a preference towards 12 months as a timeframe for remission. CONCLUSION These consensus exercises have identified domains and provisional definitions for gout remission criteria. Based on the results of these exercises, preliminary remission criteria are proposed with domains of serum urate, acute flares, tophus, pain, and patient global assessment. These preliminary criteria now require testing in clinical data sets.
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Affiliation(s)
| | | | | | - Rieke Alten
- Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany
| | | | | | | | | | - Ric Day
- University of New South Wales and St Vincent's Hospital, Sydney, Australia
| | - Leslie R Harrold
- University of Massachusetts Medical School, Worcester, and Corrona, LLC, Southborough
| | - Philip Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | | | - Gail Kerr
- Veterans Affairs Medical Center, Georgetown and Howard University Hospitals, Washington, DC
| | | | | | - Puja P Khanna
- University of Michigan and Ann Arbor VA Medical Center, Ann Arbor
| | - Chingtsai Lin
- Taichung Veteran's General Hospital, Taichung, Taiwan
| | | | - Geraldine McCarthy
- Mater Misericordiae University Hospital and University College, Dublin, Ireland
| | | | - Ted R Mikuls
- Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Fernando Perez-Ruiz
- Hospital Universitario Cruces, OSI-EEC, and Biocruces Health Research Institute, Biscay, Spain
| | - Naomi Schlesinger
- Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Carlo A Scirè
- IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Jasvinder A Singh
- University of Alabama at Birmingham and the Birmingham VA Medical Center, Birmingham
| | | | - Ole Slot
- Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | | | | | | | - Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Douglas White
- Waikato DHB and Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | | | - Xuejun Zeng
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Nicola Dalbeth
- University of Auckland and Auckland District Health Board, Auckland, New Zealand
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23
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Williamson PR, Altman DG, Bagley H, Barnes KL, Blazeby JM, Brookes ST, Clarke M, Gargon E, Gorst S, Harman N, Kirkham JJ, McNair A, Prinsen CAC, Schmitt J, Terwee CB, Young B. The COMET Handbook: version 1.0. Trials 2017; 18:280. [PMID: 28681707 PMCID: PMC5499094 DOI: 10.1186/s13063-017-1978-4] [Citation(s) in RCA: 1066] [Impact Index Per Article: 152.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The selection of appropriate outcomes is crucial when designing clinical trials in order to compare the effects of different interventions directly. For the findings to influence policy and practice, the outcomes need to be relevant and important to key stakeholders including patients and the public, health care professionals and others making decisions about health care. It is now widely acknowledged that insufficient attention has been paid to the choice of outcomes measured in clinical trials. Researchers are increasingly addressing this issue through the development and use of a core outcome set, an agreed standardised collection of outcomes which should be measured and reported, as a minimum, in all trials for a specific clinical area.Accumulating work in this area has identified the need for guidance on the development, implementation, evaluation and updating of core outcome sets. This Handbook, developed by the COMET Initiative, brings together current thinking and methodological research regarding those issues. We recommend a four-step process to develop a core outcome set. The aim is to update the contents of the Handbook as further research is identified.
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Affiliation(s)
- Paula R. Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Douglas G. Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Heather Bagley
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Karen L. Barnes
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Jane M. Blazeby
- MRC ConDuCT II Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sara T. Brookes
- MRC ConDuCT II Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mike Clarke
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- National University of Ireland Galway and HRB Trials Methodology Research Network, Galway, Ireland
| | - Elizabeth Gargon
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Sarah Gorst
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Nicola Harman
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Jamie J. Kirkham
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Angus McNair
- MRC ConDuCT II Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Cecilia A. C. Prinsen
- Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, Medizinische Fakultät, Technische Univesität Dresden, Dresden, Germany
| | - Caroline B. Terwee
- Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Bridget Young
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
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Chan CWL, Miller WC, Querée M, Noonan VK, Wolfe DL. The development of an outcome measures toolkit for spinal cord injury rehabilitation. The Canadian Journal of Occupational Therapy 2017; 84:119-129. [PMID: 28378605 DOI: 10.1177/0008417417690170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Spinal cord injury (SCI) is a complex medical condition that can be difficult to monitor. PURPOSE This study aimed to establish a common set of validated outcome measures specifically for SCI clinical practice. METHOD In a three-round online Delphi process, experts in SCI care across Canada suggested and ranked outcome measures for clinical practice. The facilitators provided feedback between rounds and determined if consensus (at least 75% agreement) was reached on a single outcome measure per clinical area. FINDINGS One hundred and forty-eight outcome measures were initially considered for inclusion. After three rounds, consensus was reached for 23 out of 30 clinical areas. In the remaining seven, more than one outcome measure was recommended. The final toolkit comprises 33 outcome measures with sufficient measurement properties for use with a SCI population. IMPLICATIONS An outcome measures toolkit validated specifically for SCI should lead to improved identification of best practice and enable clinicians to monitor client progress effectively.
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25
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Sil P, Hayes CP, Reaves BJ, Breen P, Quinn S, Sokolove J, Rada B. P2Y6 Receptor Antagonist MRS2578 Inhibits Neutrophil Activation and Aggregated Neutrophil Extracellular Trap Formation Induced by Gout-Associated Monosodium Urate Crystals. THE JOURNAL OF IMMUNOLOGY 2016; 198:428-442. [PMID: 27903742 DOI: 10.4049/jimmunol.1600766] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/23/2016] [Indexed: 12/27/2022]
Abstract
Human neutrophils (polymorphonuclear leukocytes [PMNs]) generate inflammatory responses within the joints of gout patients upon encountering monosodium urate (MSU) crystals. Neutrophil extracellular traps (NETs) are found abundantly in the synovial fluid of gout patients. The detailed mechanism of MSU crystal-induced NET formation remains unknown. Our goal was to shed light on possible roles of purinergic signaling and neutrophil migration in mediating NET formation induced by MSU crystals. Interaction of human neutrophils with MSU crystals was evaluated by high-throughput live imaging using confocal microscopy. We quantitated NET levels in gout synovial fluid supernatants and detected enzymatically active neutrophil primary granule enzymes, myeloperoxidase, and human neutrophil elastase. Suramin and PPADS, general P2Y receptor blockers, and MRS2578, an inhibitor of the purinergic P2Y6 receptor, blocked NET formation triggered by MSU crystals. AR-C25118925XX (P2Y2 antagonist) did not inhibit MSU crystal-stimulated NET release. Live imaging of PMNs showed that MRS2578 represses neutrophil migration and blocked characteristic formation of MSU crystal-NET aggregates called aggregated NETs. Interestingly, the store-operated calcium entry channel inhibitor (SK&F96365) also reduced MSU crystal-induced NET release. Our results indicate that the P2Y6/store-operated calcium entry/IL-8 axis is involved in MSU crystal-induced aggregated NET formation, but MRS2578 could have additional effects affecting PMN migration. The work presented in the present study could lead to a better understanding of gouty joint inflammation and help improve the treatment and care of gout patients.
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Affiliation(s)
- Payel Sil
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602
| | - Craig P Hayes
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602
| | - Barbara J Reaves
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602
| | - Patrick Breen
- Institute of Bioinformatics, University of Georgia, Athens, GA 30602
| | - Shannon Quinn
- Department of Computer Science, Franklin College of Arts and Sciences, University of Georgia, Athens, 30602 GA
| | - Jeremy Sokolove
- Stanford University School of Medicine, Stanford, CA 94305; and.,Internal Medicine and Rheumatology, VA Palo Alto Health Care System, Palo Alto, CA 94034
| | - Balázs Rada
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602;
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26
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Singh JA, Bharat A, Khanna D, Aquino-Beaton C, Persselin JE, Duffy E, Elashoff D, Khanna PP. Racial differences in health-related quality of life and functional ability in patients with gout. Rheumatology (Oxford) 2016; 56:103-112. [PMID: 28028159 DOI: 10.1093/rheumatology/kew356] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 08/24/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the health-related quality of life (HRQOL) and the functional ability by race in patients with gout. METHODS In a 9-month prospective cohort multicentre study, patients with gout self-reported race, dichotomized as Caucasian or African American (others excluded). We calculated HRQOL/function scores adjusted for age, study site and college education for Short Form-36 (SF-36; generic HRQOL), Gout Impact Scale (GIS; disease-specific HRQOL) and HAQ-disability index (HAQ-DI; functional ability). Longitudinally adjusted scores were computed using multivariable mixed-effect regression models with a random patient effect and fixed sequential visit effect (3-monthly visits). RESULTS Compared with Caucasians (n = 107), African Americans (n = 60) with gout were younger (61.1 vs 67.3 years) and had higher median baseline serum urate (9.0 vs 7.9 mg/dl) (P < 0.01). African Americans with gout had worse HRQOL scores on three SF-36 domains, the mental component summary (MCS) and two of the five GIS scales than Caucasians [mean (se); P ⩽ 0.02 for all]: SF-36 mental health, 39.7 (1.1) vs 45.2 (0.9); SF-36 role emotional, 42.1 (4.2) vs 51.4 (4.2); SF-36 social functioning, 36.0 (1.1) vs 40.0 (0.9) (P = 0.04); SF-36 MCS, 43.2 (3.1) vs 50.0 (3.2); GIS unmet treatment need, 37.6 (1.6) vs 31.5 (1.4); and GIS concern during attacks, 53.3 (3.7) vs 47.4 (3.7). Differences between the respective HAQ-DI total scores were not statistically significant; 0.98 (0.1) vs 0.80 (1.0) (P = 0.11). Racial differences in SF-36 mental health, role emotional and MCS scales exceeded, and for HAQ-DI approached, the minimal clinically important difference thresholds. CONCLUSIONS African Americans with gout have significantly worse HRQOL compared with Caucasians. Further research is necessary in the form of studies targeted at African Americans on how best to improve these outcomes.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center .,Department of Medicine, School of Medicine.,Division of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.,Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN
| | - Aseem Bharat
- Department of Medicine, School of Medicine.,Division of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | - Jay E Persselin
- Department of Biostatistics, VA Greater Los Angeles Healthcare System
| | - Erin Duffy
- Department of Medicine, University of California, Los Angeles, CA
| | - David Elashoff
- Department of Medicine, University of California, Los Angeles, CA
| | - Puja P Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI.,Department of Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Scirè CA, Carrara G, Viroli C, Cimmino MA, Taylor WJ, Manara M, Govoni M, Salaffi F, Punzi L, Montecucco C, Matucci-Cerinic M, Minisola G. Development and First Validation of a Disease Activity Score for Gout. Arthritis Care Res (Hoboken) 2016; 68:1530-7. [PMID: 26815286 PMCID: PMC5129490 DOI: 10.1002/acr.22844] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/06/2015] [Accepted: 01/12/2016] [Indexed: 01/24/2023]
Abstract
Objective To develop a new composite disease activity score for gout and provide its first validation. Methods Disease activity has been defined as the ongoing presence of urate deposits that lead to acute arthritis and joint damage. Every measure for each Outcome Measures in Rheumatology core domain was considered. A 3‐step approach (factor analysis, linear discriminant analysis, and linear regression) was applied to derive the Gout Activity Score (GAS). Decision to change treatment or 6‐month flare count were used as the surrogate criteria of high disease activity. Baseline and 12‐month followup data of 446 patients included in the Kick‐Off of the Italian Network for Gout cohort were used. Construct‐ and criterion‐related validity were tested. External validation on an independent sample is reported. Results Factor analysis identified 5 factors: patient‐reported outcomes, joint examination, flares, tophi, and serum uric acid (sUA). Discriminant function analysis resulted in a correct classification of 79%. Linear regression analysis identified a first candidate GAS including 12‐month flare count, sUA, visual analog scale (VAS) of pain, VAS global activity assessment, swollen and tender joint counts, and a cumulative measure of tophi. Alternative scores were also developed. The developed GAS demonstrated a good correlation with functional disability (criterion validity) and discrimination between patient‐ and physician‐reported measures of active disease (construct validity). The results were reproduced in the external sample. Conclusion This study developed and validated a composite measure of disease activity in gout. Further testing is required to confirm its generalizability, responsiveness, and usefulness in assisting with clinical decisions.
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Tan CSL, Teng GG, Chong KJ, Cheung PP, Lim AYN, Wee HL, Santosa A. Utility of the Morisky Medication Adherence Scale in gout: a prospective study. Patient Prefer Adherence 2016; 10:2449-2457. [PMID: 27980395 PMCID: PMC5144895 DOI: 10.2147/ppa.s119719] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The outcomes of any chronic illness often depend on patients' adherence with their treatment. A tool is lacking to assess adherence in gout that is standardized, allows real-time feedback, and is easy to understand. OBJECTIVE We set out to evaluate the utility of the 8-item Morisky Medication Adherence Scale (MMAS-8) in monitoring medication adherence in a multiethnic Asian gout cohort on urate-lowering therapy (ULT). METHODS This cohort study recruited patients with gout where baseline and 6-monthly clinical data, self-report of adherence, and health status by Gout Impact Scale (GIS) and EuroQoL-5 dimension 3 levels were collected. Those who received at least 9 months of ULT were analyzed. Convergent and construct validities of MMAS-8 were evaluated against medication possession ratio (MPR) and known groups, clinical outcomes, and patient-reported outcomes. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. RESULTS Of 91 patients, 92.3% were male, 72.5% Chinese with mean age 53.5 years. MMAS-8 (mean 6.17) and MPR (mean 96.3%) were poorly correlated (r=0.069, P=0.521). MMAS-8 did not differ between those who did or did not achieve target serum urate (SU) <360 µmol/L (P=0.852); or among those whose SU improved, stagnated, or worsened during follow-up (P=0.777). Adherence was associated with age (β=0.256, P=0.015) and education level (P=0.011) but not comorbidities, polypharmacy, or flare frequency. Concerns for medication side effects and anxiety or depression were associated with lower MMAS-8 (P<0.005). Internal consistency was acceptable (α=0.725) and test-retest reliability was satisfactory (ICC =0.70, 95% confidence interval [CI] 0.36-0.88). CONCLUSION MMAS-8 had limited construct validity in assessing medication adherence to ULT in our gout patients. Nevertheless, it identified patients bothered or worried about ULT side effects, and those with underlying anxiety or depression, for whom targeted education and coping support may be useful.
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Affiliation(s)
- CSL Tan
- University Medicine Cluster, Division of Rheumatology, National University Health System
| | - GG Teng
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - KJ Chong
- Department of Medicine, Yong Loo Lin School of Medicine
| | - PP Cheung
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - AYN Lim
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - HL Wee
- Department of Pharmacy, Faculty of Science
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - A Santosa
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
- Correspondence: A Santosa, University Medicine Cluster, Division of Rheumatology, National University Health System, Level 10 Tower Block, 1E Lower Kent Ridge Road, Singapore 119228, Singapore, Fax +65 6872 4130, Email
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Terslev L, Gutierrez M, Christensen R, Balint PV, Bruyn GA, Delle Sedie A, Filippucci E, Garrido J, Hammer HB, Iagnocco A, Kane D, Kaeley GS, Keen H, Mandl P, Naredo E, Pineda C, Schicke B, Thiele R, D'Agostino MA, Schmidt WA. Assessing Elementary Lesions in Gout by Ultrasound: Results of an OMERACT Patient-based Agreement and Reliability Exercise. J Rheumatol 2015; 42:2149-54. [PMID: 26472419 DOI: 10.3899/jrheum.150366] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To test the reliability of the consensus-based ultrasound (US) definitions of elementary gout lesions in patients. METHODS Eight patients with microscopically proven gout were evaluated by 16 sonographers for signs of double contour (DC), aggregates, erosions, and tophi in the first metatarsophalangeal joint and the knee bilaterally. The patients were examined twice using B-mode US to test agreement and inter- and intraobserver reliability of the elementary components. RESULTS The prevalence of the lesions were DC 52.8%, tophus 61.1%, aggregates 29.8%, and erosions 32.4%. The intraobserver reliability was good for all lesions except DC, where it was moderate. The best reliability per lesion was seen for tophus (κ 0.73, 95% CI 0.61-0.85) and lowest for DC (κ 0.53, 95% CI 0.38-0.67). The interobserver reliability was good for tophus and erosions, but fair to moderate for aggregates and DC, respectively. The best reliability was seen for erosions (κ 0.74, 95% CI 0.65-0.81) and lowest for aggregates (κ 0.21, 95% CI 0.04-0.37). CONCLUSION This is the first step to test consensus-based US definitions on elementary lesions in patients with gout. High intraobserver reliability was found when applying the definition in patients on all elementary lesions while interobserver reliability was moderate to low. Further studies are needed to improve the interobserver reliability, particularly for DC and aggregates.
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Outcome Measures for Gout Clinical Trials: a Summary of Progress. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2015. [DOI: 10.1007/s40674-015-0014-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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MacLennan S, Bekema HJ, Williamson PR, Campbell MK, Stewart F, MacLennan SJ, N'Dow JMO, Lam TBL. A core outcome set for localised prostate cancer effectiveness trials: protocol for a systematic review of the literature and stakeholder involvement through interviews and a Delphi survey. Trials 2015; 16:76. [PMID: 25887437 PMCID: PMC4355995 DOI: 10.1186/s13063-015-0598-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/10/2015] [Indexed: 12/29/2022] Open
Abstract
Background Prostate cancer is a growing health problem worldwide. The management of localised prostate cancer is controversial. It is unclear which of several surgical, radiotherapeutic, ablative, and surveillance treatments is the most effective. All have cost, process and recovery, and morbidity implications which add to treatment decision-making complexity for patients and healthcare professionals. Evidence from randomised controlled trials (RCTs) is not optimal because of uncertainty as to what constitutes important outcomes. Another issue hampering evidence synthesis is heterogeneity of outcome definition, measurement, and reporting. This project aims to determine which outcomes are the most important to patients and healthcare professionals, and use these findings to recommend a standardised core outcome set for comparative effectiveness trials of treatments for localised prostate cancer, to optimise decision-making. Methods/Design The range of potentially important outcomes and measures will be identified through systematic reviews of the literature and semi-structured interviews with patients. A consultation exercise involving representatives from two key stakeholder groups (patients and healthcare professionals) will ratify the list of outcomes to be entered into a three round Delphi study. The Delphi process will refine and prioritise the list of identified outcomes. A methodological substudy (nested RCT design) will also be undertaken. Participants will be randomised after round one of the Delphi study to one of three feedback groups, based on different feedback strategies, in order to explore the potential impact of feedback strategies on participant responses. This may assist the design of a future core outcome set and Delphi studies. Following the Delphi study, a final consensus meeting attended by representatives from both stakeholder groups will determine the final recommended core outcome set. Discussion This study will inform clinical practice and future trials of interventions of localised prostate cancer by standardising a core outcome set which should be considered in comparative effectiveness studies for localised prostate cancer. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0598-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven MacLennan
- Academic Urology Unit, University of Aberdeen, Cornhill Road, Aberdeen, UK, AB25 2ZD.
| | - Hendrika J Bekema
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzleplein, Groningen, The Netherlands, 9700 RB.
| | - Paula R Williamson
- Department of Biostatistics, University of Liverpool, Crown Street, Liverpool, UK, L69 3BX.
| | - Marion K Campbell
- Health Services Research Unit, University of Aberdeen, Cornhill Road, Aberdeen, UK, AB25 2ZD.
| | - Fiona Stewart
- Academic Urology Unit, University of Aberdeen, Cornhill Road, Aberdeen, UK, AB25 2ZD.
| | - Sara J MacLennan
- Academic Urology Unit, University of Aberdeen, Cornhill Road, Aberdeen, UK, AB25 2ZD.
| | - James M O N'Dow
- Academic Urology Unit, University of Aberdeen, Cornhill Road, Aberdeen, UK, AB25 2ZD. .,Department of Urology, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, UK, AB25 2ZD.
| | - Thomas B L Lam
- Academic Urology Unit, University of Aberdeen, Cornhill Road, Aberdeen, UK, AB25 2ZD. .,Department of Urology, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, UK, AB25 2ZD.
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Araújo F, Cordeiro I, Ramiro S, Falzon L, Branco JC, Buchbinder R. Outcomes assessed in trials of gout and accordance with OMERACT-proposed domains: a systematic literature review. Rheumatology (Oxford) 2014; 54:981-93. [DOI: 10.1093/rheumatology/keu424] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Indexed: 11/12/2022] Open
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Concerns of Patients With Gout Are Incompletely Captured by OMERACT-Endorsed Domains of Measurement for Chronic Gout Studies. J Clin Rheumatol 2014; 20:138-40. [DOI: 10.1097/rhu.0000000000000090] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dalbeth N, Zhong CS, Grainger R, Khanna D, Khanna PP, Singh JA, McQueen FM, Taylor WJ. Outcome measures in acute gout: a systematic literature review. J Rheumatol 2014; 41:558-68. [PMID: 24334652 PMCID: PMC4217650 DOI: 10.3899/jrheum.131244] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Five core domains have been endorsed by Outcome Measures in Rheumatology (OMERACT) for acute gout: pain, joint swelling, joint tenderness, patient global assessment, and activity limitation. We evaluated instruments for these domains according to the OMERACT filter: truth, feasibility, and discrimination. METHODS A systematic search strategy for instruments used to measure the acute gout core domains was formulated. For each method, articles were assessed by 2 reviewers to summarize information according to the specific components of the OMERACT filter. RESULTS Seventy-seven articles and abstracts met the inclusion criteria. Pain was most frequently reported (76 studies, 20 instruments). The pain instruments used most often were 100 mm visual analog scale (VAS) and 5-point Likert scale. Both methods have high feasibility, face and content validity, and within- and between-group discrimination. Four-point Likert scales assessing index joint swelling and tenderness have been used in numerous acute gout studies; these instruments are feasible, with high face and content validity, and show within- and between-group discrimination. Five-point Patient Global Assessment of Response to Treatment (PGART) scales are feasible and valid, and show within- and between-group discrimination. Measures of activity limitations were infrequently reported, and insufficient data were available to make definite assessments of the instruments for this domain. CONCLUSION Many different instruments have been used to assess the acute gout core domains. Pain VAS and 5-point Likert scales, 4-point Likert scales of index joint swelling and tenderness and 5-point PGART instruments meet the criteria for the OMERACT filter.
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Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Cathy S Zhong
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Puja P Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Jasvinder A Singh
- Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, AL. USA
| | - Fiona M McQueen
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand
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de Wit M, Abma T, Koelewijn-van Loon M, Collins S, Kirwan J. Involving patient research partners has a significant impact on outcomes research: a responsive evaluation of the international OMERACT conferences. BMJ Open 2013; 3:e002241. [PMID: 23667160 PMCID: PMC3651970 DOI: 10.1136/bmjopen-2012-002241] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 04/02/2013] [Accepted: 04/03/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the inclusion of patients as international research partners in Outcome Measures in Rheumatology (OMERACT) conferences and how this has influenced the scope and conduct of outcomes research in rheumatology. DESIGN A thematic content analysis of OMERACT internal documents, publications and conference proceedings, followed by a responsive evaluation including 32 qualitative semistructured interviews. SETTING The international, biannual research conference OMERACT 10 (Malaysia, 2010). PARTICIPANTS Senior researchers (n=10), junior researchers (n=2), representatives of the pharmaceutical industry and regulators (n=2), conference staff (n=2), new patient delegates (n=8) and experienced patient delegates (n=8). RESULTS The role of patients evolved over 10 years from a single patient focus group to full participation in all areas of the meeting and inclusion in research group meetings between conferences. Five main categories of impact emerged: widening the research agenda; including patient relevant outcomes in core sets; enhancing patient reported instruments; changing the culture of OMERACT and consequences outside OMERACT. Patient participants identified previously neglected outcome domains such as fatigue, sleep disturbances and flares which prompted collaborative working on new programmes of research. Specific benefits and challenges for patients and professionals were identified, such as personal fulfilment, widening of research interests, difficulties in establishing equal partnerships and concerns about loss of research rigour. CONCLUSIONS Including patients as partners in OMERACT conferences has widened its focus and adjusted the way of working. It has resulted in new developments in the research agenda and the use of more patient-relevant outcomes in clinical trials. These collaborations have influenced perceptions and beliefs among many patients and researchers, and led to wider patient involvement as partners in research.
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Affiliation(s)
- Maarten de Wit
- Metamedica, VU Medical Centre, Amsterdam, The Netherlands
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Taylor WJ. Gout measures: Gout Assessment Questionnaire (GAQ, GAQ2.0), and physical measurement of tophi. Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S59-63. [PMID: 22588771 DOI: 10.1002/acr.20622] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- William J Taylor
- University of Otago, Wellington, and Hutt Valley District Health Board, Lower Hutt, New Zealand.
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Gaffo AL, Schumacher HR, Saag KG, Taylor WJ, Dinnella J, Outman R, Chen L, Dalbeth N, Sivera F, Vázquez-Mellado J, Chou CT, Zeng X, Perez-Ruiz F, Kowalski SC, Goldenstein-Schainberg C, Chen L, Bardin T, Singh JA. Developing a provisional definition of flare in patients with established gout. ACTA ACUST UNITED AC 2012; 64:1508-17. [PMID: 22083456 DOI: 10.1002/art.33483] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Various nonvalidated criteria for disease flare have been used in studies of gout. Our objective was to develop empirical definitions for a gout flare from patient-reported features. METHODS Possible elements for flare criteria were previously reported. Data were collected from 210 gout patients at 8 international sites to evaluate potential gout flare criteria against the gold standard of an expert rheumatologist definition. Flare definitions based on the presence of the number of criteria independently associated with the flare and classification and regression tree approaches were developed. RESULTS The mean ± SD age of the study participants was 56.2 ± 15 years, 207 of them (98%) were men, and 54 of them (26%) had flares of gout. The presence of any patient-reported warm joint, any patient-reported swollen joint, patient-reported pain at rest score of >3 (0-10 scale), and patient-reported flare were independently associated with the study gold standard. The greatest discriminating power was noted for the presence of 3 or more of the above 4 criteria (sensitivity 91% and specificity 82%). Requiring all 4 criteria provided the highest specificity (96%) and positive predictive value (85%). A classification tree identified pain at rest with a score of >3, followed by patient self-reported flare, as the rule associated with the gold standard (sensitivity 83% and specificity 90%). CONCLUSION We propose definitions for a disease flare based on self-reported items in patients previously diagnosed as having gout. Patient-reported flare, joint pain at rest, warm joints, and swollen joints were most strongly associated with presence of a gout flare. These provisional definitions will next be validated in clinical trials.
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Affiliation(s)
- Angelo L Gaffo
- Birmingham VA Medical Center and University of Alabama at Birmingham, AL, USA
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Yamanaka H. Japanese guideline for the management of hyperuricemia and gout: second edition. NUCLEOSIDES NUCLEOTIDES & NUCLEIC ACIDS 2012; 30:1018-29. [PMID: 22132951 DOI: 10.1080/15257770.2011.596496] [Citation(s) in RCA: 225] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Gout is a urate deposition disease caused by persistent hyperuricemia. Because gout patients present with a variety of clinical symptoms, it is necessary to have a guideline for the standard management and care of gout and hyperuricemia. The Japanese Society of Gout and Nucleic Acid Metabolism, a scientific society committed to study nucleic acid metabolism and related diseases, established the first edition of the "Guideline for the Management of Hyperuricemia and Gout" in 2002, and published the revised version in January 2010. This second edition is not only evidence based on a search of systemic literature, but also includes consensus levels by a Delphi exercise to determine the strength of the recommendations. A draft version of this guideline was reviewed by internal and external reviewers as well as a patient. In this guideline, key messages from each chapter are listed as statements together with the evidence level, consensus level, and strength of the recommendation. In this proceeding, several selected chapters on the clinical management of gout and hyperuricemia are described. We hope this guideline is appropriately used for the standard management and care of patients with hyperuricemia and gout in daily practice.
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Affiliation(s)
- Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Shinjuku-Ku, Tokyo, Japan.
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Stamp LK, Khanna PP, Dalbeth N, Boers M, Maksymowych WP, Schumacher HR, Becker MA, MacDonald PA, Edwards NL, Singh JA, Simon LS, McQueen FM, Neogi T, Gaffo AL, Strand V, Taylor WJ. Serum urate in chronic gout--will it be the first validated soluble biomarker in rheumatology? J Rheumatol 2012; 38:1462-6. [PMID: 21724717 DOI: 10.3899/jrheum.110273] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To summarize evidence for and endorsement of serum urate (SU) as having fulfilled the OMERACT filter as a soluble biomarker in chronic gout at the 2010 Outcome Measures in Rheumatology Meeting (OMERACT 10). METHODS Data were presented to support the use of SU as a soluble biomarker in chronic gout and specifically the ability to utilize it to predict future patient-reported outcomes. RESULTS SU was accepted as having fulfilled the OMERACT filter by 78% of voters. However, consensus was not obtained regarding its use as a soluble biomarker in chronic gout. Although the majority of the criteria for a soluble biomarker were fulfilled, the key criterion of association of the biomarker with outcomes was not agreed upon. It was agreed that the appropriate choice of endpoint must be linked to its clinical importance to the individual with the disorder and its temporal relationship to the intervention. Appropriate outcomes in chronic gout may therefore include gout flares, reduction in tophi, and patient-reported outcomes. CONCLUSION SU is a critical outcome measure. It has the potential to fulfil criteria for a soluble biomarker. Further analyses of existing data from randomized controlled trials will be required to determine whether SU can predict future important outcomes, in particular disability.
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Affiliation(s)
- Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand.
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Dalbeth N, McQueen FM, Singh JA, MacDonald PA, Edwards NL, Schumacher HR, Simon LS, Stamp LK, Neogi T, Gaffo AL, Khanna PP, Becker MA, Taylor WJ. Tophus measurement as an outcome measure for clinical trials of chronic gout: progress and research priorities. J Rheumatol 2012; 38:1458-61. [PMID: 21724716 DOI: 10.3899/jrheum.110272] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite the recognition that tophus regression is an important outcome measure in clinical trials of chronic gout, there is no agreed upon method of tophus measurement. A number of methods have been used in clinical trials of chronic gout, from simple physical measurement techniques to more complex advanced imaging methods. This article summarizes methods of tophus measurement and discusses their properties. Physical measurement using Vernier calipers meets most aspects of the Outcome Measures in Rheumatology (OMERACT) filter. Rigorous testing of the complex methods, particularly with respect to reliability and sensitivity to change, is needed to determine the appropriate use of these methods. Further information is also required regarding which method of physical measurement is best for use in future clinical trials. The need to develop and test a patient-reported outcome measure of tophus burden is also highlighted.
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Affiliation(s)
- Nicola Dalbeth
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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Vázquez-Mellado J, Hernández-Cuevas CB, Alvarez-Hernández E, Ventura-Rios L, Peláez-Ballestas I, Casasola-Vargas J, García-Méndez S, Burgos-Vargas R. The diagnostic value of the proposal for clinical gout diagnosis (CGD). Clin Rheumatol 2011; 31:429-34. [DOI: 10.1007/s10067-011-1873-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 09/16/2011] [Accepted: 09/27/2011] [Indexed: 10/17/2022]
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Singh JA, Yang S, Strand V, Simon L, Forsythe A, Hamburger S, Chen L. Validation of pain and patient global scales in chronic gout: data from two randomised controlled trials. Ann Rheum Dis 2011; 70:1277-81. [PMID: 21622774 DOI: 10.1136/ard.2010.144022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess validity of pain and patient global scales in gout. METHODS The authors used data from pegloticase clinical trials in chronic refractory gout to examine the validity of visual analogue scale (VAS) pain, Short-Form 36 (SF-36) bodily pain subscale and VAS patient global assessment (all scales 0-100). Convergent/divergent validity with clinical characteristics was tested by using Spearman's correlation coefficient. For discriminant ability, the authors compared the change at 6 months between placebo and pegloticase arms and calculated effect size (ES) and standardised response mean (SRM). RESULTS 212 patients (mean age, 55.4 years, 82% men; 73% with tophaceous gout) provided data. VAS pain was statistically significantly correlated with tender joints (r=0.42), swollen joints (r=0.30), SF-36 physical (r=-0.56) and Mental Component Summary (r=-0.36) and Health Assessment Questionnaire scores (r=0.54; all p-values <0.0001), but not disease duration (r=-0.01; p=0.84), gout flares (r=0.12; p=0.08), comorbidities (r=0.05; p=0.47) or plasma urate (r=0.01; p=0.89). Similar and significant correlation coefficients with tender and swollen joints were noted for VAS patient global assessment (r=0.35 and 0.23; p<0.0012 for both) and SF-36 pain subscale (r=-0.27 and -0.19; p<0.006 for both). Pegloticase group had significantly more improvement than placebo at 6 months, mean (SD): VAS pain, -9.2 (29.3) versus 1.9 (26.4), p=0.0002; SF-36 pain, 14.6 (25.6) versus -0.04 (21.1), p<0.0001; and patient global, -9.3 (26.5) versus 3.4 (22.8), p<0.0001. ES and SRMs in pegloticase group were as follows: VAS pain, 0.34 and 0.30; SF-36 pain, 0.69 and 0.57; patient global, 0.49 and 0.44. CONCLUSION VAS pain, SF-36 pain and patient global VAS are valid outcome measures in patients with chronic gout.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service and Center for Surgical Medical Acute Care Research and Transitions, Birmingham VA Medical Center, Alabama, USA.
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Serum Urate as a Soluble Biomarker in Chronic Gout—Evidence that Serum Urate Fulfills the OMERACT Validation Criteria for Soluble Biomarkers. Semin Arthritis Rheum 2011; 40:483-500. [DOI: 10.1016/j.semarthrit.2010.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/23/2010] [Accepted: 09/24/2010] [Indexed: 02/07/2023]
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Froud R, Eldridge S, Kovacs F, Breen A, Bolton J, Dunn K, Fritz J, Keller A, Kent P, Lauridsen HH, Ostelo R, Pincus T, van Tulder M, Vogel S, Underwood M. Reporting outcomes of back pain trials: a modified Delphi study. Eur J Pain 2011; 15:1068-74. [PMID: 21596600 DOI: 10.1016/j.ejpain.2011.04.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 04/08/2011] [Accepted: 04/21/2011] [Indexed: 01/05/2023]
Abstract
BACKGROUND Low back pain is a common and expensive health complaint. Many low back pain trials have been conducted, but these are reported in a variety of ways and are often difficult to interpret. AIM To facilitate consensus on a statement recommending reporting methods for future low back pain trials. METHODS We presented experts with clinicians' views on different reporting methods and asked them to rate and comment on the suitability reporting methods for inclusion in a standardized set. Panellists developed a statement of recommendation over three online rounds. We used a modified Delphi process and the RAND/UCLA appropriateness method as a formal framework for establishing appropriateness and quantifying panel disagreement. RESULTS A group of 63 experts from 14 countries participated. Consensus was reached on a statement recommending that the continuous patient-reported outcomes commonly used in back pain trials, are reported using between-group mean differences (accompanied by minimally important difference (between-group/population-level) thresholds where these exist), the proportion of participants improving and deteriorating according to established and relevant minimally important change thresholds, and the number needed to treat; all with 95% confidence intervals. Outcomes may additionally be reported using alternative approaches (e.g. relative risks, odds ratios, or standardized mean difference) according to the needs of a particular trial. CONCLUSIONS A group of back pain experts reached a high level of consensus on a statement recommending reporting methods for patient-reported outcomes in future low back pain trials. The statement has the potential to increase interpretability and improve patient care.
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Affiliation(s)
- Robert Froud
- Centre for Health Sciences, Queen Mary University of London, Yvonne Carter Building, Turner Street, Whitechapel, London E12AT, UK.
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Pincus T, Miles C, Froud R, Underwood M, Carnes D, Taylor SJC. Methodological criteria for the assessment of moderators in systematic reviews of randomised controlled trials: a consensus study. BMC Med Res Methodol 2011; 11:14. [PMID: 21281501 PMCID: PMC3044921 DOI: 10.1186/1471-2288-11-14] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 01/31/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current methodological guidelines provide advice about the assessment of sub-group analysis within RCTs, but do not specify explicit criteria for assessment. Our objective was to provide researchers with a set of criteria that will facilitate the grading of evidence for moderators, in systematic reviews. METHOD We developed a set of criteria from methodological manuscripts (n = 18) using snowballing technique, and electronic database searches. Criteria were reviewed by an international Delphi panel (n = 21), comprising authors who have published methodological papers in this area, and researchers who have been active in the study of sub-group analysis in RCTs. We used the Research ANd Development/University of California Los Angeles appropriateness method to assess consensus on the quantitative data. Free responses were coded for consensus and disagreement. In a subsequent round additional criteria were extracted from the Cochrane Reviewers' Handbook, and the process was repeated. RESULTS The recommendations are that meta-analysts report both confirmatory and exploratory findings for sub-groups analysis. Confirmatory findings must only come from studies in which a specific theory/evidence based a-priori statement is made. Exploratory findings may be used to inform future/subsequent trials. However, for inclusion in the meta-analysis of moderators, the following additional criteria should be applied to each study: Baseline factors should be measured prior to randomisation, measurement of baseline factors should be of adequate reliability and validity, and a specific test of the interaction between baseline factors and interventions must be presented. CONCLUSIONS There is consensus from a group of 21 international experts that methodological criteria to assess moderators within systematic reviews of RCTs is both timely and necessary. The consensus from the experts resulted in five criteria divided into two groups when synthesising evidence: confirmatory findings to support hypotheses about moderators and exploratory findings to inform future research. These recommendations are discussed in reference to previous recommendations for evaluating and reporting moderator studies.
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Affiliation(s)
- Tamar Pincus
- Department of Psychology, Royal Holloway, University of London, London, UK
| | - Clare Miles
- Department of Psychology, Royal Holloway, University of London, London, UK
| | - Robert Froud
- Centre for Health Sciences, Institute of Health Science Education, Queen Mary University of London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Dawn Carnes
- Centre for Health Sciences, Institute of Health Science Education, Queen Mary University of London, UK
| | - Stephanie JC Taylor
- Centre for Health Sciences, Institute of Health Science Education, Queen Mary University of London, UK
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ten Klooster PM, Oude Voshaar MAH, Taal E, van de Laar MAFJ. Comparison of measures of functional disability in patients with gout. Rheumatology (Oxford) 2010; 50:709-13. [DOI: 10.1093/rheumatology/keq387] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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PELÁEZ-BALLESTAS INGRIS, HERNÁNDEZ CUEVAS CLAUDIA, BURGOS-VARGAS RUBÉN, HERNÁNDEZ ROQUE LIZANDRA, TERÁN LEOBARDO, ESPINOZA JESÚS, ESQUIVEL-VALERIO JORGEA, GOYCOCHEA-ROBLES MARÍAVICTORIA, ACEVES FRANCISCOJ, BERNARD ANAGUILAISNE, VENTURA LUCIO, SHUMSKY CLARA, HERNÁNDEZ GARDUÑO ADOLFO, VÁZQUEZ-MELLADO JANITZIA. Diagnosis of Chronic Gout: Evaluating the American College of Rheumatology Proposal, European League Against Rheumatism Recommendations, and Clinical Judgment. J Rheumatol 2010; 37:1743-8. [DOI: 10.3899/jrheum.091385] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Observation of monosodium urate (MSU) crystal is the gold standard for diagnosis of gout, but is rarely performed in daily clinical practice, and diagnosis is based on clinical judgment. Our aim was to identify clinical and paraclinical data included in the European League Against Rheumatism recommendations (EULARr) and American College of Rheumatology proposed criteria (ACRp) for diagnosis of gout in patients with chronic gout according to their attending rheumatologists.Methods.This cross-sectional and multicenter study included consecutive patients from outpatient clinics with a diagnosis of gout by their attending rheumatologists according to their expertise. The frequency of each item from the ACRp and EULARr was determined. Possible combinations of the items that were frequent, clinically relevant, and simple to evaluate in daily practice were determined.Results.We studied 549 patients (96% men), mean age 50 ± 14 years. Analysis of MSU crystals was performed in 15%. We selected 7 clinical criteria and 1 laboratory measure because of their frequency, importance, and simplicity to obtain: current or past history of: > 1 attack of acute arthritis (93%); mono or oligoarthritis attacks (74%); rapid progression of pain and swelling (< 24 hours; 74%); podagra (70%); erythema (56%); unilateral tarsitis (33%); tophi (52%); and hyperuricemia (93%). The chronic gout diagnosis (CGD) proposal comprised ≥ 4/8 of these; 88% of patients had the criteria of the CGD proposal while 75% had 6/11 ACRp criteria (p = 0.001). When analysis of MSU crystals was added, 90.1% (CGD) and 83.9% (ACRp) met the criteria (p = 0.004).Conclusion.Current or past history of ≥ 4/8 CGD parameters is highly suggestive of chronic gout.
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Hirsch JD, Terkeltaub R, Khanna D, Singh J, Sarkin A, Shieh M, Kavanaugh A, Lee SJ. Gout disease-specific quality of life and the association with gout characteristics. Patient Relat Outcome Meas 2010; 2010:1-8. [PMID: 21686040 PMCID: PMC3113652 DOI: 10.2147/prom.s8310] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Indexed: 11/23/2022] Open
Abstract
PURPOSE: Assess the association of gout characteristics with health-related quality of life (HRQoL) using a new gout-specific HRQoL instrument, the Gout Impact Scale (GIS). PATIENTS AND METHODS: Gout patients completed the GIS (five scales [0-100 score each] representing impact of gout overall [three scales] and during an attack [two scales]) and other questions describing recent gout attacks, treatment, gout history, comorbidities, and demographics. Physicians confirmed gout diagnosis, presence of tophi, and most recent serum uric acid (sUA) level. Relationships between gout characteristics and GIS scores were examined using analysis of variance and correlation analyses. RESULTS: The majority of patients were male (90.2%) with a mean age of 62.2 (±11.8) years. Approximately one-half (49.7%) reported ≥3 gout attacks in the past year and the majority (57.9%) reported experiencing gout-related pain between attacks. Patients had appreciable concern about their gout ("gout concern overall" scale, 63.1 ± 28.0) but believed their treatment was adequate ("unmet gout treatment need" scale (38.2 ± 21.4) below scale mid-point). Significantly worse GIS scores were associated with increasing attack frequency and greater amount of time with pain between attacks (most scales, P < 0.001). Common objective measures such as sUA level, presence of tophi and the number of joints involved in a typical attack did not appear to be good indicators of the impact of gout on the patients' HRQoL. CONCLUSION: Attack frequency and gout pain between attacks were important correlates of patients' ratings of gout impact on their HRQoL. Further studies are needed to determine the minimal important difference for each GIS scale and interpret our results relative to other patient populations with gout.
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Affiliation(s)
- Jan D Hirsch
- Skaggs School of Pharmacy and Pharmaceutical Sciences
- Veterans Administration San Diego Healthcare System, La Jolla, CA, USA
| | - Robert Terkeltaub
- Veterans Administration San Diego Healthcare System, La Jolla, CA, USA
| | - Dinesh Khanna
- Department of Medicine/Rheumatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jasvinder Singh
- Department of Medicine/ Rheumatology, Minneapolis VA Healthcare System, Minneapolis MN, USA
| | | | | | - Arthur Kavanaugh
- Center for Innovative Therapy, Division of Rheumatology, Allergy, and Immunology, University of California San Diego, La Jolla, CA, USA
| | - Susan J Lee
- Center for Innovative Therapy, Division of Rheumatology, Allergy, and Immunology, University of California San Diego, La Jolla, CA, USA
- Veterans Administration San Diego Healthcare System, La Jolla, CA, USA
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