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Santos-Moreno P, Rodríguez-Vargas GS, Rodríguez-Florido F, Rubio-Rubio JA, Rodríguez PA, Rojas-Villarraga A. Comparison and Influence of a Multicomponent Educational Program on the Patient-Reported Outcomes of a Group of Patients With Rheumatoid Arthritis. J Clin Rheumatol 2024; 30:200-207. [PMID: 38809130 DOI: 10.1097/rhu.0000000000002105] [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: 05/30/2024]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic disease that affects different areas of the patient's body. Patient education and health literacy is essential for them to participate actively in follow-up. OBJECTIVES The aim of this study was to assess differences between clinimetric measurements done by a medical team and patient-reported outcome measures (PROMs) in RA and understand the impact of patient education strategies in order to identify differences between RA assessment methods. METHODS This is a longitudinal cohort study. It included adult patients with RA and access to digital tools. These were divided into 3 groups by type of education. Group 1 included patients who participated in a multicomponent RA educational program. Group 2 did not have this multicomponent RA education. Group 3 did not receive any education. The 3 groups performed PROMs. Disease activity scales, functional class, and quality of life were measured. Univariate and bivariate analysis (χ 2 and Wilcoxon for paired data) were done. RESULTS Twenty-eight patients were included in group 1, 26 in group 2, and 37 in group 3. All were women. In group 1, there were no significant differences in clinimetrics between the medical team and patient's PROMs except for fatigue. In group 2 and group 3, significant differences were found. The RAPID3 and PAS variables did not show significant differences when analyzed by intervention subgroups. CONCLUSIONS This study shows no differences between clinimetrics/PROMs for patients with a high-level education on RA and physicians. On the other hand, when patient did not have any RA education, the clinimetric results differed from physician measurement.
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2
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Katz PP, Barber CEH, Duarte-García A, Garg S, Machua W, Rodgers W, Santiago-Casas Y, Suter L, Bartels CM, Yazdany J. Development of the American College of Rheumatology Patient-Reported Outcome Quality Measures for Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2024; 76:777-787. [PMID: 38225171 PMCID: PMC11132939 DOI: 10.1002/acr.25301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/27/2023] [Accepted: 01/11/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE As part of a Centers for Disease Control and Prevention-funded American College of Rheumatology (ACR) initiative, we sought to develop quality measures related to Patient Reported Outcome Measure (PROM) use for systemic lupus erythematosus (SLE) clinical care. METHODS An expert workgroup composed of physician, patient, and researcher representatives convened to identify patient-reported outcome (PRO) domains of greatest importance to people with SLE. A patient advisory panel separately ranked domains. PROMs assessing priority domains were identified through structured literature review, and detailed psychometric reviews were conducted for each PROM. In a Delphi process, the expert workgroup rated PROMs on content validity, psychometric quality, feasibility of implementation, and importance for guiding patient self-management. The patient advisory panel reviewed PROMs in parallel and contributed to the final recommendations. RESULTS Among relevant PRO domains, the workgroup and patient partners ranked depression, physical function, pain, cognition, and fatigue as high-priority domains. The workgroup recommended at least once yearly measurement for (1) assessment of depression using the Patient Health Questionnaire or Patient Reported Outcomes Measurement Information System (PROMIS) depression scales; (2) assessment of physical function using PROMIS physical function scales or the Multi-Dimensional Health Assessment Questionnaire; and (3) optional assessments of fatigue and cognition. Pain scales evaluated were not found to be sufficiently superior to what is already assessed in most SLE clinic visits. CONCLUSION Expert workgroup members and patient partners recommend that clinicians assess depression and physical function at least once yearly in all people with SLE. Additional PROMs addressing cognition and fatigue can also be assessed. Next steps are to incorporate PROM-based quality measures into the ACR The Rheumatology Informatics System for Effectiveness registry.
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Affiliation(s)
| | | | | | - Shivani Garg
- University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Wendy Rodgers
- Lupus Foundation Care and Support Services, Los Angeles, California
| | | | - Lisa Suter
- Yale School of Medicine, New Haven, Connecticut, and Veterans Administration Hospital, West Haven, Connecticut
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3
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Berry J, Tarn J, Lendrem D, Casement J, Ng WF. What can patients tell us in Sjögren's syndrome? RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2024; 5:34-41. [PMID: 38571930 PMCID: PMC10985711 DOI: 10.1515/rir-2024-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 10/04/2023] [Indexed: 04/05/2024]
Abstract
In Sjögren's Syndrome (SS), clinical heterogeneity and discordance between disease activity measures and patient experience are key obstacles to effective therapeutic development. Patient reported outcome measures (PROMs) are useful tools for understanding the unmet needs from the patients' perspective and therefore they are key for the development of patient centric healthcare systems. Initial concern about the subjectivity of PROMs has given way to methodological rigour and clear guidance for the development of PROMs. To date, several studies of patient stratification using PROMs have identified similar symptom-based subgroups. There is evidence to suggest that these subgroups may represent different disease endotypes with differing responses to therapeutic interventions. Stratified medicine approaches, alongside sensitive outcome measures, have the potential to improve our understanding of SS pathobiology and therapeutic development. The inclusion of PROMs is important for the success of such approaches. In this review we discuss the opportunities of using PROMs in understanding the pathogenesis of and therapeutic development for SS.
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Affiliation(s)
- Joe Berry
- Translational and Clinical Research Institute, Newcastle University, Newcastle uponTyne, UK
| | - Jessica Tarn
- Translational and Clinical Research Institute, Newcastle University, Newcastle uponTyne, UK
| | - Dennis Lendrem
- Translational and Clinical Research Institute, Newcastle University, Newcastle uponTyne, UK
| | - John Casement
- Translational and Clinical Research Institute, Newcastle University, Newcastle uponTyne, UK
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Newcastle University, Newcastle uponTyne, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre& NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle uponTyne, UK
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4
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Koster F, Kok MR, Lopes Barreto D, Weel-Koenders AEAM. Capturing Patient Value in an Economic Evaluation. Arthritis Care Res (Hoboken) 2024; 76:191-199. [PMID: 37667586 DOI: 10.1002/acr.25229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/10/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Economic evaluations predominantly use generic outcomes, such as the Euro Quality of Life-5 Dimension (EQ-5D), to assess health status. However, because of the generic nature, they are less suitable to capture the quality of life of patients with specific conditions. Given the transition to patient-centered (remote) care delivery, this study aims to evaluate the possibility of using disease-specific measures in a cost-effectiveness analysis. METHODS A real-life cohort from Maasstad Hospital (2020-2021) in the Netherlands, with 772 patients with rheumatoid arthritis (RA), was used to assess the cost-effectiveness of electronic consultations (e-consultations) compared with face-to-face consultations. The Incremental Cost-Effectiveness Ratio (ICER), based on the generic EQ-5D, was compared with ICER's based on RA-specific measures: the Rheumatoid Arthritis Impact of Disease (RAID) and Health Assessment Questionnaire-Disability Index (HAQ-DI). To compare the cost-effectiveness of these different measures, HAQ-DI and RAID were expressed in quality-adjusted life-years (QALYs) via estimated conversion equations. RESULTS Disease-specific patient-reported outcome measures (PROMs) offer a promising alternative for traditional measures in economic evaluations, capturing patient-relevant domains more comprehensively. Because PROMs are increasingly applied in clinical practice, the next step entails modeling of an RA patient-wide conversion equation to implement PROMs in economic evaluations. CONCLUSION The conventional ICER (eg, EQ-5D) indicates that e-consultations are cost-effective with cost savings of -€161,000 per QALY gained for a prevalent RA cohort treated in a secondary trainee hospital. RA-specific measures show similar results, with ICERs of -€163,000 per HAQ-DI (QALY) and -€223,000 per RAID (QALY) gained. RA-specific measures capture patient-relevant domains and offer the opportunity to improve the assessment and treatment of the disease impact.
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Affiliation(s)
- Fiona Koster
- Maasstad Hospital and Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marc R Kok
- Maasstad Hospital, Rotterdam, The Netherlands
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5
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Knight E, Schifferdecker KE, Eakin GS, Reeve BB. Selecting patient-reported outcome measures of health-related quality of life in adult rheumatology: quality and breadth of coverage. Rheumatol Int 2023; 43:627-638. [PMID: 36125521 DOI: 10.1007/s00296-022-05200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/27/2022] [Indexed: 11/25/2022]
Abstract
Patient-centered research should assess outcomes important to patients and include patient-reported outcome measures (PROMs) to assess health-related quality of life (HRQOL) domains. Using a well-known HRQOL framework (World Health Organization QOL, or WHOQOL), we reviewed established PROMs used with adults with different types of arthritis to evaluate their HRQOL domain coverage and psychometric evidence to help PROM users select measures and determine whether other measures should be validated and/or developed. Nineteen PROMs and 92 corresponding articles were reviewed to determine which HRQOL domains were assessed. To support a streamlined but rigorous review, we used a rating system based on criteria established in part through existing rubrics (e.g., OMERACT COSMIN). Psychometric properties were rated on a scale from 1 to 18, where 18 was strongest. We examined the intersection between level of domain coverage and extent of psychometric support. Measures most commonly assessed physical health and level of independence, while fewer assessed social relations, environment, and psychological health. No measures assessed spirituality and religion, which may be relevant depending on intended use. PROMs with higher psychometric evidence tended to assess a broader range of HRQOL domains. Rubric scores ranged from 3 to 16, with an average of 9.3. Prominent and psychometrically sound PROMs are available that cover many of the WHOQOL domains. While gaps exist in the domain of spirituality, future work should focus on refining optimal use of existing PROMs relevant for arthritis versus developing new measures. We provide guidance on selecting PROMs, to that end.
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Affiliation(s)
- Erin Knight
- Center for Program Design and Evaluation, Dartmouth Institute for Health Policy and Clinical Practice, WTRB Level 5, One Medical Center Drive, Lebanon, NH, 03756, USA.
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
| | - Karen E Schifferdecker
- Center for Program Design and Evaluation, Dartmouth Institute for Health Policy and Clinical Practice, WTRB Level 5, One Medical Center Drive, Lebanon, NH, 03756, USA
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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6
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Seppen BF, Wiegel J, Nurmohamed MT, Bos WH, ter Wee MM. Facilitators and barriers to adhere to monitoring disease activity with ePROs: a focus group study in patients with inflammatory arthritis. Rheumatol Int 2023; 43:677-685. [PMID: 36627396 PMCID: PMC9995401 DOI: 10.1007/s00296-022-05263-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/25/2022] [Indexed: 01/11/2023]
Abstract
Telemonitoring disease activity with electronic patient-reported outcomes (ePROs) may reduce the workload of rheumatic care by decreasing outpatient clinic visits. However, low adherence to reporting ePROs is frequently observed. Our objective was to identify facilitators and barriers to weekly monitoring of disease activity with ePROs. Patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) who recently participated in one of the two telemonitoring studies with ePROs completed in a smartphone app, were invited to participate in focus group discussions (FGD). Thematic analysis was used to identify themes that play a role in the decision to continue or stop reporting weekly ePROs. A total of 22 patients participated in three FGDs. Five themes were identified that were of importance to adhere to telemonitoring: (1) questionnaire frequency, (2) discussing results of completed ePROs, (3) physical consultations, (4) patient insight into disease activity and (5) user experience of the app. All themes contained both barrier and facilitator elements. The results suggest that to improve adherence to telemonitoring of disease activity with ePROs, the perceived benefits of completing ePROs should be maximized. This can be done by providing patients the ability to skip (unneeded) physical consultations in case of low disease activity, and training clinicians to always discuss the completed ePROs. In addition, it is essential to reduce the effort to report ePROs, by tailoring the frequency of ePROs based on the patients' disease activity or preference, aiming for optimal app functionality as well as by sending notifications when new ePROs are available.
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Affiliation(s)
- Bart F. Seppen
- grid.16872.3a0000 0004 0435 165XAmsterdam Rheumatology and Immunology Center, Reade, Admiraal Helfrichstraat 1, 1056 AA Amsterdam, The Netherlands
- grid.16872.3a0000 0004 0435 165XAmsterdam Rheumatology and Immunology Center, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Societal Participation in Health, Amsterdam, The Netherlands
| | - Jimmy Wiegel
- grid.16872.3a0000 0004 0435 165XAmsterdam Rheumatology and Immunology Center, Reade, Admiraal Helfrichstraat 1, 1056 AA Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Societal Participation in Health, Amsterdam, The Netherlands
| | - Michael T. Nurmohamed
- grid.16872.3a0000 0004 0435 165XAmsterdam Rheumatology and Immunology Center, Reade, Admiraal Helfrichstraat 1, 1056 AA Amsterdam, The Netherlands
- grid.16872.3a0000 0004 0435 165XAmsterdam Rheumatology and Immunology Center, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- grid.509540.d0000 0004 6880 3010Department of Rheumatology and Immunology, Amsterdam UMC Location Vrije Universiteit, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, The Netherlands
| | - Wouter H. Bos
- grid.16872.3a0000 0004 0435 165XAmsterdam Rheumatology and Immunology Center, Reade, Admiraal Helfrichstraat 1, 1056 AA Amsterdam, The Netherlands
| | - Marieke M. ter Wee
- grid.509540.d0000 0004 6880 3010Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Societal Participation in Health, Amsterdam, The Netherlands
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7
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Patterson SL, Sun S, Rychkov D, Katz P, Tsitsiklis A, Nakamura MC, Serpa PH, Langelier CR, Sirota M. Physical Activity Associates With Lower Systemic Inflammatory Gene Expression in Rheumatoid Arthritis. J Rheumatol 2022; 49:1320-1327. [PMID: 35777820 PMCID: PMC9722583 DOI: 10.3899/jrheum.220050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE While general population studies have shown inverse associations between physical activity and common inflammatory biomarkers, the effects of physical activity on inflammatory gene expression and signaling pathways in rheumatoid arthritis (RA) remain unknown. We aimed to determine whether physical activity independently associates with expression of inflammatory genes among people with RA. METHODS This was a prospective observational study of adults with RA. Physical activity was measured by quantitative actigraphy over 7 consecutive days, and peripheral blood collected during the same time period was used for RNA sequencing followed by differential gene expression, pathway, and network analyses. RESULTS Actigraphy and RNA sequencing data were evaluated in 35 patients. The cohort had a mean age of 56 (SD 12) years, and was 91% female, 31% White, 9% Black, 9% Asian, and 40% Hispanic. We found 767 genes differentially expressed (adjusted P < 0.1) between patients in the greatest vs lowest physical activity tertiles, after adjusting for sex, age, race, and ethnicity. The most active patients exhibited dose-dependent downregulation of several immune signaling pathways implicated in RA pathogenesis. These included CD40, STAT3, TREM-1, interleukin (IL)-17A, IL-8, Toll-like receptor, and interferon (IFN) signaling pathways. Upstream cytokine activation state analysis predicted reduced activation of tumor necrosis factor-α and IFN in the most active group. In sensitivity analyses, we adjusted for RA disease activity and physical function and found consistent results. CONCLUSION Patients with RA who were more physically active had lower expression of immune signaling pathways implicated in RA pathogenesis, even after adjusting for disease activity, suggesting that physical activity may confer a protective effect in RA.
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Affiliation(s)
- Sarah L Patterson
- S.L. Patterson, MS, P. Katz, PhD, Division of Rheumatology, University of California;
| | - Shenghuan Sun
- S. Sun, BS, D. Rychkov, PhD, M. Sirota, PhD, Department of Pediatrics, University of California
| | - Dmitry Rychkov
- S. Sun, BS, D. Rychkov, PhD, M. Sirota, PhD, Department of Pediatrics, University of California
| | - Patricia Katz
- S.L. Patterson, MS, P. Katz, PhD, Division of Rheumatology, University of California
| | - Alexandra Tsitsiklis
- A. Tsitsiklis, PhD, P. Hayakawa Serpa, BA, Division of Infectious Diseases, University of California
| | - Mary C Nakamura
- M.C. Nakamura, MD, PhD, Division of Rheumatology, University of California, and Department of Veterans Affairs Medical Center
| | - Paula Hayakawa Serpa
- A. Tsitsiklis, PhD, P. Hayakawa Serpa, BA, Division of Infectious Diseases, University of California
| | - Charles R Langelier
- C.R. Langelier, MD, PhD, Division of Infectious Diseases, University of California, and Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Marina Sirota
- S. Sun, BS, D. Rychkov, PhD, M. Sirota, PhD, Department of Pediatrics, University of California
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8
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Studenic P, Stamm TA, Mosor E, Bini I, Caeyers N, Gossec L, Kouloumas M, Nikiphorou E, Olsder W, Padjen I, Ramiro S, Stones S, Wilhelmer TC, Alunno A. EULAR points to consider for including the perspective of young patients with inflammatory arthritis into patient-reported outcomes measures. RMD Open 2022; 8:rmdopen-2022-002576. [PMID: 35906026 PMCID: PMC9345076 DOI: 10.1136/rmdopen-2022-002576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Paul Studenic
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Wien, Austria .,Department of Medicine (Solna), Division of Rheumatology, Karolinska Institute, Stockholm, Sweden
| | - Tanja A Stamm
- Ludwig Boltzmann Institut für Arthritis und Rehabilitation, Wien, Austria.,Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Erika Mosor
- Ludwig Boltzmann Institut für Arthritis und Rehabilitation, Wien, Austria.,Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ilaria Bini
- Anmar Young, Rome, Italy.,EULAR Young PARE, Zürich, Switzerland
| | | | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France.,AP-HP.Sorbonne Université, Rheumatology department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK.,Rheumatology Department, King's College Hospital, London, UK
| | - Wendy Olsder
- EULAR Young PARE, Zürich, Switzerland.,Youth-R-Well, Nieuwegein, The Netherlands
| | - Ivan Padjen
- Department of Internal Medicine, Division of Clinical Immunology and Rheumatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Simon Stones
- EULAR PARE, Zürich, Switzerland.,Envision Pharma Group Limited, Wilmslow, UK
| | | | - Alessia Alunno
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aguila, Italy.,Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
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9
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Shi Y, Xie Y, Zhang G, Feng Y. Tofacitinib for the treatment of rheumatoid arthritis: a real-world study in China. Intern Emerg Med 2022; 17:703-714. [PMID: 34559374 DOI: 10.1007/s11739-021-02852-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/12/2021] [Indexed: 12/30/2022]
Abstract
Tofacitinib has only been available in China for 2 years to treat rheumatoid arthritis (RA). Our purpose was to compare real-world effectiveness of tofacitinib with that of disease-modifying anti-rheumatic drugs (DMARDs) in Chinese patients with RA. The records of patients with RA treated at Guangdong Provincial People's Hospital between July 2017 and September 2019 were retrospectively reviewed. Patients were divided into those treated with tofacitinib, biological DMARDs (bDMARDs), and conventional synthetic DMARDs (csDMARDs). Clinical disease activity index (CDAI), simplified disease activity index (SDAI), health assessment questionnaire-disability index (HAQ-DI), visual analog scale (VAS) pain score, patient global assessment of disease activity (PtGA), physician global assessment of disease activity (PhGA), and swollen joint and tender joint count were compared among the groups up to 12 months of treatment. A total of 150 patients were included: 63 were treated with tofacitinib, 48 with bDMARDs, and 39 with csDMARDs. Tofacitinib was first-line treatment in 26.98% of patients, second-line treatment in 49.21%, and third-line treatment in 26.98%. Patients in the tofacitinib group had significantly higher disease duration (6.11 ± 6.97 years) than those in the other groups. All disease indices in the three groups decreased with time, indicating improvement of symptoms, with no differences among the groups at 12 months. Tofacitinib appeared to improve symptoms more rapidly than other treatments; however, differences in disease indices were not significant. This real-world study suggests that tofacitinib is rapidly effective and that the effects are sustained after 12 months in Chinese patients with RA.
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Affiliation(s)
- Yunzhen Shi
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, 106 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
| | - Yuesheng Xie
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, 106 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Guangfeng Zhang
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, 106 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Yuan Feng
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, 106 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
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10
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Pickles T, Macefield R, Aiyegbusi OL, Beecher C, Horton M, Christensen KB, Phillips R, Gillespie D, Choy E. Patient Reported Outcome Measures for Rheumatoid Arthritis Disease Activity: a systematic review following COSMIN guidelines. RMD Open 2022; 8:e002093. [PMID: 35351807 PMCID: PMC8966547 DOI: 10.1136/rmdopen-2021-002093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/03/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The current standard of care in rheumatoid arthritis (RA) requires regular assessment of disease activity (DA). All standard RA DA measurement instruments require joint counts to be undertaken by a healthcare professional with/without a blood test. Few healthcare providers have the capacity to assess patients as frequently as stipulated by guidelines. Patient Reported Outcome Measures (PROMs) could be an efficient and informative way to assess RA DA, which is highlighted by the SARS-COV-2 pandemic, as most consultations are remote rather than face-to-face. We aimed to assess all PROMs for RA DA against the internationally recognised COSMIN guidelines to provide evidence-based recommendations to select the most suitable PROMs. METHODS Review registered on PROSPERO as CRD42020176176. The search strategy was based on a previous similar systematic review and expanded to include all articles up to January 2019. All identified articles were rated by two independent assessors following the COSMIN guidelines. RESULTS 668 abstracts were identified, with 10 articles included. A further 21 were identified from a previous review. Ten PROMs were identified. There was insufficient evidence to place any of the identified PROMs into recommendation for use category A due to lack of evidence for content validity, as stipulated by the COSMIN guidelines. CONCLUSION Lack of evidence of content validity limits suitable PROM selection, therefore none can be recommended for use. It is acknowledged that all included PROMs were developed before the COSMIN guidelines were published. Future research on PROMs for RA DA must provide evidence of content validity.
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Affiliation(s)
- Tim Pickles
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Rhiannon Macefield
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Brmingham, UK
- NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Claire Beecher
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, National University of Ireland Galway, Galway, Ireland
- Health Research Board - Trials Methodology Research Network, National University of Ireland, Galway, Ireland
| | - Mike Horton
- Psychometric Laboratory for Health Sciences, University of Leeds, Leeds, UK
| | | | - Rhiannon Phillips
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Ernest Choy
- Department of Infection and Immunity, Cardiff University, Cardiff, UK
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11
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MacBrayne A, Marsh W, Humby F. Review: Remote disease monitoring in rheumatoid arthritis. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_142_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Unger J, Mattsson M, Drăgoi RG, Avram C, Boström C, Buttgereit F, Lackner A, Witte T, Raffeiner B, Peichl P, Durechova M, Hermann J, Stamm TA, Dejaco C. The Experiences of Functioning and Health of Patients With Primary Sjögren's Syndrome: A Multicenter Qualitative European Study. Front Med (Lausanne) 2021; 8:770422. [PMID: 34869487 PMCID: PMC8637170 DOI: 10.3389/fmed.2021.770422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To identify a spectrum of perspectives on functioning and health of patients with primary Sjögren's syndrome (pSS) from the five European countries in order to reveal commonalities and insights in their experiences. Methods: A multicenter focus group study on the patients with pSS about their perspectives of functioning and health was performed. Focus groups were chaired by trained moderators based on an interview guide, audiotaped, and transcribed. After conducting a meaning condensation analysis of each focus group, we subsequently combined the extracted concepts from each country and mapped them to the International Classification of Functioning, Disability and Health (ICF). Results: Fifty-one patients with pSS participated in 12 focus groups. We identified a total of 82 concepts meaningful to people with pSS. Of these, 55 (67%) were mentioned by the patients with pSS in at least four of five countries and 36 (44%) emerged in all the five countries. Most concepts were assigned to the ICF components activities and participation (n = 25, 30%), followed by 22 concepts (27%) that were considered to be not definable or not covered by the ICF; 15 concepts (18%) linked to body structures and functions. Participants reported several limitations in the daily life due to a mismatch between the capabilities of the person, the demands of the environment and the requirements of the activities. Conclusion: Concepts that emerged in all the five non-English speaking countries may be used to guide the development and adaption of the patient-reported outcome measures and to enhance the provision of treatment options based on the aspects meaningful to patients with pSS in clinical routine.
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Affiliation(s)
- Julia Unger
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.,Department of Health Studies, Institute of Occupational Therapy, University of Applied Sciences FH JOANNEUM, Bad Gleichenberg, Austria
| | - Malin Mattsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Affiliated to Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiotherapy, Sunderby Hospital, Luleå, Sweden
| | - Răzvan G Drăgoi
- Department of Balneology, Rehabilitation Medicine and Rheumatology, "Victor Babeş" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Claudiu Avram
- Department of Physical Therapy and Special Motility, West University of Timisoara, Timisoara, Romania
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Affiliated to Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charitè University Medicine, Berlin, Germany
| | - Angelika Lackner
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Torsten Witte
- Department of Rheumatology and Immunology, Medical University of Hanover, Hanover, Germany
| | - Bernd Raffeiner
- Department of Rheumatology, Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
| | | | - Martina Durechova
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University Vienna, Vienna, Austria
| | - Josef Hermann
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Christian Dejaco
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.,Department of Rheumatology, Hospital of Brunico (SABES-ASDAA), Brunico, Italy
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13
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Mosor E, Studenic P, Alunno A, Padjen I, Olsder W, Ramiro S, Bini I, Caeyers N, Gossec L, Kouloumas M, Nikiphorou E, Stones S, Wilhelmer TC, Stamm TA. Young people's perspectives on patient-reported outcome measures in inflammatory arthritis: results of a multicentre European qualitative study from a EULAR task force. RMD Open 2021; 7:rmdopen-2020-001517. [PMID: 33514672 PMCID: PMC7849893 DOI: 10.1136/rmdopen-2020-001517] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/24/2020] [Accepted: 01/14/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Although patient-reported outcome measures (PROMs) are increasingly used in clinical practice and research, it is unclear whether these instruments cover the perspective of young people with inflammatory arthritis (IA). The aims of this study were to explore whether PROMs commonly used in IA adequately cover the perspective of young people from different European countries. METHODS A multinational qualitative study was conducted in Austria, Croatia, Italy and the Netherlands. Young people with either rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), Still's disease, psoriatic arthritis (PsA) or spondyloarthritis (SpA), aged 18-35 years, participated in semistructured focus group interviews. Thematic analysis was used and data saturation was defined as no new emergent concepts in at least three subsequent focus groups. RESULTS Fifty-three patients (21 with RA/JIA/Still's, 17 with PsA, 15 with SpA; 72% women) participated in 12 focus groups. Participants expressed a general positive attitude towards PROMs and emphasised their importance in clinical practice. In addition, 48 lower level concepts were extracted and summarised into 6 higher level concepts describing potential issues for improvement. These included: need for lay-term information regarding the purpose of using PROMs; updates of certain outdated items and using digital technology for data acquisition. Some participants admitted their tendency to rate pain, fatigue or disease activity differently from what they actually felt for various reasons. CONCLUSIONS Despite their general positive attitude, young people with IA suggested areas for PROM development to ensure that important concepts are included, making PROMs relevant over the entire course of a chronic disease.
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Affiliation(s)
- Erika Mosor
- Section for Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Wien, Austria
| | - Paul Studenic
- Internal Medicine 3, Division of Rheumatology, Medical University Vienna, Wien, Austria.,Department of Medicine (Solna), Division of Rheumatology, Karolinska Institute, Stockholm, Sweden
| | - Alessia Alunno
- Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Umbria, Italy
| | - Ivan Padjen
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.,University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Wendy Olsder
- EULAR Young PARE, Zürich, Switzerland.,Youth-R-Well, Nieuwegein, The Netherlands
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, South Holland, The Netherlands.,Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Ilaria Bini
- EULAR Young PARE, Zürich, Switzerland.,Anmar Young, Rome, Italy
| | - Nele Caeyers
- EULAR PARE, Zurich, Switzerland.,ReumaNET, Leuven, Belgium
| | - Laure Gossec
- Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, Paris, France.,APHP, Rheumatology Department, Pitie Salpetriere University Hospital, Paris, France
| | | | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK.,Rheumatology Department, King's College Hospital NHS Trust, London, UK
| | - Simon Stones
- EULAR Patient Research Partner, Manchester, UK.,University of Leeds, Leeds, West Yorkshire, UK
| | | | - Tanja A Stamm
- Section for Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Wien, Austria
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14
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Küçükdeveci AA, Elhan AH, Erdoğan BD, Kutlay Ş, Gökmen D, Ateş C, Yüksel S, Lundgren-Nilsson A, Escorpizo R, Stucki G, Tennant A, Conaghan PG. Use and detailed metric properties of patient-reported outcome measures for rheumatoid arthritis: a systematic review covering two decades. RMD Open 2021; 7:rmdopen-2021-001707. [PMID: 34376556 PMCID: PMC8356163 DOI: 10.1136/rmdopen-2021-001707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction The importance of patient-reported outcome measures (PROMs) for rheumatoid arthritis (RA) clinical studies has been recognised for many years. The current study aims to describe the RA PROMs used over the past 20 years, and their performance metrics, to underpin appropriate tool selection. Methods The study included a systematic search for PROMs that have been in use over the period 2000–2019, with detailed documentation of their psychometric properties, and a user-friendly presentation of the extensive evidence base. Results 125 PROMs were identified with psychometric evidence available. The domains of pain, fatigue, emotional functions, mobility, physical functioning and work dominated, with self-efficacy and coping as personal factors. Domains such as stiffness and sleep were poorly served. The most frequently used PROMs included the Health Assessment Questionnaire Disability Index (HAQ), the Short Form 36 (SF-36), the EuroQoL and the Modified HAQ which, between them, appeared in more than 3500 papers. Strong psychometric evidence was found for the HAQ, and the SF-36 Physical Functioning and Vitality (fatigue) domains. Otherwise, all domains except stiffness, sleep, education and health utility, had at least one PROM with moderate level of psychometric evidence. Conclusion There is a broad range of PROMs for measuring RA outcomes, but the quality of psychometric evidence varies widely. This work identifies gaps in key RA domains according to the biopsychosocial model.
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Affiliation(s)
- Ayşe A Küçükdeveci
- Department of Physical Medicine and Rehabilitation, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Atilla H Elhan
- Department of Biostatistics, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Beyza D Erdoğan
- Department of Biostatistics, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Şehim Kutlay
- Department of Physical Medicine and Rehabilitation, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Derya Gökmen
- Department of Biostatistics, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Can Ateş
- Department of Biostatistics, Aksaray University, School of Medicine, Aksaray, Turkey
| | - Selcen Yüksel
- Department of Biostatistics, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | - Asa Lundgren-Nilsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Gerold Stucki
- Department of Health Sciences and Health Policy, University of Lucerne, Luzern, Switzerland
| | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
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15
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Tarar AB, Weddell J, Manning F, Dutta S, Paskins Z, Scott IC. Clinical decision-making in remote rheumatology consultations: a service evaluation of new patient and inflammatory rheumatic disease follow-up appointments. Rheumatol Adv Pract 2021; 5:rkab036. [PMID: 34142006 PMCID: PMC8206513 DOI: 10.1093/rap/rkab036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/13/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ahmed B Tarar
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Burslem
| | - Jake Weddell
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Burslem
| | - Fay Manning
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Burslem.,Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Shouma Dutta
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Burslem
| | - Zoe Paskins
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Burslem.,Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Ian C Scott
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Burslem.,Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
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16
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Churruca K, Pomare C, Ellis LA, Long JC, Henderson SB, Murphy LED, Leahy CJ, Braithwaite J. Patient-reported outcome measures (PROMs): A review of generic and condition-specific measures and a discussion of trends and issues. Health Expect 2021; 24:1015-1024. [PMID: 33949755 PMCID: PMC8369118 DOI: 10.1111/hex.13254] [Citation(s) in RCA: 214] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/22/2021] [Accepted: 03/25/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are questionnaires that collect health outcomes directly from the people who experience them. This review critically synthesizes information on generic and selected condition-specific PROMs to describe trends and contemporary issues regarding their development, validation and application. METHODS We reviewed academic and grey literature on validated PROMs by searching databases, prominent websites, Google Scholar and Google Search. The identification of condition-specific PROMs was limited to common conditions and those with a high burden of disease (eg cancers, cardiovascular disorders). Trends and contemporary issues in the development, validation and application of PROMs were critically evaluated. RESULTS The search yielded 315 generic and condition-specific PROMs. The largest numbers of measures were identified for generic PROMs, musculoskeletal conditions and cancers. The earliest published PROMs were in mental health-related conditions. The number of PROMs grew substantially between 1980s and 2000s but slowed more recently. The number of publications discussing PROMs continues to increase. Issues identified include the use of computer-adaptive testing and increasing concerns about the appropriateness of using PROMs developed and validated for specific purposes (eg research) for other reasons (eg clinical decision making). CONCLUSIONS The term PROM is a relatively new designation for a range of measures that have existed since at least the 1960s. Although literature on PROMs continues to expand, challenges remain in selecting reliable and valid tools that are fit-for-purpose from the many existing instruments. PATIENT OR PUBLIC CONTRIBUTION Consumers were not directly involved in this review; however, its outcome will be used in programmes that engage and partner with consumers.
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Affiliation(s)
- Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Chiara Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Janet C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Suzanna B Henderson
- The Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia
| | - Lisa E D Murphy
- The Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia
| | - Christopher J Leahy
- The Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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17
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Verhoeven MMA, Tekstra J, Marijnissen ACA, Meier AJL, Westgeest AAA, Lafeber FPJG, Jacobs JWG, van Laar JM, Welsing PMJ. Utility of the HandScan in monitoring disease activity and prediction of clinical response in rheumatoid arthritis patients: an explorative study. Rheumatol Adv Pract 2021; 5:rkab004. [PMID: 33693304 PMCID: PMC7931797 DOI: 10.1093/rap/rkab004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aims were to determine the ability of the HandScan [assessing inflammation in hand and wrist joints using optical spectral transmission (OST)] to measure RA disease activity longitudinally, compared with DAS28, and to determine whether short-term (i.e. 1 month) changes in the OST score can predict treatment response at 3 or 6 months. METHODS Participants visited the outpatient clinic before the start of (additional) RA medication and 1, 3 and 6 months thereafter. Disease activity was monitored at each visit with the HandScan and DAS28 in parallel. A mixed effects model with DAS28 as the outcome variable with a random intercept at patient level, visit month and DAS28 one visit earlier was used to evaluate whether changes in the OST score are related to changes in DAS28. Binary logistic regression was used to test the predictive value of short-term changes in the OST score together with the baseline OST score for achievement of treatment response (EULAR or ACR criteria). All models were adjusted for RA stage (early or established). RESULTS In total, 64 RA patients were included. One unit change in OST score was found to be related to an average DAS28 change of 0.03 (95% CI: 0.01, 0.06, P = 0.03). When adding OST score as a variable in the longitudinal model, the ability of the model to estimate DAS28 (i.e. explained variance) increased by 2%, to 59%. Neither baseline OST score nor short-term change in OST score was predictive for treatment response at 3 or 6 months. CONCLUSION A longitudinal association of OST score with DAS28 exists, although explained variance is low. The predictive ability of short-term changes in HandScan for treatment response is limited.
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Affiliation(s)
- Maxime M A Verhoeven
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Janneke Tekstra
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Anne C A Marijnissen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Anna J L Meier
- Department of Rheumatology, Máxima MC, Eindhoven, The Netherlands
| | | | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht
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18
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Bos WH, van Tubergen A, Vonkeman HE. Telemedicine for patients with rheumatic and musculoskeletal diseases during the COVID-19 pandemic; a positive experience in the Netherlands. Rheumatol Int 2021; 41:565-573. [PMID: 33449162 PMCID: PMC7809638 DOI: 10.1007/s00296-020-04771-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/10/2020] [Indexed: 12/14/2022]
Abstract
To describe the delivery of care for patients with rheumatic and musculoskeletal diseases (RMDs) from the perspective of rheumatologists in the Netherlands during the first months of the COVID-19 pandemic. A mixed methods design was used with quantitative and qualitative data from a cross-sectional survey sent to all members of the Dutch Rheumatology Society in May 2020. The survey contained questions on demographics, the current way of care delivery, and also on usage, acceptance, facilitators and barriers of telemedicine. Quantitative data were analyzed descriptively. The answers to the open questions were categorized into themes. Seventy-five respondents completed the survey. During the COVID-19 pandemic, continuity of care was guaranteed through telephone and video consultations by 99% and 9% of the respondents, respectively. More than 80% of the total number of outpatient visits were performed exclusively via telephone with in-person visits only on indication. One-quarter of the respondents used patient reported outcomes to guide telephone consultations. The top three facilitators for telemedicine were less travel time for patients, ease of use of the system and shorter waiting period for patients. The top three barriers were impossibility to perform physical examination, difficulty estimating how the patient is doing and difficulty in reaching patients. During the COVID-19 epidemic, care for patients with RMDs in the Netherlands continued uninterrupted by the aid of telemedicine. On average, respondents were content with current solutions, although some felt insecure mainly because of the inability to perform physical examination and missing nonverbal communication with their patients.
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Affiliation(s)
- Wouter H Bos
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.
| | - Astrid van Tubergen
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Harald E Vonkeman
- Centre for eHealth and Well-Being Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
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19
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McKenna SP, Heaney A. Setting and maintaining standards for patient-reported outcome measures: can we rely on the COSMIN checklists? J Med Econ 2021; 24:502-511. [PMID: 33759686 DOI: 10.1080/13696998.2021.1907092] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As test-developers we have often been troubled by published reviews of patient-reported outcome measures (PROMs). Too often minor issues are judged important while other reviews exclude the best measures available. Perhaps this led several groups to make recommendations for evaluating the quality of PROMs. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist is the latest set of recommendations. While reviewing the COSMIN literature and reviews conducted using their recommendations several concerns became apparent. The checklist is not evidence-based, relying on the opinion of researchers experienced in health-related quality of life. PROMs measuring other types of outcomes are inadequately covered by the checklist. COSMIN choose to focus on Classical Test Theory and the checklists are not appropriate for use with PROMs developed using modern measurement. Such an approach only obstructs progress in the field of outcome measurement. The retrospective nature of the evaluations also penalizes new PROMs. While the checklists imply that composite, ordinal level measurement is acceptable, crucial aspects of instrument development and quality are excluded. Reviews based on the COSMIN checklist produce contradictory conclusions and fail to provide evidence to support the recommendations. These problems suggest that the checklists themselves lack reliability and validity. It is also clear that several reviewers lack the expertise to apply the checklists. Researchers require a good grounding in instrument development and psychometrics to produce quality reviews. The science of modern PROM development is still in an early phase. Few available PROMs have sufficient quality, limiting the need for complex reviews. Standards need to be agreed for high quality outcome measurement. The issue is who should set these standards? Most published reviews merely scratch the surface and lack essential detail. All reviews of PROMs should be treated with caution, irrespective of whether the COSMIN checklist was employed.
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Affiliation(s)
- Stephen P McKenna
- Galen Research, Manchester, UK
- School of Health Sciences, University of Manchester, Manchester, UK
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20
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Neubert A, Brito Fernandes Ó, Lucevic A, Pavlova M, Gulácsi L, Baji P, Klazinga N, Kringos D. Understanding the use of patient-reported data by health care insurers: A scoping review. PLoS One 2020; 15:e0244546. [PMID: 33370405 PMCID: PMC7769438 DOI: 10.1371/journal.pone.0244546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 12/11/2020] [Indexed: 12/03/2022] Open
Abstract
Background Patient-reported data are widely used for many purposes by different actors within a health system. However, little is known about the use of such data by health insurers. Our study aims to map the evidence on the use of patient-reported data by health insurers; to explore how collected patient-reported data are utilized; and to elucidate the motives of why patient-reported data are collected by health insurers. Methods The study design is that of a scoping review. In total, 11 databases were searched on. Relevant grey literature was identified through online searches, reference mining and recommendations from experts. Forty-two documents were included. We synthesized the evidence on the uses of patient-reported data by insurers following a structure-process-outcome approach; we also mapped the use and function of those data by a health insurer. Results Health insurers use patient-reported data for assurance and improvement of quality of care and value-based health care. The patient-reported data most often collected are those of outcomes, experiences and satisfaction measures; structure indicators are used to a lesser extent and often combined with process indicators. These data are mainly used for the purposes of procurement and purchasing of services, quality assurance, improvement and reporting, and strengthening the involvement of insured people. Conclusions The breadth to which insurers use patient-reported data in their business models varies greatly. Some hindering factors to the uptake of such data are the varying and overlapping terminology in use in the field and the limited involvement of insured people in a health insurer’s business. Health insurers are advised to be more explicit in regard to the role they want to play within the health system and society at large, and accommodate implications for the use of patient-reported data accordingly.
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Affiliation(s)
- Anne Neubert
- Department of Orthopaedics and Traumatology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Service Research and Health Economics, Centre for Health and Society, Heinrich-Heine-University, Düsseldorf, Germany
| | - Óscar Brito Fernandes
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
- * E-mail:
| | - Armin Lucevic
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Dionne Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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21
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Estermann L, Marks M, Herren D, Schindele S. Determinants of long-term satisfaction after silicone MCP arthroplasty in patients with inflammatory diseases. HAND SURGERY & REHABILITATION 2020; 39:545-549. [DOI: 10.1016/j.hansur.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
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22
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Seppen BF, Wiegel J, L'ami MJ, Duarte Dos Santos Rico S, Catarinella FS, Turkstra F, Boers M, Bos WH. Feasibility of Self-Monitoring Rheumatoid Arthritis With a Smartphone App: Results of Two Mixed-Methods Pilot Studies. JMIR Form Res 2020; 4:e20165. [PMID: 32955447 PMCID: PMC7536594 DOI: 10.2196/20165] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 01/16/2023] Open
Abstract
Background Several mobile apps that monitor symptoms of rheumatoid arthritis (RA) exist, but a recent systematic review indicated that high-quality apps are lacking. When patients self-monitor their own disease with patient-reported outcomes (PROs) and self-initiate care at the right moment, it may be possible to reduce the frequency of their clinic visits, which would reduce health care burden and costs. We developed an app, that is, the MijnReuma Reade app, for this purpose and performed 2 pilot tests with weekly self-monitoring. Objective The primary objective of this study was to design, develop, and evaluate the usability, satisfaction, and usage of the MijnReuma Reade app—an app that allows patients with RA to monitor their own disease. The secondary objective was to review the patients’ perspectives on app usage and its intended purpose. Methods This app was designed in collaboration with patients with RA, rheumatologists, and information technology experts. Two 1-month pilot studies were performed, after which satisfaction (0-10 scale), usability (system usability scale, 0-100), and usage (proportion of completed questionnaires) of this app were assessed. After the second pilot study, semistructured interviews were performed to determine patients’ perspectives and the promoters and barriers of app usage. Results In the first and second pilot study, 42 and 27 patients were included, respectively. Overall, the patients were satisfied (medians, 8 and 7) and found the app usable (mean system usability scores, 76 and 71) in pilot studies 1 and 2, respectively. App usage declined over time in both the pilot studies; 61% (17/28) and 37% (10/27) of the patients who disclosed their usage statistics completed the final weekly questionnaire in pilot study 1 and pilot study 2, respectively. Approximately 81% (25/31) of the patients indicated they would like to skip hospital visits if the self-monitored disease activity is low. In the semistructured interviews, technical problems, internal resistance (respondent fatigue, the app reminded them of their disease), and a lack of symptoms were identified as barriers for usage. Patients reported that “experiencing more grip on their disease” and “improved communication with their physician” were promoters for usage. Patients reported that pain positively mediated usage, that is, more pain promoted and less pain discouraged app usage. Conclusions This study illustrates the feasibility of the MijnReuma Reade app that enables self-monitoring of the disease activity in patients with RA with the overarching aim to allocate clinical consultations according to need. Satisfaction with the app and usability of the app were found to be high; however, app usage declined over time. Patients acknowledged the potential of the app to self-monitor their own disease and would like to be able to skip clinic visits if the monitored disease activity is low. To evaluate this strategy, a randomized controlled trial is underway.
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Affiliation(s)
- Bart F Seppen
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Rheumatology, VU Medical Center, Amsterdam UMC, Amsterdam, Netherlands
| | - Jimmy Wiegel
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Rheumatology, VU Medical Center, Amsterdam UMC, Amsterdam, Netherlands
| | - Merel J L'ami
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | | | | | - Franktien Turkstra
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Maarten Boers
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Epidemiology & Biostatistics, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Wouter H Bos
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
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23
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Krusche M, Klemm P, Grahammer M, Mucke J, Vossen D, Kleyer A, Sewerin P, Knitza J. Acceptance, Usage, and Barriers of Electronic Patient-Reported Outcomes Among German Rheumatologists: Survey Study. JMIR Mhealth Uhealth 2020; 8:e18117. [PMID: 32390592 PMCID: PMC7400039 DOI: 10.2196/18117] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/22/2020] [Accepted: 05/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background The use of patient-reported outcomes (PROs) allows for patient-centered, measurable, and transparent care. Electronic PROs (ePROs) have many benefits and hold great potential to improve current usage of PROs, yet limited evidence exists regarding their acceptance, usage, and barriers among rheumatologists. Objective This study aims to evaluate the current level of acceptance, usage, and barriers among German rheumatologists regarding the use of ePROs. The importance of different ePRO features for rheumatologists was investigated. Additionally, the most frequently used PROs for patients with rheumatoid arthritis (RA) were identified. Methods Data were collected via an online survey consisting of 18 questions. The survey was completed by members of the Working Group Young Rheumatology of the German Society for Rheumatology (Arbeitsgemeinschaft Junge Rheumatologie der Deutschen Gesellschaft für Rheumatologie [DGRh]) at the 2019 annual DGRh conference. Only members currently working in clinical adult rheumatology were eligible to complete the survey. Results A total of 119 rheumatologists completed the survey, of which 107 (89.9%) reported collecting PROs in routine practice and 28 (25.5%) already used ePROs. Additionally, 44% (43/97) were planning to switch to ePROs in the near future. The most commonly cited reason for not switching was the unawareness of suitable software solutions. Respondents were asked to rate the features of ePROs on a scale of 0 to 100 (0=unimportant, 100=important). The most important features were automatic score calculation and display (mean 77.50) and simple data transfer to medical reports (mean 76.90). When asked about PROs in RA, the respondents listed pain, morning stiffness, and patient global assessment as the most frequently used PROs. Conclusions The potential of ePROs is widely seen and there is great interest in them. Despite this, only a minority of physicians use ePROs, and the main reason for not implementing them was cited as the unawareness of suitable software solutions. Developers, patients, and rheumatologists should work closely together to help realize the full potential of ePROs and ensure a seamless integration into clinical practice.
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Affiliation(s)
- Martin Krusche
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin, Germany.,Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany
| | - Philipp Klemm
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology, Immunology, Osteology and Physical Medicine, Justus Liebig University Gießen, Campus Kerckhoff, Bad Nauheim, Germany
| | | | - Johanna Mucke
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology and Hiller Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Diana Vossen
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Rheinisches Rheumazentrum Meerbusch, St Elisabeth Hospital, Meerbusch, Germany
| | - Arnd Kleyer
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Philipp Sewerin
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology and Hiller Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Johannes Knitza
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
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24
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Desai S, Stevens E, Emani S, Meyers P, Iversen M, Solomon DH. Improving Quality of Care in Rheumatoid Arthritis Through Mobile Patient-Reported Outcome Measurement: Focus Group Study. JMIR Form Res 2020; 4:e15158. [PMID: 32459179 PMCID: PMC7316226 DOI: 10.2196/15158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/12/2019] [Accepted: 12/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) for chronic disease management can be integrated into the routine workflow by leveraging mobile technology. OBJECTIVE The objective of our study was to describe the process of our quality improvement (QI) efforts using tablets for PRO collection in a busy, academic rheumatology practice to support a treat-to-target (TTT) approach for rheumatoid arthritis (RA) management. METHODS Our QI team designed a process for routine collection of PROs for RA patients at the Arthritis Center, employing information technology and an electronic medical record (EMR) system. Patients received a tablet at the clinic check-in desk to complete the Routine Assessment of Patient Index Data 3 (RAPID3) survey, a validated RA PRO. RAPID3 scores were uploaded to the EMR in real time and available for use in shared decision making during routine office visits. Weekly data were collected on RAPID3 completion rates and shared with front desk staff and medical assistants to drive improvement. Patients in our patient family advisory council and focus groups provided informal feedback on the process. RESULTS From May 1, 2017, to January 31, 2019, a total of 4233 RAPID3 surveys were completed by 1691 patients. The mean age of patients was 63 (SD 14) years; 84.00% (1420/1691) of the patients were female, and 83.00% (1403/1691) of the patients were white. The rates of RAPID3 completion increased from 14.3% (58/405) in May 2017 to 68.00% (254/376) in September 2017 and were sustained over time through January 2019. Informal feedback from patients was positive and negative, relating to the usability of the tablet and the way rheumatologists used and explained the RAPID3 data in shared decision making during the office visit. CONCLUSIONS We designed a sustainable and reliable process for collecting PROs from patients with RA in the waiting room and integrated these data through the EMR during office visits.
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Affiliation(s)
- Sonali Desai
- Brigham & Women's Hospital, Boston, MA, United States
| | - Emma Stevens
- Brigham & Women's Hospital, Boston, MA, United States
| | - Srinivas Emani
- Division of General Medicine, Department of Medicine, Brigham & Women's Hospital, Boston, MA, United States
| | | | - Maura Iversen
- Department of Physical Therapy, Movement & Rehabilitation Services, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Daniel H Solomon
- Division of Rheumatology, Brigham & Women's Hospital, Boston, MA, United States
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25
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Mandl P, Aletaha D. The role of ultrasound and magnetic resonance imaging for treat to target in rheumatoid arthritis and psoriatic arthritis. Rheumatology (Oxford) 2020; 58:2091-2098. [PMID: 31518423 DOI: 10.1093/rheumatology/kez397] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/04/2019] [Accepted: 08/07/2019] [Indexed: 01/04/2023] Open
Abstract
The treat-to-target (T2T) approach has revolutionized the way we treat patients with rheumatic and musculoskeletal diseases. Recent attention has focused on imaging techniques, in particular musculoskeletal ultrasound and MRI as a focus for T2T strategies. Recently, a number of randomized clinical trials have been performed that compared tight clinical control vs control augmented by imaging techniques. While the three published trials have concluded that imaging does not add to tight clinical care, implementing imaging into the T2T strategy has actual advantages, such as the detection of subclinical involvement, and information on joint involvement/pathology and may possess potential advantages as evidenced by certain secondary endpoints. This review examines the findings of these studies and discusses the advantages and disadvantages of incorporating imaging into the T2T strategy.
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Affiliation(s)
- Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
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26
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Boone NW, Sepriano A, van der Kuy PH, Janknegt R, Peeters R, Landewé RBM. Routine Assessment of Patient Index Data 3 (RAPID3) alone is insufficient to monitor disease activity in rheumatoid arthritis in clinical practice. RMD Open 2019; 5:e001050. [PMID: 31908842 PMCID: PMC6927511 DOI: 10.1136/rmdopen-2019-001050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 11/04/2022] Open
Abstract
Objective To test the longitudinal association between patient-reported outcome, Routine Assessment of Patient Index Data 3 (RAPID3) and the Disease Activity Score in 28 joints that includes the erythrocyte sedimentation rate (DAS28-ESR) in routine-care patients with rheumatoid arthritis (RA). Methods Patients with RA treated with disease-modifying antirheumatic drugs were included in this prospective observational cohort. The longitudinal association between RAPID3 (0-10) and DAS28-ESR and its individual components (swollen joint count (SJC), erythrocyte sedimentation rate (ESR) (mm/hour), tender joint count (TJC) and patient global assessment (PGA)) was tested using generalised estimating equations in patients with more than two consecutive visits with data on RAPID3 and DAS28-ESR. Interactions between RAPID3 and gender, pain, PGA and age at baseline were tested, and if significant (p<0.20) and clinically relevant, models were fit in the corresponding strata. Results In total, 330 patients were included (mean follow-up 10.7 (SD 9.7) months, female gender 67.9%). The longitudinal association between RAPID3 and DAS28-ESR was weak (β=0.29 (95% CI 0.24 to 0.35), n=207), meaning that one unit increase in RAPID3 corresponded to a 0.29 unit increase in Disease Activity Score in 28 joints (DAS28). RAPID3 was most strongly associated with subjective (TJC: β=0.89 (95% CI 0.61 to 1.17); PGA: β=0.94 (95% CI 0.84 to 1.04)) and not with objective components of DAS28 (SJC: β=0.29 (95% CI 0.17 to 0.41), n=172). The association between RAPID3 and ESR was poor but modified by gender, being only significant in men (β=0.37 (95% CI 0.08 to 0.67)). Conclusions These data suggest that RAPID3 does not sufficiently capture changes in objective inflammatory signs. Monitoring by RAPID3 alone is therefore insufficient to follow disease activity in patients wth RA in clinical practice.
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Affiliation(s)
- Niels W Boone
- Department of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen, Limburg, The Netherlands
| | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Paul-Hugo van der Kuy
- Department of Clinical Pharmacy, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Rob Janknegt
- Department of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen, Limburg, The Netherlands
| | - Ralph Peeters
- Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Robert B M Landewé
- Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands.,Department of Rheumatology, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
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27
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England BR, Tiong BK, Bergman MJ, Curtis JR, Kazi S, Mikuls TR, O'Dell JR, Ranganath VK, Limanni A, Suter LG, Michaud K. 2019 Update of the American College of Rheumatology Recommended Rheumatoid Arthritis Disease Activity Measures. Arthritis Care Res (Hoboken) 2019; 71:1540-1555. [PMID: 31709779 DOI: 10.1002/acr.24042] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/13/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To provide updated American College of Rheumatology (ACR) recommendations on rheumatoid arthritis (RA) disease activity measurements to facilitate a treat-to-target approach in routine clinical care. METHODS A working group conducted a systematic literature review from the time of the prior ACR recommendations literature search. Properties of disease activity measures were abstracted, and study quality was assessed using the Consensus-Based Standards for the selection of Health Measurement Instruments 4-point scoring method, allowing for overall level of evidence assessment. Measures that fulfilled a minimum standard were identified, and through a modified Delphi process preferred measures were selected for regular use in most clinic settings. RESULTS The search identified 5,199 articles, of which 110 were included in the review. This search identified 46 RA disease activity measures that contained patient, provider, laboratory, and/or imaging data. Descriptions of the measures, properties, study quality, level of evidence, and feasibility were abstracted and scored. Following a modified Delphi process, 11 measures fulfilled a minimum standard for regular use in most clinic settings, and 5 measures were recommended: the Disease Activity Score in 28 Joints with Erythrocyte Sedimentation Rate or C-Reactive Protein Level, Clinical Disease Activity Index, Simplified Disease Activity Index, Routine Assessment of Patient Index Data 3, and Patient Activity Scale-II. CONCLUSION We have updated prior ACR recommendations for preferred RA disease activity measures, identifying 11 measures that met a minimum standard for regular use and 5 measures that were preferred for regular use in most clinic settings.
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Affiliation(s)
- Bryant R England
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | | | | | | | | | - Ted R Mikuls
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - James R O'Dell
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | | | | | - Lisa G Suter
- Yale University, New Haven, Connecticut, and VA Medical Center, West Haven, Connecticut
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD, the National Databank for Rheumatic Diseases, Wichita, Kansas
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28
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Barber CEH, Zell J, Yazdany J, Davis AM, Cappelli L, Ehrlich-Jones L, Everix D, Thorne JC, Bohm V, Suter L, Limanni A, Michaud K. 2019 American College of Rheumatology Recommended Patient-Reported Functional Status Assessment Measures in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2019; 71:1531-1539. [PMID: 31709771 DOI: 10.1002/acr.24040] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/08/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop American College of Rheumatology (ACR) recommendations for patient-reported Functional Status Assessment Measures (FSAMs) for use in routine clinical practice in patients with rheumatoid arthritis (RA). METHODS We convened a workgroup to conduct a systematic review of published literature through March 16, 2017 and abstract FSAM properties. Based upon initial search results and clinical input, we focused on the following FSAMs appropriate for routine clinical use: the Health Assessment Questionnaire (HAQ) and derived measures and the Patient-Reported Outcomes Measurement Information System (PROMIS) tool. We used the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 4-point scoring method to evaluate each FSAM, allowing for overall level of evidence assessment. We identified FSAMs fulfilling a predefined minimum standard and, through a modified Delphi process, selected preferred FSAMs for regular use in most clinic settings. RESULTS The search identified 11,835 articles, of which 56 were included in the review. Descriptions of the measures, properties, study quality, level of evidence, and feasibility were abstracted and scored. Following a modified Delphi process, 7 measures fulfilled the minimum standard for regular use in most clinic settings, and 3 measures were recommended: the PROMIS physical function 10-item short form (PROMIS PF10a), the HAQ-II, and the Multidimensional HAQ. CONCLUSION This work establishes ACR recommendations for preferred RA FSAMs for regular use in most clinic settings. These results will inform clinical practice and can support future ACR quality measure development as well as highlight ongoing research needs.
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Affiliation(s)
| | | | | | - Aileen M Davis
- Krembil Research Institute, University Health Network, and University of Toronto, Toronto, Ontario, Canada
| | | | | | - Donna Everix
- Mills Peninsula Health Services, Burlingame, California, and OnMyCare Home Health, Fremont, California
| | | | | | - Lisa Suter
- Yale University, New Haven, Connecticut, and Veterans Affairs Medical Center, West Haven, Connecticut
| | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD, the National Databank for Rheumatic Diseases, Wichita, Kansas
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29
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Batko B, Batko K, Krzanowski M, Żuber Z. Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis. J Clin Med 2019; 8:E1416. [PMID: 31500394 PMCID: PMC6780913 DOI: 10.3390/jcm8091416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/26/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022] Open
Abstract
Principles of treat-to-target (T2T) have been widely adopted in both multinational and regional guidelines for rheumatoid arthritis (RA). Several questionnaire studies among physicians and real-world data have suggested that an evidence-practice gap exists in RA management. Investigating physician adherence to T2T, which requires a process measure, is difficult. Different practice patterns among physicians are observed, while adherence to protocolized treatment declines over time. Rheumatologist awareness, agreement, and claims of adherence to T2T guidelines are not always consistent with medical records. Comorbidities, a difficult disease course, communication barriers, and individual preferences may hinder an intensive, proactive treatment stance. Interpreting deviations from protocolized treatment/T2T guidelines requires sufficient clinical context, though higher adherence seems to improve clinical outcomes. Nonmedical constraints in routine care may consist of barriers in healthcare structure and socioeconomic factors. Therefore, strategies to improve the institution of T2T should be tailored to local healthcare. Educational interventions to improve T2T adherence among physicians may show a moderate, although beneficial effect. Meanwhile, a proportion of patients with inadequately controlled RA exists, while management decisions may not be in accordance with T2T. Physicians tend to be aware of current guidelines, but their institution in routine practice seems challenging, which warrants attention and further study.
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Affiliation(s)
- Bogdan Batko
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Gustawa Herlinga-Grudźińskiego 1 St, 30-705 Cracow, Poland.
- Department of Rheumatology, J. Dietl Specialist Hospital, Skarbowa 1 St, 31-121 Cracow, Poland.
| | - Krzysztof Batko
- Chair and Head of Nephrology, Jagiellonian University Medical College, Kopernika St 15c, 31-501 Cracow, Poland.
| | - Marcin Krzanowski
- Chair and Head of Nephrology, Jagiellonian University Medical College, Kopernika St 15c, 31-501 Cracow, Poland.
| | - Zbigniew Żuber
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Gustawa Herlinga-Grudźińskiego 1 St, 30-705 Cracow, Poland.
- Ward for Older Children with Neurology and Rheumatology Subdivision, St. Louis Regional Specialised Children's Hospital, 31-503 Cracow, Poland.
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30
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Sanchez-Villamañan MDC, Gonzalez-Vargas J, Torricelli D, Moreno JC, Pons JL. Compliant lower limb exoskeletons: a comprehensive review on mechanical design principles. J Neuroeng Rehabil 2019; 16:55. [PMID: 31072370 PMCID: PMC6506961 DOI: 10.1186/s12984-019-0517-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 03/26/2019] [Indexed: 12/04/2022] Open
Abstract
Exoskeleton technology has made significant advances during the last decade, resulting in a considerable variety of solutions for gait assistance and rehabilitation. The mechanical design of these devices is a crucial aspect that affects the efficiency and effectiveness of their interaction with the user. Recent developments have pointed towards compliant mechanisms and structures, due to their promising potential in terms of adaptability, safety, efficiency, and comfort. However, there still remain challenges to be solved before compliant lower limb exoskeletons can be deployed in real scenarios. In this review, we analysed 52 lower limb wearable exoskeletons, focusing on three main aspects of compliance: actuation, structure, and interface attachment components. We highlighted the drawbacks and advantages of the different solutions, and suggested a number of promising research lines. We also created and made available a set of data sheets that contain the technical characteristics of the reviewed devices, with the aim of providing researchers and end-users with an updated overview on the existing solutions.
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Affiliation(s)
| | - Jose Gonzalez-Vargas
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Avda Doctor Arce, 37, E-28002 Madrid, Spain
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Avda Doctor Arce, 37, E-28002 Madrid, Spain
| | - Juan C. Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Avda Doctor Arce, 37, E-28002 Madrid, Spain
| | - Jose L. Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Avda Doctor Arce, 37, E-28002 Madrid, Spain
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31
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Okura C, Ishikawa H, Abe A, Yonemoto Y, Okamura K, Suto T, Oyakawa T, Miyagawa Y, Otani H, Ito S, Kobayashi D, Nakazono K, Murasawa A, Takagishi K, Chikuda H. Long-term patient reported outcomes of elbow, wrist and hand surgery for rheumatoid arthritis. Int J Rheum Dis 2018; 21:1701-1708. [PMID: 30187667 DOI: 10.1111/1756-185x.13340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM A retrospective questionnaire survey was conducted to investigate the long-term outcomes of elbow, wrist and hand surgery for rheumatoid arthritis (RA). METHODS One hundred and thirteen RA patients underwent primary elective elbow, wrist or hand surgery at our hospital between January 2002 and December 2003. To evaluate the outcomes at 10 years after surgery, the patient-reported outcomes were assessed using an original questionnaire that inquired about the site of treatment; the modified Stanford Health Assessment Questionnaire (mHAQ) was also used. RESULTS Responses were obtained from 67 patients (98 sites). In the 10 years after surgery, the Disease Activity Score of 28 joint - erythrocyte sedimentation rate (4) and the modified Health Assessment Questionnaire scores of the patients showed significant improvement. Nearly 85% of patients were satisfied with the outcome at the surgical site. The most frequent reason for perceived improvement was 'pain relief' (all surgical sites). An 'improved appearance' was frequently reported after finger surgery and 'increased power' was frequently reported after wrist and thumb surgeries. With regard to elbow surgery, 30% of the patients were satisfied with the increase in motion and power. In contrast, approximately 20% of patients complained of decreased power around the surgical site after elbow and thumb surgeries. CONCLUSIONS Our original patient-reported outcome assessment tool revealed that elbow, wrist and hand surgery provided long-lasting benefits in RA patients. While the efficacy differed in some of the surgical sites, pain relief was the most favorable effect. Altered medical therapy may also have impacted the patient-perceived outcomes of surgery at 10 years.
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Affiliation(s)
- Chisa Okura
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan.,Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hajime Ishikawa
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Asami Abe
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Yukio Yonemoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Koichi Okamura
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takahito Suto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tomo Oyakawa
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Yusuke Miyagawa
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Hiroshi Otani
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Satoshi Ito
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Daisuke Kobayashi
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Kiyoshi Nakazono
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Akira Murasawa
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.,Department of Orthopaedic Surgery, Saint-Pierre Hospital, Takasaki, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Fautrel B, Alten R, Kirkham B, de la Torre I, Durand F, Barry J, Holzkaemper T, Fakhouri W, Taylor PC. Call for action: how to improve use of patient-reported outcomes to guide clinical decision making in rheumatoid arthritis. Rheumatol Int 2018; 38:935-947. [PMID: 29564549 PMCID: PMC5953992 DOI: 10.1007/s00296-018-4005-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/03/2018] [Indexed: 01/05/2023]
Abstract
Current guidelines for the management of rheumatoid arthritis (RA) recommend early treatment and a treat-to-target goal of remission or low disease activity. Over the past decade, this approach has been extremely successful in reducing disease activity and joint damage in patients with RA. At the same time, however, overall patient perception of well-being appears to have decreased with respect to outcome measures considered important by patients themselves, such as pain, fatigue, physical function and quality of life. The timely and effective use of patient-reported outcomes (PROs) could encourage physicians to focus more on the impact of RA on patients and how patients are feeling. This in turn would facilitate shared decision making between patients and physicians, ultimately leading to a more patient-centered approach and improved patient care. Indeed, PROs provide information about individual patients that complements information provided by physical assessment and composite scores, and can also be used to guide patient care, such as determining whether a clinic visit is needed or whether treatment modifications are necessary. This is particularly important for patients who do not achieve the aspirational target of remission or low disease activity with pharmacological treatment. A number of validated PRO questionnaires are available, but how and which PROs should be incorporated into rheumatology clinical practice as part of the decision-making process is still controversial. Combining PROs with technology, such as computer adaptive tests, electronic PRO systems, web-based platforms and patient dashboards, could further aid PRO integration into daily rheumatology clinical practice.
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Affiliation(s)
- Bruno Fautrel
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Universitaire Paris 06, Paris, France
- Department of Rheumatology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rieke Alten
- Schlosspark-Klinik University Medicine, 14059, Berlin, Germany
| | - Bruce Kirkham
- Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK
| | | | | | - Jane Barry
- Eli Lilly and Company, Basingstoke, Hampshire, UK
| | | | - Walid Fakhouri
- Eli Lilly and Company, Indianapolis, IN, USA
- Eli Lilly and Company, Basingstoke, Hampshire, UK
| | - Peter C Taylor
- Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK.
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Højgaard P, Klokker L, Orbai AM, Holmsted K, Bartels EM, Leung YY, Goel N, de Wit M, Gladman DD, Mease P, Dreyer L, Kristensen LE, FitzGerald O, Tillett W, Gossec L, Helliwell P, Strand V, Ogdie A, Terwee CB, Christensen R. A systematic review of measurement properties of patient reported outcome measures in psoriatic arthritis: A GRAPPA-OMERACT initiative. Semin Arthritis Rheum 2018; 47:654-665. [DOI: 10.1016/j.semarthrit.2017.09.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/06/2017] [Indexed: 01/10/2023]
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Banderas B, Skup M, Shields AL, Stokes J, Foley C, Ganguli A. Psychometric evaluation of the Rheumatoid Arthritis Symptom Questionnaire (RASQ) in an observational study. Curr Med Res Opin 2017; 33:2121-2128. [PMID: 28885061 DOI: 10.1080/03007995.2017.1378173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To describe the psychometric performance of the scores produced by the Rheumatoid Arthritis Symptom Questionnaire (RASQ), a new patient-reported outcome (PRO) questionnaire developed to assess the signs and symptoms of rheumatoid arthritis (RA). METHODS Adult subjects with clinically confirmed RA completed a set of questionnaires (including the RASQ) at an initial study visit (Day 1), and then completed the RASQ and the Patient Global Impression of Change (PGI-C) on their own on Day 8. Demographic and health data were summarized using descriptive statistics, and psychometric analyses were conducted, including: acceptability, item and scale distribution, reliability (internal consistency and test-re-test reliability), and construct-related validity (convergent validity and known-groups methods). RESULTS In total, 200 subjects (females = 61.5%; white = 72.0%; and age [mean] = 60.7 years) with RA were recruited across the US and included in the analysis. There were no missing data recorded for the RASQ, and scores were well distributed for both timepoints. The RASQ Total Symptom Score surpassed the threshold (α ≥ 0.70) for internal consistency at Day 1 (α = 0.967) and test-re-test score reliability (intra-class correlation coefficient [ICC] > 0.70) (ICC = 0.960). Convergent validity analyses demonstrated that the RASQ items and Total Symptom Score had high correlations (convergent validity) with other PRO questionnaires. Known-groups methods demonstrated that the RASQ (Total Symptom Score and all single items) can differentiate between clinically distinct groups. CONCLUSIONS The RASQ is capable of producing psychometrically sound scores when administered to adults with RA.
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Cruz-Castillo Y, Montero N, Salazar-Ponce R, Villacís-Tamayo R. Quality of Life in Ecuadorian Patients With Rheumatoid Arthritis: A Cross-sectional Study. ACTA ACUST UNITED AC 2017; 15:296-300. [PMID: 29102587 DOI: 10.1016/j.reuma.2017.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/28/2017] [Accepted: 08/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate health-related quality of life (HRQoL) and associated clinical, demographic and socioeconomic factors in a cohort of Ecuadorian patients with rheumatoid arthritis (RA). PATIENTS AND METHODS A cross-sectional descriptive study evaluating (HRQoL) with the Spanish version of the Quality of Life Rheumatoid Arthritis (QoL-RA) instrument in patients diagnosed with RA according to the criteria of the American College of Rheumatology and the European League Against Rheumatism. In addition, the following data were obtained: age, sex, marital status, socioeconomic stratum, comorbidities, disease duration, medication, rheumatoid factor positivity, disease activity using the simplified disease activity index and physical functionality measured with the modified Health Assessment Questionnaire (MHAQ). RESULTS A total of 163 patients were assessed, the mean score of the QoL-RA scale was 6.84±1.5 points. The highest measurements were obtained in the domains of interaction (8.04±1.9) and support (8.01±2). The factors that were associated with the overall quality of life assessment were: functionality measured with MHAQ (r=-0.70; P<.001); disease duration in years (r=-0.178; P<.05); and disease activity (mean difference of 1.5; 95%CI: 1.09 to 1.91). CONCLUSION The patients evaluated had a good to moderate HRQoL. The domains related to support and social life were those with the highest scores and the lowest scores were related to pain and nervous tension. Functionality, duration, and disease activity were statistically associated with HRQoL.
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Affiliation(s)
| | - Nadia Montero
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador.
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Walker UA, Mueller RB, Jaeger VK, Theiler R, Forster A, Dufner P, Ganz F, Kyburz D. Disease activity dynamics in rheumatoid arthritis: patients' self-assessment of disease activity via WebApp. Rheumatology (Oxford) 2017; 56:1707-1712. [PMID: 28957553 PMCID: PMC5873216 DOI: 10.1093/rheumatology/kex229] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Indexed: 11/15/2022] Open
Abstract
Objectives The aim was to evaluate patient self-assessment of RA disease activity in terms of Routine Assessment of Patient Index Data (RAPID) scores via a Web-based smartphone application (WebApp). Methods In this prospective, multicentre study, adult RA patients were examined by a rheumatologist at baseline and after 3 months. Patients were asked to complete WebApp questionnaires weekly. The time course of patient-assessed RAPID3/4 scores and their correlations with rheumatologist-assessed DAS28, as well as Clinical and Simplified Disease Activity Indices (CDAI/SDAI), were evaluated. Results Eighty patients were included in the analysis (median RA duration, 4.5 years; age, 57 years; 59% female). At baseline, there was a moderate to strong correlation between RAPID3 and DAS28 (r = 0.63), CDAI (r = 0.65) and SDAI (r = 0.61) scores. Similar or stronger correlations were seen at the 3-month follow-up visit (DAS28 r = 0.66, CDAI r = 0.71 and SDAI r = 0.61). Similar correlations were seen between RAPID4 and rheumatologist assessments. Correlations were not influenced by demographics or RA treatment. In the 3-month period, the RAPID3 score changed into a higher severity category than the category at baseline at least once in 47% of patients. When DAS28 scores were predicted from the RAPID3, 11% of patients had an increase of > 1 DAS28 unit during the 3-month observation period. Conclusion Web-based patient assessments were strongly correlated with rheumatologist assessments of RA activity and showed considerable variation during follow-up. This provides a rationale for further exploration of their use as cost-effective tools to monitor RA activity between outpatient visits and to optimize tight control strategies.
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Affiliation(s)
- Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel
| | - Ruediger B Mueller
- Division of Rheumatology, Department of Internal Medicine, Kantonsspital St Gallen, St Gallen
| | | | | | - Adrian Forster
- Department of Rheumatology, Klinik St Katharinental, Diessenhofen
| | | | | | - Diego Kyburz
- Department of Rheumatology, University Hospital Basel, Basel
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Brown GA, Cotton A, Guinto J, Sharma A, Ciurtin C. Outcome measures of disease activity in inflammatory arthritis. Br J Hosp Med (Lond) 2017; 78:432-437. [PMID: 28783399 DOI: 10.12968/hmed.2017.78.8.432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The most common types of chronic inflammatory arthritis are rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. In order to assess the activity of these diseases and tailor therapy, several outcome measures have been developed. They include composite scores based on clinical findings, biochemical markers and patient questionnaires. This article discusses the most commonly used outcome measures and looks at their limitations in quantifying the complex clinical features of different types of inflammatory arthritis, focusing in particular on rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.
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Affiliation(s)
- Geraint A Brown
- Registrar, Department of Rheumatology, University College London Hospital NHS Trust, London
| | - Alice Cotton
- Clinical Research Nurse, Department of Rheumatology, University College London Hospital NHS Trust, London
| | - Jesusa Guinto
- Clinical Research Nurse, Department of Rheumatology, University College London Hospital NHS Trust, London
| | - Arti Sharma
- Clinical Trial Coordinator, Department of Rheumatology, University College London Hospital NHS Trust, London
| | - Coziana Ciurtin
- Consultant, Department of Rheumatology, University College London Hospital NHS Trust, London NW1 2PQ
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Eosinophilia in rheumatoid arthritis patients and its relation to disease activity: A single center experience from Kashmir, India. EGYPTIAN RHEUMATOLOGIST 2017. [DOI: 10.1016/j.ejr.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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