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Kunni K, Langegård U, Ohlsson-Nevo E, Kristensen I, Sjövall K, Fessé P, Åkeflo L, Ahlberg K, Fransson P. Symptom experience and symptom distress in patients with malignant brain tumor treated with proton therapy: A five-year follow-up study. Tech Innov Patient Support Radiat Oncol 2024; 31:100269. [PMID: 39280778 PMCID: PMC11402412 DOI: 10.1016/j.tipsro.2024.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/15/2024] [Accepted: 08/12/2024] [Indexed: 09/18/2024] Open
Abstract
Background and purpose Since patients with primary brain tumor are expected to become long-term survivors, the prevention of long-term treatment-induced side effects is particularly important. This study aimed to explore whether symptom experience and symptom distress change over five years in adults with primary brain tumors treated with proton therapy. An additional aim was to explore whether symptom experience and symptom distress correlate. Materials and methods The study had a longitudinal observational design. Adult (≥18 years) patients (n = 170) with primary brain tumors treated with proton therapy were followed over five years. Symptom experience and symptom distress were evaluated using the patient-reported Radiotherapy-Related Symptom Assessment Scale. Data from baseline, 1, 12, and 60 months were analyzed using non-parametric tests. Results Of the 170 patients, the levels of symptoms and symptom distress were low. Fatigue increased at 1 (p=0.005) and 12 months (p=0.025) and was the most frequent symptom from baseline to 60 months' follow-up. Cognitive impairment increased at 12 (p=0.027) and 60 months (p<0.001) and was the most distressing symptom at 60 months' follow-up. There were significant, moderate to strong, correlations at all time points between symptom experience and symptom distress of fatigue, insomnia, pain, dyspnea, cognitive impairment, worry, anxiety, nausea, sadness, constipation, and skin reactions. Conclusion Symptom experience and symptom distress changed in intensity over time with cognitive impairment as the most distressing symptom at 60 months. Future research should focus on identifying effective interventions aimed at alleviating these symptoms and reducing symptom distress for this vulnerable group of patients.
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Affiliation(s)
- Kristin Kunni
- Skandion Clinic, Uppsala, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Ulrica Langegård
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Emma Ohlsson-Nevo
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ingrid Kristensen
- Department of Haematology, Oncology and Radiation Physics, Lund University Hospital, Lund, Sweden
- Department of Clinical Sciences, Oncology and Pathology, Lund University, Lund, Sweden
| | - Katarina Sjövall
- Department of Health and Society, Kristianstad University, Kristianstad, Sweden
| | - Per Fessé
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Linda Åkeflo
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Karin Ahlberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Per Fransson
- Department of Nursing, Umeå University, Umeå, Sweden
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Cella D, de la Loge C, Fofana F, Guo S, Ellis A, Fleurinck C, Massow U, Dougados M, Navarro-Compán V, Walsh JA. The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) scale in patients with axial spondyloarthritis: psychometric properties and clinically meaningful thresholds for interpretation. J Patient Rep Outcomes 2024; 8:92. [PMID: 39133438 PMCID: PMC11319684 DOI: 10.1186/s41687-024-00769-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/24/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Fatigue is an important symptom for most patients with axial spondyloarthritis (axSpA). The FACIT-Fatigue is a 13-item patient-reported outcome (PRO) instrument that has been used in axSpA clinical trials to measure fatigue severity and impact on daily activities. However, the psychometric properties of the FACIT-Fatigue are not fully evaluated across the entire spectrum of axSpA including non-radiographic axSpA (nr-axSpA) and radiographic axSpA (r-axSpA). This study determined: (1) the psychometric properties of the FACIT-Fatigue in nr-axSpA, r-axSpA, and the broad axSpA population and (2) FACIT-Fatigue scores representing meaningful within-patient change (MWPC), meaningful between-group differences, and cross-sectional severity bands. METHODS Data from two Phase 3 trials in adults with nr-axSpA (BE MOBILE 1; N = 254) and r-axSpA (BE MOBILE 2; N = 332) were analyzed pooled and separately to assess the psychometric properties of the FACIT-Fatigue. MWPC and meaningful between-group difference estimates were derived using anchor-based and distribution-based methods. Cross-sectional fatigue severity bands were estimated using logistic regression analysis. RESULTS The FACIT-Fatigue presented good internal consistency, adequate convergent and known-groups validity, and was sensitive to change over time across the full axSpA spectrum. A 5-11-point increase in FACIT-Fatigue score was estimated to represent a MWPC, with an 8-point increase selected as the responder definition. A 2.14-5.34-point difference in FACIT-Fatigue score change over a 16-week period was estimated to represent a small-to-medium meaningful between-group difference. FACIT-Fatigue score severity bands were defined as: none or minimal (>40), mild (>30 to ≤40), moderate (>21 to ≤30), and severe (≤21). CONCLUSIONS These findings support the use of the FACIT-Fatigue as a fit-for-purpose measure to assess fatigue-related treatment benefit in axSpA clinical trials. The proposed score estimates and thresholds can guide FACIT-Fatigue score interpretation across the full axSpA spectrum. TRIAL REGISTRATION ClinicalTrials.Gov, NCT03928704. Registered 26 April 2019-Retrospectively registered, https://classic. CLINICALTRIALS gov/ct2/show/NCT03928704 . CLINICALTRIALS Gov, NCT03928743. Registered 26 April 2019-Retrospectively registered, https://classic. CLINICALTRIALS gov/ct2/show/NCT03928743 .
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Affiliation(s)
- David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA.
| | | | | | | | | | | | | | - Maxime Dougados
- Department of Rheumatology, Hôpital Cochin, University Paris Cité, Paris, France
| | | | - Jessica A Walsh
- Salt Lake City Veterans Affairs Health and University of Utah Health, Salt Lake City, UT, USA
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Dubreuil M, Navarro-Compán V, Boonen A, Gaffney K, Gensler LS, de la Loge C, Vaux T, Fleurinck C, Massow U, Taieb V, Mørup MF, Deodhar A, Rudwaleit M. Improved physical functioning, sleep, work productivity and overall health-related quality of life with bimekizumab in patients with axial spondyloarthritis: results from two phase 3 studies. RMD Open 2024; 10:e004202. [PMID: 38834351 PMCID: PMC11163688 DOI: 10.1136/rmdopen-2024-004202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/08/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE To assess the impact of bimekizumab on physical functioning, sleep, work productivity and overall health-related quality of life (HRQoL) in patients with non-radiographic (nr-) and radiographic (r-) axial spondyloarthritis (axSpA) in the phase 3 studies BE MOBILE 1 and 2. METHODS Patients were randomised to subcutaneous bimekizumab 160 mg or placebo every 4 weeks; from Week 16, all patients received bimekizumab 160 mg every 4 weeks. We report the following outcomes to Week 52: Bath Ankylosing Spondylitis Functional Index (BASFI), Medical Outcomes Study Sleep Scale Revised (MOS-Sleep-R) Index II, Work Productivity and Activity Impairment: axSpA (WPAI:axSpA), Short Form-36 Physical and Mental Component Summary (SF-36 PCS/MCS) and Ankylosing Spondylitis Quality of Life (ASQoL). RESULTS At Week 16, bimekizumab-randomised patients demonstrated significantly greater improvement from baseline versus placebo in BASFI, SF-36 PCS and ASQoL (p<0.001), and numerically greater improvements in MOS-Sleep-R Index II and WPAI:axSpA scores. Higher proportions of bimekizumab-randomised versus placebo-randomised patients at Week 16 achieved increasingly stringent thresholds for improvements in BASFI (0 to ≤4), and thresholds for meaningful improvements in SF-36 PCS (≥5-point increase from baseline) and ASQoL (≥4-point decrease from baseline). Responses were sustained or further improved to Week 52, where 60%-70% of bimekizumab-treated patients achieved BASFI ≤4 and meaningful improvements in SF-36 PCS and ASQoL, regardless of whether originally randomised to bimekizumab or placebo. CONCLUSION Bimekizumab treatment led to early improvements in physical function, sleep, work productivity and overall HRQoL at Week 16 in patients across the full axSpA disease spectrum. Improvements were sustained to Week 52. TRIAL REGISTRATION NUMBERS NCT03928704; NCT03928743.
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Affiliation(s)
- Maureen Dubreuil
- Department of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Care and Public Health Research Institute (Caphri), Maastricht University, Maastricht, The Netherlands
| | - Karl Gaffney
- Norfolk and Norwich University Hospital NHS Trust, Norfolk, UK
| | - Lianne S Gensler
- Department of Medicine/Rheumatology, University of California San Francisco, San Francisco, California, USA
| | | | | | | | | | | | | | - Atul Deodhar
- Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
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Navarro-Compán V, Ramiro S, Deodhar A, Mease PJ, Rudwaleit M, de la Loge C, Fleurinck C, Taieb V, Mørup MF, Massow U, Kay J, Magrey M. Association of clinical response criteria and disease activity levels with axial spondyloarthritis core domains: results from two phase 3 randomised studies, BE MOBILE 1 and 2. RMD Open 2024; 10:e004040. [PMID: 38599650 PMCID: PMC11015249 DOI: 10.1136/rmdopen-2023-004040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVE To assess how achievement of increasingly stringent clinical response criteria and disease activity states at week 52 translate into changes in core domains in patients with non-radiographic (nr-) and radiographic (r-) axial spondyloarthritis (axSpA). METHODS Patients in BE MOBILE 1 and 2 achieving different levels of response or disease activity (Assessment of SpondyloArthritis International Society (ASAS) and Ankylosing Spondylitis Disease Activity Score (ASDAS) response criteria, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI50)) at week 52 were pooled, regardless of treatment arm. Associations between achievement of these endpoints and change from baseline (CfB) in patient-reported outcomes (PROs) measuring core axSpA domains, including pain, fatigue, physical function, overall functioning and health, and work and employment, were assessed. RESULTS Achievement of increasingly stringent clinical efficacy endpoints at week 52 was generally associated with sequentially greater improvements from baseline in all PROs. Patients with nr-axSpA achieving ASAS40 demonstrated greater improvements (CfB) than patients who did not achieve ASAS40 but did achieve ASAS20, in total spinal pain (-5.3 vs -2.8, respectively), Functional Assessment of Chronic Illness-Fatigue subscale (12.7 vs 6.7), Bath Ankylosing Spondylitis Function Index (-3.9 vs -1.8), European Quality of Life 5-Dimension 3-Level Version (0.30 vs 0.16), Work Productivity and Activity Impairment-axSpA presenteeism (-35.4 vs -15.9), overall work impairment (-36.5 vs -12.9), activity impairment (-39.0 vs -21.0) and sleep (9.0 vs 3.9). Results were similar for ASDAS and BASDAI50. Similar amplitudes of improvement were observed between patients with nr-axSpA and r-axSpA. CONCLUSIONS Patients treated with bimekizumab across the full axSpA disease spectrum, who achieved increasingly stringent clinical response criteria and lower disease activity at week 52, reported larger improvements in core axSpA domains.
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Affiliation(s)
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
- Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | - Atul Deodhar
- Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Philip J Mease
- School of Medicine, Swedish Medical Center and University, Seattle, Washington, USA
| | - Martin Rudwaleit
- Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | | | | | | | | | | | - Jonathan Kay
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Marina Magrey
- Case Western Reserve University, Cleveland, Ohio, USA
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Webers C, Boonen A, Vonkeman HE, van Tubergen A. Factors Associated With Residual Disease in Axial Spondyloarthritis: Results From a Clinical Practice Registry. J Rheumatol 2023; 50:1430-1438. [PMID: 37453735 DOI: 10.3899/jrheum.2023-0194] [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] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To explore residual disease, defined as substantial symptoms and disease burden despite a remission or low disease activity (LDA) state, in patients with axial spondyloarthritis (axSpA), and to determine which factors are associated with residual disease. METHODS For this cross-sectional observational study, 1 timepoint per patient was used from SpA-Net, a web-based monitoring registry for SpA. Patients with an Ankylosing Spondylitis Disease Activity Score (ASDAS) < 2.1 (LDA) were included. Indicators of residual disease (outcomes) included fatigue (primary outcome), pain, physical functioning, health-related quality of life (HRQOL), and peripheral symptoms. Sex was the primary explanatory factor for residual disease. Other explanatory factors included demographics and disease-related factors. Associations between these factors and presence and extent of residual disease were explored using logistic and linear regression. RESULTS In total, 267 patients in an LDA state were included. Mean age was 50.6 (SD 14.3) years and 100 (37.5%) were female. Residual disease occurred frequently (n = 114 [42.7%] had fatigue scores > 4/10; n = 34 [17.8%] had pain scores > 4/10), including in those in remission (ASDAS < 1.3). Physical HRQOL was reduced in 27% and moderate/poor in 33%. Multivariable regression analyses showed that reported fatigue was more severe and prevalent in female patients (fatigue severity [0-10]: Bfemale = 0.78, 95% CI 0.18-1.38; fatigue > 4/10: ORfemale = 3.29, 95% CI 1.74-6.20). Other indicators of residual disease (ie, pain, peripheral symptoms, physical HRQOL) were also more severe and/or more prevalent in females. CONCLUSION Residual disease is frequent in patients with axSpA who are in an LDA state, including remission, and it is particularly prevalent in female patients. Future studies should address how to manage or prevent residual disease in axSpA.
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Affiliation(s)
- Casper Webers
- C. Webers, MD, PhD, A. Boonen, MD, PhD, A. van Tubergen, MD, PhD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, and Care and Public Health Research Institute, Maastricht University, Maastricht;
| | - Annelies Boonen
- C. Webers, MD, PhD, A. Boonen, MD, PhD, A. van Tubergen, MD, PhD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, and Care and Public Health Research Institute, Maastricht University, Maastricht
| | - Harald E Vonkeman
- H.E. Vonkeman, MD, PhD, Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, and Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands
| | - Astrid van Tubergen
- C. Webers, MD, PhD, A. Boonen, MD, PhD, A. van Tubergen, MD, PhD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, and Care and Public Health Research Institute, Maastricht University, Maastricht
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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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Kim S, Xu Y, Dore K, Gewurtz R, Larivière N, Letts L. Fatigue self-management led by occupational therapists and/or physiotherapists for chronic conditions: A systematic review and meta-analysis. Chronic Illn 2022; 18:441-457. [PMID: 34515530 PMCID: PMC9397391 DOI: 10.1177/17423953211039783] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effectiveness of occupational therapist-/physiotherapist-guided fatigue self-management for individuals with chronic conditions. METHODS Eight databases, including MEDLINE and EMBASE, were searched until September 2019 to identify relevant studies. Randomised controlled trials and quasi-experimental studies of self-management interventions specifically developed or delivered by occupational therapists/physiotherapists to improve fatigue symptoms of individuals with chronic conditions were included. A narrative synthesis and meta-analysis were conducted to determine the effectiveness of fatigue self-management. RESULTS Thirty-eight studies were included, and fatigue self-management approaches led by occupational therapists/physiotherapists were divided into six categories based on the intervention focus: exercise, energy conservation, multimodal programmes, activity pacing, cognitive-behavioural therapy, and comprehensive fatigue management. While all exercise programmes reported significant improvement in fatigue, other categories showed both significant improvement and no improvement in fatigue. Meta-analysis yielded a standardised mean difference of the overall 13 studies: 0.42 (95% confidence interval:-0.62 to - 0.21); standardised mean difference of the seven exercise studies was -0.55 (95% confidence interval: -0.78 to -0.31). DISCUSSION Physical exercises inspired by the self-management principles may have positive impacts on fatigue symptoms, quality of life, and other functional abilities.
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Affiliation(s)
- Sungha Kim
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Ying Xu
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Kelly Dore
- Department of Medicine, 12362McMaster Education Research, Innovation & Theory (MERIT), 12370David Braley Health Science Centre, Hamilton, ON, Canada
| | - Rebecca Gewurtz
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Nadine Larivière
- Department of Medicine, 12362McMaster Education Research, Innovation & Theory (MERIT), 12370David Braley Health Science Centre, Hamilton, ON, Canada
| | - Lori Letts
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
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Navarro-Compán V, Wei JCC, Van den Bosch F, Magrey M, Wang L, Fleishaker D, Cappelleri JC, Wang C, Wu J, Dina O, Fallon L, Strand V. Effect of tofacitinib on pain, fatigue, health-related quality of life and work productivity in patients with active ankylosing spondylitis: results from a phase III, randomised, double-blind, placebo-controlled trial. RMD Open 2022; 8:e002253. [PMID: 35654457 PMCID: PMC9163535 DOI: 10.1136/rmdopen-2022-002253] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/31/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) impacts quality of life. We assessed patient-reported outcomes (PROs), pain, fatigue, health-related quality of life (HRQoL) and work productivity in a phase III trial of tofacitinib. METHODS Adults with AS and with inadequate response/intolerance to ≥2 non-steroidal anti-inflammatory drugs received tofacitinib 5 mg twice daily or placebo for 16 weeks. Afterwards, all received open-label tofacitinib until week 48. Change from baseline to week 48 was determined for PROs: total back pain; nocturnal spinal pain; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) overall spinal pain (Q2); Functional Assessment of Chronic Illness Therapy-Fatigue; BASDAI fatigue (Q1); AS Quality of Life (ASQoL); Short Form-36 Health Survey Version 2 (SF-36v2); EuroQoL-Five Dimension-Three Level health profile and Visual Analogue Scale; and the Work Productivity and Activity Impairment (WPAI) questionnaire. Improvements from baseline ≥minimum clinically important difference, and scores ≥normative values at week 16 were evaluated. RESULTS In 269 randomised and treated patients, at week 16, there were greater least squares mean improvements from baseline with tofacitinib 5 mg twice daily versus placebo in BASDAI overall spinal pain (-2.85 vs -1.34), BASDAI fatigue (-2.36 vs -1.08), ASQoL (-4.03 vs -2.01) and WPAI overall work impairment (-21.49 vs -7.64) (all p<0.001); improvements continued/increased to week 48. Improved spinal pain with tofacitinib was seen by week 2. Patients receiving tofacitinib reported clinically meaningful PRO improvements at week 16. Percentages with PRO scores ≥normative values at week 16 were greater with tofacitinib in SF-36v2 Physical Component Summary, physical functioning and bodily pain domains (p≤0.05). CONCLUSIONS In patients with AS, treatment with tofacitinib 5 mg twice daily resulted in clinically meaningful improvements in pain, fatigue, HRQoL and work productivity versus placebo to week 16, which were sustained to week 48. TRIAL REGISTRATION NUMBER NCT03502616.
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Affiliation(s)
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology and Institute of Medicine, College of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent, Belgium
| | - Marina Magrey
- Case Western Reserve University School of Medicine, Division of Rheumatology, University Hospital of Cleveland, Cleveland, Ohio, USA
| | - Lisy Wang
- Pfizer Inc, Groton, Connecticut, USA
| | | | | | | | - Joseph Wu
- Pfizer Inc, Groton, Connecticut, USA
| | | | | | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
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Krishnan S, Sarda S, Kunzweiler C, Wu M, Sundaresan S, Huynh L, Duh MS, Escalante CP. Literature Review of Fatigue Scales and Association with Clinically Meaningful Improvements in Outcomes Among Patients With and Without Paroxysmal Nocturnal Hemoglobinuria. Adv Ther 2022; 39:1959-1975. [PMID: 35316499 PMCID: PMC9056457 DOI: 10.1007/s12325-022-02111-7] [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: 01/16/2022] [Accepted: 03/02/2022] [Indexed: 11/15/2022]
Abstract
Introduction Paroxysmal nocturnal hemoglobinuria (PNH) is a rare blood disorder characterized by anemia and debilitating fatigue. Limited evidence characterizes the association between hemoglobin, an indicator of anemia and disease activity, and patient-reported fatigue scales. This review identifies benchmarks for clinically meaningful improvements in patients with and without PNH. Methods MEDLINE, Embase, Cochrane, and PsycINFO databases were searched along with Google Scholar to identify publications for patients with and without PNH. Full-text articles and conference abstracts of clinical trials or observational studies that examined patient-reported fatigue or associations between fatigue and hemoglobin were included. Results Fourteen publications were included in this study. Four clinical trials conducted in patients with PNH reported that patients achieved and sustained clinically meaningful improvements in fatigue. However, these studies did not examine the association between fatigue and hemoglobin. Ten studies conducted in patients with cancer and anemia (with or without chemotherapy) demonstrated an association between increased hemoglobin and improvements in fatigue (P < 0.05). The greatest incremental gain in fatigue improvement was observed when hemoglobin increased from 11 to 12 g/dL. Conclusion Evidence among patients with cancer without PNH demonstrates that increased hemoglobin levels are associated with clinically significant improvements in fatigue. Future studies should validate this relationship among patients with PNH. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02111-7.
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Elera-Fitzcarrald C, Rocha J, Burgos PI, Ugarte-Gil MF, Petri M, Alarcón GS. Measures of Fatigue in Patients With Rheumatic Diseases: A Critical Review. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:369-409. [PMID: 33091265 DOI: 10.1002/acr.24246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
Affiliation(s)
| | - Judith Rocha
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula I Burgos
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuel F Ugarte-Gil
- Hospital Guillermo Almenara Irigoyen, and Universidad Científica del Sur, Lima, Peru
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Graciela S Alarcón
- University of Alabama at Birmingham, and Universidad Peruana Cayetano Heredia, Lima, Peru
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Ogdie A, Duarte-García A, Hwang M, Navarro-Compán V, van der Heijde D, Mease P. Measuring Outcomes in Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:47-71. [PMID: 33091248 DOI: 10.1002/acr.24266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Mark Hwang
- University of Texas Health Science Center at Houston
| | | | | | - Philip Mease
- Swedish Medical Center, Providence St. Joseph Health, and University of Washington School of Medicine, Seattle
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12
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Ohlsson-Nevo E, Ahlgren J, Karlsson J. Impact of health-related stigma on psychosocial functioning in cancer patients: Construct validity of the stigma-related social problems scale. Eur J Cancer Care (Engl) 2020; 29:e13312. [PMID: 32865867 PMCID: PMC7757179 DOI: 10.1111/ecc.13312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 07/06/2020] [Accepted: 08/07/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the validity of Stigma-related Social Problems scale (SSP) in a cancer population. MATERIALS AND METHODS The SSP was sent to 1,179 cancer patients. Mean age was 67.9 year and 43% were women. Tests of internal consistency reliability, construct validity, item-scale convergent validity, ceiling and floor effects and known-group validity were conducted. RESULTS The response rate was 62%, and the final sample comprised 728 patients. Reliability coefficients were high for both subscales (Cronbach's alpha = 0.94). Exploratory factor analyses confirmed the unidimensionality and homogeneity of the scales. Item-scale correlations for both scales indicated satisfactory item-scale convergent validity. The proportion of subjects scoring at the lowest possible score level was 26% for the Distress scale and 28% for the Avoidance scale, while ceiling effects were marginal (<1%). The proportion of missing items was low, ranging from 1.4% to 1.5%. Known-group validity tests confirmed that the scales could capture expected differences between subgroups. CONCLUSIONS The SSP scale is a feasible instrument with sound psychometric properties that is validated in a study on 728 cancer patients. The instrument can be used to identify cancer patients at risk for psychosocial disturbances and thus in need of support.
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Affiliation(s)
- Emma Ohlsson-Nevo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Johan Ahlgren
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Regional Oncological Centre Uppsala-Örebro, Uppsala, Sweden
| | - Jan Karlsson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
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13
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Langegård U, Fransson P, Johansson B, Ohlsson-Nevo E, Sjövall K, Ahlberg K. Development and initial psychometric evaluation of a radiotherapy-related symptom assessment tool, based on data from patients with brain tumours undergoing proton beam therapy. Scand J Caring Sci 2020; 35:796-804. [PMID: 32720338 DOI: 10.1111/scs.12894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Currently, no available tool easily and effectively measures both the frequency, intensity and distress of symptoms among patients receiving radiotherapy. A core symptom set (fatigue, insomnia, pain, appetite loss, cognitive problems, anxiety, nausea, depression, constipation, diarrhoea and skin reaction) has been identified and assessed across oncology research to better understand the pattern of symptoms and treatment side effects. AIM The aim was to develop a tool measuring the multiple-symptom experience in patients undergoing radiotherapy and evaluate its psychometric properties (validity, reliability and responsiveness). DESIGN This study has a prospective, longitudinal and quantitative design. METHODS We developed a patient-reported outcome questionnaire, the Radiotherapy-Related Symptoms Assessment Scale to assess the frequency, intensity and distress associated with symptoms. Patients (n = 175) with brain tumours undergoing proton beam therapy completed the Radiotherapy-Related Symptoms Assessment Scale and the health-related quality of life questionnaire (EORTC QLQ-C30) during treatment. We assessed the validity, reliability and responsiveness of the Radiotherapy-Related Symptoms Assessment Scale and evaluated the validity against QLQ-C30. RESULTS There were significant questionnaire-questionnaire correlations regarding selected items, primarily fatigue, insomnia and pain, indicating satisfactory criterion-related validity. The Radiotherapy-Related Symptoms Assessment Scale had fair to good retest reliability. CONCLUSION The Radiotherapy-Related Symptoms Assessment Scale is a valid instrument for assessing symptom intensity and distress in patients with brain tumour undergoing PBT, with psychometric properties within the expected range. The Radiotherapy-Related Symptoms Assessment Scale provides nurses with substantial information on symptom experience but requires little effort from the patient. Additional studies are required to further assess the psychometric properties in patients with different cancer diagnoses receiving conventional radiotherapy.
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Affiliation(s)
- Ulrica Langegård
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Fransson
- Department of Nursing, Norrland University Hospital, Umeå University, Umeå, Sweden.,Cancer Center, Norrlands University Hospital, Umeå, Sweden
| | - Birgitta Johansson
- Experimental Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Emma Ohlsson-Nevo
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Katarina Sjövall
- Department of Health and Society, Kristianstad University, Kristianstad, Sweden
| | - Karin Ahlberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abstract
PURPOSE OF REVIEW Patients with ankylosing spondylitis (AS) warrant a comprehensive clinical assessment because of the lack of biomarkers of disease activity, prognosis and response to biologic therapy. Multiple AS-related questionnaires have been developed to assess the disease status accurately, but feasibility remains a problem in clinical practice. The purpose of this review is to assess the pearls and pitfalls of AS-related outcome measures. RECENT FINDINGS Single-item questionnaires to measure pain, stiffness and fatigue in patients with AS are easily administrable but may lack a sufficient degree of responsiveness on an individual patient level. The Bath Ankylosing Disease Activity Index remains the gold standard for assessing disease activity in a routine practice, despite poor correlation with C-reactive protein (CRP) levels and MRI inflammation. The Ankylosing Spondylitis Disease Activity Score, a validated and highly discriminatory tool for assessing disease activity in AS, has been developed but lacks feasibility as erythrocytic sedimentation rate and CRP values are often not available during a clinic visit. RAPID-3 appears feasible to assess patients with AS quantitatively over time in busy clinical settings. SUMMARY The assessment of disease status in AS is complex and is impacted by multiple factors. The biggest challenge in AS is to incorporate the disease-specific indices into a routine practice. VIDEO ABSTRACT: http://links.lww.com/COR/A42.
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15
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Shmidt E, Suárez-Fariñas M, Mallette M, Moniz H, Bright R, Shah SA, Merrick M, Shapiro J, Xu F, Saha S, Sands BE. Erectile Dysfunction Is Highly Prevalent in Men With Newly Diagnosed Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:1408-1416. [PMID: 30861068 PMCID: PMC10424100 DOI: 10.1093/ibd/izy401] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Cross-sectional studies on sexual function in men with inflammatory bowel disease (IBD) yield mixed results. Using a prospective incidence cohort, we aimed to describe sexual function at baseline and over time and to identify factors associated with impaired sexual function in men with IBD. METHODS Men 18 years and older enrolled between April 2008 and January 2013 in the Ocean State Crohn's and Colitis Area Registry (OSCCAR) with a minimum of 2 years of follow-up were eligible for study. Male sexual function was assessed using the International Index of Erectile Function (IIEF), a self-administered questionnaire that assesses 5 dimensions of sexual function over the most recent 4 weeks. To assess changes in the IIEF per various demographic and clinical factors, linear mixed effects models were used. RESULTS Sixty-nine of 82 eligible men (84%) completed the questionnaire (41 Crohn's disease, 28 ulcerative colitis). The mean age (SD) of the cohort at diagnosis was 43.4 (19.2) years. At baseline, 39% of men had global sexual dysfunction, and 94% had erectile dysfunction. Independent factors associated with erectile dysfunction are older age and lower physical and mental component summary scores on the Short Form Health Survey (SF-36). CONCLUSION In an incident cohort of IBD patients, most men had erectile dysfunction. Physicians should be aware of the high prevalence of erectile dysfunction and its associated risk factors among men with newly diagnosed IBD to direct multidisciplinary treatment planning.
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Affiliation(s)
- E Shmidt
- University of Minnesota, Division of Gastroenterology, Hepatology and Nutrition, Minneapolis, Minnesota, USA
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - M Suárez-Fariñas
- Department of Population Health Science and Policy, Department of Genetics and Genomics Science, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - M Mallette
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - H Moniz
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - R Bright
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - S A Shah
- The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - M Merrick
- Crohn's & Colitis Foundation of America, New York, New York, USA
| | - J Shapiro
- Division of Pediatric Gastroenterology, Nutrition, and Liver Diseases, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - F Xu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S Saha
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - B E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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16
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Amo-Setién FJ, Abajas-Bustillo R, Torres-Manrique B, Martín-Melón R, Sarabia-Cobo C, Molina-Mula J, Ortego-Mate C. Characteristics of nursing interventions that improve the quality of life of people with chronic diseases. A systematic review with meta-analysis. PLoS One 2019; 14:e0218903. [PMID: 31233569 PMCID: PMC6590814 DOI: 10.1371/journal.pone.0218903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/11/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The objective of this systematic review was to determine the characteristics of the interventions conducted by nurses that attempt to improve the health related quality of life (HRQoL) of people over 18 years of age with chronic diseases. METHODS This systematic review with meta-analysis summarizes 24 studies, conducted in 10 countries, that evaluated HRQoL through the Short-Form Health Survey (SF). Five databases were accessed to find the available studies from December 31st, 2000 to May 22sd, 2017. Selected studies were coded according to the characteristics of the sample and the intervention. A model of random effects was adopted for the overall estimation and to explain the heterogeneity. RESULTS Twenty-four studies were included in the systematic review and meta-analysis providing a sample of 4324 chronic patients aged 63.4 years. Among the 8 subscales and two summary measures that comprise the SF-36, only an overall significant effect size (ES) index was found in the Mental Health Component summary score (ES = 0.14; 95% CI:0.03 - 0.26; I2 = 44.6, p = 0.042) and the Mental Health subscale. This improvement on HRQoL was associated to interventions on "Case Management" and "Treatments and Procedures", which were based on a theory, were of shorter duration, and had a follow-up period. CONCLUSIONS Interventions targeting people with chronic diseases resulted in a slight increase in the HRQoL that was not always significant, which suggests that there is a need for their continuous improvement.
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Affiliation(s)
| | | | | | | | - Carmen Sarabia-Cobo
- Faculty of Nursing, University of Cantabria, IDIVAL Nursing Group, Santander, Spain
| | - Jesús Molina-Mula
- Nursing and Physiotherapy Department, University of Illes Balears, Palma, Spain
| | - Carmen Ortego-Mate
- Faculty of Nursing, University of Cantabria, IDIVAL Nursing Group, Santander, Spain
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17
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Amo-Setién FJ, Abajas-Bustillo R, Torres-Manrique B, Martín-Melón R, Sarabia-Cobo C, Molina-Mula J, Ortego-Mate C. Characteristics of nursing interventions that improve the quality of life of people with chronic diseases. A systematic review with meta-analysis. PLoS One 2019. [DOI: https://doi.org/10.1371/journal.pone.0218903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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18
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Shmidt E, Suárez-Fariñas M, Mallette M, Moniz H, Bright R, Shah SA, Merrick M, Shapiro J, Xu F, Sands B, Saha S. A Longitudinal Study of Sexual Function in Women With Newly Diagnosed Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:1262-1270. [PMID: 30726913 PMCID: PMC11079919 DOI: 10.1093/ibd/izy397] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/07/2018] [Accepted: 12/20/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The literature provides conflicting data on sexual function in women with inflammatory bowel disease (IBD). We aim to describe sexual function at baseline and over time in a prospective inception cohort of adult women with IBD. METHODS Women age 18 years or older enrolled in the Ocean State Crohn's & Colitis Area Registry (OSCCAR) with 2 years of prospective follow-up were included in the study. All subjects were enrolled within 1 year of IBD diagnosis. Female sexual function was assessed using the Female Sexual Function Index (FSFI). Linear mixed effects models were used to assess changes in FSFI by various demographic and clinical factors. RESULTS One hundred sixteen of 130 eligible women (89%) were included in the study. Ninety-seven percent of women had sexual dysfunction, defined as an FSFI score of <26.55, with a baseline mean FSFI score (SD) of 16.4 (8.4) overall (15.5 [8.6] in Crohn's disease, 17.4 [8.1] in UC, P = 0.22). Despite improvement in overall disease activity, there was no significant change in the FSFI score or individual domain scores over the entire 2-year study period. Among all women with IBD, older age, nonsingle marital status, lower Short Form Health Survey (SF-36) Physical Component Summary score, and the use of biologics were independent risk factors for sexual dysfunction. CONCLUSIONS Almost all women experienced sexual dysfunction that did not improve over time despite improvement in overall disease activity. Future studies are warranted to identify underlying mechanisms that explain the associations between demographic and clinical factors and sexual dysfunction among newly diagnosed women.
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Affiliation(s)
- Eugenia Shmidt
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; University of Minnesota, Division of Gastroenterology, Hepatology and Nutrition, Minneapolis, Minnesota, USA
| | - Mayte Suárez-Fariñas
- Department of Population Health Science and Policy, Department of Genetics and Genomics Science, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Heather Moniz
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - Renee Bright
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - Samir A. Shah
- The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Marjorie Merrick
- Crohn’s & Colitis Foundation of America (retired), New York, New York, USA
| | - Jason Shapiro
- Division of Pediatric Gastroenterology, Nutrition, and Liver Diseases, Hasbro Children’s Hospital, Providence, Rhode Island, USA
| | - Fang Xu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bruce Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sumona Saha
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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19
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Prior J, Muller S, Helliwell T, Hider S, Barraclough K, Dasgupta B, Mallen C. The association of pain and stiffness with fatigue in incident polymyalgia rheumatica: baseline results from the polymyalgia rheumatica cohort study. Prim Health Care Res Dev 2019; 20:e46. [PMID: 32799976 PMCID: PMC6536760 DOI: 10.1017/s1463423619000082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 12/21/2018] [Accepted: 01/08/2019] [Indexed: 12/03/2022] Open
Abstract
We aimed to examine the association between pain, stiffness and fatigue in newly diagnosed polymyalgia rheumatica (PMR) patients using baseline data from a prospective cohort study. Fatigue is a known, but often ignored symptom of PMR. Newly diagnosed PMR patients were recruited from general practice and mailed a baseline questionnaire. This included a numerical rating scale for pain and stiffness severity, manikins identifying locations of pain and stiffness and the FACIT-Fatigue questionnaire. A total of 652 PMR patients responded (88.5%). The mean age of responders was 72.6 years (SD 9.0) and the majority were female (62.0%). Manikin data demonstrated that bilateral shoulder and hip pain and stiffness were common. The mean fatigue score (FACIT) was 33.9 (SD 12.4). Adjusted regression analysis demonstrated that a higher number of pain sites (23-44 sites) and higher pain and stiffness severity were associated with greater levels of fatigue. In newly diagnosed PMR patients, fatigue was associated with PMR symptom severity.
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Affiliation(s)
- J.A. Prior
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - S. Muller
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - T. Helliwell
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - S.L. Hider
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, Staffordshire, UK
| | | | - B. Dasgupta
- Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - C.D. Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
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21
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Ohlsson-Nevo E, Karlsson J. Impact of health-related stigma on psychosocial functioning in the general population: Construct validity and Swedish reference data for the Stigma-related Social Problems scale (SSP). Res Nurs Health 2018; 42:72-81. [PMID: 30499114 PMCID: PMC6827347 DOI: 10.1002/nur.21924] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/25/2018] [Indexed: 02/06/2023]
Abstract
Felt stigma is an internalized sense of shame about having an unwanted condition, along with fear of discrimination. The Stigma‐related Social Problems (SSP) scale was constructed to measure the impact of health‐related stigma on psychosocial functioning in people with different diseases and disorders. The performance of the SSP scale was tested in 3,422 subjects from the general population (Mid‐Swed Health Survey) and in subgroups according to gender, age, occupation, and education. The homogeneity and construct validity of the Distress and Avoidance scales were confirmed by exploratory factor analysis and the two factors were accurately reproduced across gender and age subgroups. The internal consistency reliability was high for both the Distress and Avoidance scales. Reliability coefficients were above the 0.90 standard for the Distress scale in all subgroups and for the Avoidance scale in most subgroups. The SSP scale is an instrument with sound psychometric properties that can be used to identify psychosocial disturbances.
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Affiliation(s)
- Emma Ohlsson-Nevo
- School of Health Sciences, Department of Surgery, Örebro University Örebro, Örebro, Sweden.,Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Jan Karlsson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
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22
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Langegård U, Ahlberg K, Fransson P, Johansson B, Sjövall K, Bjork-Eriksson T, Ohlsson-Nevo E. Evaluation of quality of care in relation to health-related quality of life of patients diagnosed with brain tumor: a novel clinic for proton beam therapy. Support Care Cancer 2018; 27:2679-2691. [PMID: 30484013 PMCID: PMC6541566 DOI: 10.1007/s00520-018-4557-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/15/2018] [Indexed: 12/31/2022]
Abstract
Purpose Patients with brain tumors constitute a vulnerable group, and it is important that they receive the highest quality of care (QoC). The study aim was to describe the perceptions of QoC and its association with health-related quality of life in brain tumor patients undergoing proton beam therapy in a newly established clinic. Method Data were collected at the start of treatment and after 3 and 6 weeks. Adult patients (≥ 18 years old) with brain tumors (n = 186) completed two self-administered questionnaires: a modified Quality from the Patients’ Perspective, which measures perceived reality and subjective importance of care, and the EORTC QLQ-C30. Data were analyzed using parametric and non-parametric statistical tests. Results The perceived QoC was highest for treatment information and lowest for dietician and smoking information, whereas interaction with doctors and nurses was rated as the most important aspect of quality of care. Subjective importance ratings were significantly higher than perceived reality ratings for 60% of items. A better global health was moderately correlated with a higher perceived support for fatigue. Conclusions A need for quality improvement was identified for several aspects of patient care. Greater symptom distress during the treatment period led to greater perceived importance of symptom support. Ensuring QoC is complex and collaboration with other health care professionals is essential. Relevance to clinical practice The clinic could improve QoC regarding information about possible symptoms, adjust care according to patient perceptions of importance, and involve patients in care decisions. Electronic supplementary material The online version of this article (10.1007/s00520-018-4557-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulrica Langegård
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe, Box 457, 405 30, Göteborg, Sweden.
| | - Karin Ahlberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe, Box 457, 405 30, Göteborg, Sweden
| | - Per Fransson
- Department of Nursing, Umeå University, Umeå, Sweden.,Cancercentrum, Norrlands University Hospital, Umeå, Sweden
| | - Birgitta Johansson
- Experimental Oncology, Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Katarina Sjövall
- Department of Oncology, Skane University Hospital, Scania, Sweden.,Department of Oncology, Lund University, Lund, Sweden
| | - Thomas Bjork-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,The Skandion Clinic, Uppsala, Sweden.,Regional Cancer Center West, Gothenburg, Sweden
| | - Emma Ohlsson-Nevo
- University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Pearson NA, Packham JC, Tutton E, Parsons H, Haywood KL. Assessing fatigue in adults with axial spondyloarthritis: a systematic review of the quality and acceptability of patient-reported outcome measures. Rheumatol Adv Pract 2018; 2:rky017. [PMID: 31431965 PMCID: PMC6649921 DOI: 10.1093/rap/rky017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/01/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim was to evaluate the quality and acceptability of patient-reported outcome measures used to assess fatigue in patients with axial spondyloarthritis. METHODS A two-stage systematic review of major electronic databases (1980-2017) was carried out to: (i) identify measures; and (ii) identify evaluative studies. Study and measurement quality were evaluated following international standards. Measurement content was appraised against a conceptual model of RA-fatigue. RESULTS From 387 reviewed abstracts, 23 articles provided evidence for nine fatigue-specific measures: 6 multi-item and 3 single-item. No axial spondyloarthritis-fatigue-specific measure was identified. Evidence of reliability was limited, but acceptable for the Multi-dimensional Fatigue Inventory (internal consistency, test-retest) and Short Form 36-item Health Survey Vitality subscale (SF-36 VT; internal consistency). Evidence of construct validity was moderate for the Functional Assessment of Chronic Illness Therapy-Fatigue and 10 cm visual analog scale, limited for the SF-36 VT and not available for the remaining measures. Responsiveness was rarely evaluated. Evidence of measurement error, content validity or structural validity was not identified. Most measures provide a limited reflection of fatigue; the most comprehensive were the Multi-dimensional Assessment of Fatigue, Multi-dimensional Fatigue Inventory-20, Functional Assessment of Chronic Illness Therapy-fatigue and Fatigue Severity Scale. CONCLUSION The limited content and often poor quality of the reviewed measures limit any clear recommendation for fatigue assessment in this population; assessments should be applied with caution until further robust evidence is established. Well-developed, patient-derived measures can provide essential evidence of the patient's perspective to inform clinical research and drive tailored health care. The collaborative engagement of key stakeholders must seek to ensure that future fatigue assessment is relevant, acceptable and of high quality.
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Affiliation(s)
- Nathan A Pearson
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jonathan C Packham
- Institute of Applied Clinical Science, Keele University, Staffordshire, UK
- Haywood Academic Rheumatology Centre, Staffordshire, UK
| | - Elizabeth Tutton
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Trauma Research, Kadoorie Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Helen Parsons
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kirstie L Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Deodhar AA, Dougados M, Baeten DL, Cheng‐Chung Wei J, Geusens P, Readie A, Richards HB, Martin R, Porter B. Effect of Secukinumab on Patient-Reported Outcomes in Patients With Active Ankylosing Spondylitis: A Phase III Randomized Trial (MEASURE 1). Arthritis Rheumatol 2017; 68:2901-2910. [PMID: 27390130 PMCID: PMC5132041 DOI: 10.1002/art.39805] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/28/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the effect of secukinumab (interleukin-17A inhibitor) on patient-reported outcomes in patients with active ankylosing spondylitis (AS). METHODS In this phase III study, 371 patients were randomized (1:1:1) to receive intravenous (IV) secukinumab 10 mg/kg at baseline and weeks 2 and 4 followed by subcutaneous (SC) secukinumab 150 mg every 4 weeks (IV→150 mg group), or SC secukinumab 75 mg every 4 weeks (IV→75 mg group), or placebo. Patient-reported outcomes included the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BASDAI criteria for 50% improvement (BASDAI 50), Short Form 36 (SF-36) physical component summary (PCS) score and mental component summary (MCS) score, Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, Bath Ankylosing Spondylitis Functional Index (BASFI), EuroQol 5-domain (EQ-5D) questionnaire, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and Work Productivity and Activity Impairment-General Health questionnaire (WPAI-GH). RESULTS At week 16, secukinumab IV→150 mg or IV→75 mg was associated with statistically and clinically significant improvements from baseline versus placebo in the BASDAI (-2.3 for both regimens versus -0.6; P < 0.0001 and P < 0.001, respectively), SF-36 PCS (5.6 for both regimens versus 1.0; P < 0.0001 and P < 0.001, respectively), and ASQoL (-3.6 for both regimens versus -1.0; P < 0.0001 and P < 0.001, respectively). Clinically significant improvements in the SF-36 MCS, BASFI, EQ-5D, and BASDAI 50 were observed with both secukinumab groups versus placebo at week 16; improvements were also observed in the FACIT-F and WPAI-GH. All improvements were sustained through week 52. CONCLUSION Our findings indicate that secukinumab provides significant and sustained improvements in patient-reported disease activity and health-related quality of life, and reduces functional impairment, fatigue, and impact of disease on work productivity in patients with active AS.
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Affiliation(s)
| | | | | | | | - Piet Geusens
- Maastricht University HospitalMaastrichtThe Netherlands
| | - Aimee Readie
- Novartis Pharmaceuticals CorporationEast HanoverNew Jersey
| | | | - Ruvie Martin
- Novartis Pharmaceuticals CorporationEast HanoverNew Jersey
| | - Brian Porter
- Novartis Pharmaceuticals CorporationEast HanoverNew Jersey
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Franco-Aguirre JQ, Cardona-Tapias AA, Cardona-Arias JA. Health-related quality of life of rheumatic disease patients treated in a specialized IPS in Medellin, Colombia. J Med Life 2017; 10:223-231. [PMID: 29362597 PMCID: PMC5771252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To compare Health-Related Quality of Life (HRQOL) profiles and their associated factors in people with rheumatoid arthritis (RA), spondyloarthritis (SpA), fibromyalgia (FM) and rheumatoid comorbidity treated in a specialized health center (SHC) in Medellin, Colombia. METHODS A cross-sectional analytical study was performed with 93 RA patients, 30 SpA patients, 41 primary FM patients and 48 secondary FM patients with a concurrent diagnosis of RA or SpA. A demographic, socioeconomic, and clinical survey (the IPAQ, International Physical Activity Questionnaire) and the SF-36 survey validated in Medellin were administered. The statistical analyses were executed using SPSS 21.0 Results. Significant differences were found in all HRQOL dimensions among the patients, with physical performance perceived as the worst in the four groups. FM had the worst HRQOL profile, whereas the least affected group was SpA. Patients with RA and rheumatoid comorbidity shared similar HRQOL scores. The years of study, age and economic satisfaction variables were associated with the physical performance, vitality, social functioning, and mental health domains. CONCLUSION The HRQOL profile was negative in patients with rheumatic diseases and lower in patients with FM. Additionally, variables or subgroups with greater deterioration were identified. This information will be useful for health activities and generate evidence in favor of incorporating HRQOL measurements into rheumatology services to complement clinical evaluations.
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Affiliation(s)
- JQ Franco-Aguirre
- Research Group on Health and Sustainability, School of Microbiology, University of Antioquia, Medellin, Colombia
| | | | - JA Cardona-Arias
- School of Microbiology, University of Antioquia U de A, Medellin, Colombia; School of Medicine,Cooperative University of Colombia
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Kwan YH, Fong W, Lui NL, Yong ST, Cheung YB, Malhotra R, Thumboo J, Østbye T. Validity and reliability of the Health Assessment Questionnaire among patients with spondyloarthritis in Singapore. Int J Rheum Dis 2016; 21:699-704. [PMID: 27860306 DOI: 10.1111/1756-185x.12989] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yu Heng Kwan
- Program in Health Systems and Services Research; Duke-NUS Medical School; Singapore Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore Singapore
| | - Nai Lee Lui
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore Singapore
| | - Si Ting Yong
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore Singapore
| | - Yin Bun Cheung
- Centre of Quantitative Medicine; Duke-NUS Medical School; Singapore Singapore
| | - Rahul Malhotra
- Program in Health Systems and Services Research; Duke-NUS Medical School; Singapore Singapore
- Centre of Ageing Research and Education; Duke-NUS Medical School; Singapore Singapore
| | - Julian Thumboo
- Program in Health Systems and Services Research; Duke-NUS Medical School; Singapore Singapore
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore Singapore
| | - Truls Østbye
- Program in Health Systems and Services Research; Duke-NUS Medical School; Singapore Singapore
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Validity and reliability of the Short Form 36 Health Surveys (SF-36) among patients with spondyloarthritis in Singapore. Rheumatol Int 2016; 36:1759-1765. [PMID: 27664139 DOI: 10.1007/s00296-016-3567-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/15/2016] [Indexed: 01/14/2023]
Abstract
The Short Form 36 Health Survey (SF-36) is a popular health-related quality of life (HrQoL) tool. However, few studies have assessed its psychometric properties in patients with spondyloarthritis (SpA). We therefore aimed to assess the reliability and validity of the SF-36 in patients with SpA in Singapore. Cross-sectional data from a registry of 196 SpA patients recruited from a dedicated tertiary referral clinic in Singapore from 2011 to 2014 was used. Analyses were guided by the COnsensus-based Standards for the selection of health Measurement INstruments framework. Internal consistency reliability was assessed using Cronbach's alpha. Construct validity was assessed through 33 a priori hypotheses by correlations of the eight subscales and two summary scores of SF-36 with other health outcomes. Known-group construct validity was assessed by comparison of the means of the subscales and summary scores of the SF-36 of SpA patients and the general population of Singapore using student's t tests. Among 196 patients (155 males (79.0 %), median (range) age: 36 (17-70), 166 Chinese (84.6 %)), SF-36 scales showed high internal consistency ranging from 0.88 to 0.90. Convergent construct validity was supported as shown by fulfillment of all hypotheses. Divergent construct validity was supported, as SF-36 MCS was not associated with PGA, pain and HAQ. Known-group construct validity showed SpA patients had lower scores of 3.8-12.5 when compared to the general population at p < 0.001. This study supports the SF-36 as a valid and reliable measure of HrQoL for use in patients with SpA at a single time point.
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The health-related quality of life of ankylosing spondylitis patients assessed by SF-36: a systematic review and meta-analysis. Qual Life Res 2016; 25:2711-2723. [PMID: 27324038 DOI: 10.1007/s11136-016-1345-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE The main purpose of this meta-analysis was to evaluate the impact of ankylosing spondylitis on the health-related quality of life assessed by the Medical Outcomes Short-Form-36 questionnaire (SF-36). METHODS A systematic literature search was performed on PubMed and Web of Science until January 22, 2016 to obtain eligible studies. Random effect model was performed to summarize the scores of each domain. The radar chart was used to compare the scores of AS patients with other health conditions. Spearman's correlation analysis and meta-regression were used to explore the related factors. STATA (version 11.0) and SPSS (version 13.0) were adopted in this meta-analysis. RESULTS Thirty-eight studies were included in this study, which were all reliable to summarize the scores of the SF-36. Pooled mean scores of the physical health domains ranged from 45.93 to 58.17, with the RP and PF domains being the lowest and the highest, respectively. Pooled mean scores of the mental health domains ranged from 47.49 to 62.52, with the VT and SF domains being the lowest and the highest, respectively. Besides, the physical component summary was lower than the mental component summary. BASDAI and BASFI were negatively associated with some domains of the SF-36 significantly. Patients with AS had a substantial impaired HRQoL in comparison with the general population. CONCLUSIONS AS could adversely affect the HRQoL of patients. Measuring HRQoL should be considered as an essential part of the overall assessment of health status of AS patients, which would provide valuable clues for improving the management of disease and making decisions regarding treatment.
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Stupar M, Côté P, Beaton DE, Boyle E, Cassidy JD. Structural and construct validity of the Whiplash Disability Questionnaire in adults with acute whiplash-associated disorders. Spine J 2015; 15:2369-77. [PMID: 26165476 DOI: 10.1016/j.spinee.2015.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 05/20/2015] [Accepted: 07/01/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Few instruments are available to measure disability associated with whiplash-associated disorders (WAD). The Whiplash Disability Questionnaire (WDQ) was developed to measure disability resulting from WAD, but its validity is unknown for acute WAD. PURPOSE The aim was to determine the structural and construct validity of the WDQ in individuals with acute WAD. STUDY DESIGN/SETTING This was a cohort study. PATIENT SAMPLE Ontario adults with WAD were enrolled within 3 weeks of their motor vehicle collision. OUTCOME MEASURES The outcome measure was the WDQ. METHODS We included insurance claimants who were aged 18 years or older and diagnosed with acute WAD Grades I to III. All participants completed the WDQ, a 13-item questionnaire scored from 0 (no disability) to 130 (complete disability). We assessed the factor structure of the WDQ and tested its construct validity against self-perceived recovery, neck pain (Numerical Rating Scale [NRS]), neck disability (Neck Disability Index [NDI] and Neck Bournemouth Questionnaire), health-related quality of life (36-Item Short Form Health Survey [SF-36]), and depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]). RESULTS The mean age of the 130 participants was 42.1 years (standard deviation [SD]=13.2), and 70% were women. Twenty-six percent had WAD I, 73.1% had WAD II, and 0.8% had WAD III. Mean time since injury was 6.5 days (SD=4.9). The mean WDQ score was 49.8 (SD=29.1). Our analysis suggested that the WDQ includes two factors: daily activities and emotional status. This factor structure remained stable in sensitivity analyses (eg, zeros imputed for missing values, and the item with the most missing values or resulting in complex loading excluded). Strong correlations were found between the total WDQ score and the NDI, the Bournemouth questionnaire, the SF-36 physical function, and the NRS (for the neck, shoulder, mid and low back pain) satisfying a priori hypotheses. We found a priori hypothesized moderate correlations between the WDQ, and the CES-D and SF-36 mental function. CONCLUSIONS The WDQ includes two factors and has strong construct validity in individuals with acute WAD. Our results demonstrate that the WDQ is valid for use as an overall summative scale or as the daily activities and emotional subscales in clinical and research settings to determine disability status.
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Affiliation(s)
- Maja Stupar
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario, Canada; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, 6100 Leslie St, Toronto, Ontario, Canada.
| | - Pierre Côté
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario, Canada; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, 6100 Leslie St, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, Canada
| | - Dorcas E Beaton
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada; Institute for Work & Health, 481 University Avenue, Toronto, Ontario, Canada
| | - Eleanor Boyle
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, Canada; Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Campusvej 55, Odense, Denmark
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, Canada; Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Campusvej 55, Odense, Denmark; Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, 700 Bay Street, Suite 602, Toronto, Ontario, Canada
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Sun JJ, Zhai XF. Relationship between psychosocial factors and quality of life in patients with inflammatory bowel disease. Shijie Huaren Xiaohua Zazhi 2014; 22:4695-4700. [DOI: 10.11569/wcjd.v22.i30.4695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To analyze psychosocial factors affecting quality of life in patients with inflammatory bowel disease (IBD).
METHODS: Both outpatients and inpatients treated in the Affiliated Hospital and Second Affiliated Hospital of Nantong University from October 2012 to March 2014 were included. A survey of general information was conducted. Disease activity index was adopted as the standard to determine the disease stage. Patients' anxiety and depression were assessed using self-rating anxiety scale and self-rating depression scale, respectively. A survey of the quality of life was carried out using the medical outcomes study short-form 36 (SF-36). The relationship between quality of life and psychosocial factors was then analyzed statistically.
RESULTS: This study included 90 cases of IBD, including 48 cases of ulcerative colitis and 42 cases of Crohn's disease. There were 42 males and 48 females, and their average age was 51.31 ± 14.97 years. According to the score of disease activity index, 54 patients were in remission stage and 36 patients were in active stage. Fifteen patients suffered from anxiety and 36 patients from depression, accounting for 16.67% and 40.00%, respectively, which were considerably higher than the normal levels. IBD patients' quality of life was significantly worse compared with healthy people, and the quality of life in the active stage was considerably lower than that in the remission stage. Disease activity index, anxiety and depression were negatively correlated with patients' quality of life.
CONCLUSION: The quality of life in patients with IBD worsens considerably, which negatively correlates with disease activity, anxiety and depression.
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Cohen BL, Zoëga H, Shah SA, LeLeiko N, Lidofsky S, Bright R, Flowers N, Law M, Moniz H, Merrick M, Sands BE. Fatigue is highly associated with poor health-related quality of life, disability and depression in newly-diagnosed patients with inflammatory bowel disease, independent of disease activity. Aliment Pharmacol Ther 2014; 39:811-22. [PMID: 24612278 PMCID: PMC4670472 DOI: 10.1111/apt.12659] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 05/06/2013] [Accepted: 01/24/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fatigue is common in Crohn's disease (CD) and ulcerative colitis (UC). Data on fatigue in newly diagnosed patients are unavailable. AIM To report prevalence of fatigue in newly diagnosed CD and UC patients and examine its association with health-related quality of life (HRQOL), depression and disability. METHODS The Ocean State Crohn's and Colitis Area Registry (OSCCAR) is a statewide cohort of newly diagnosed inflammatory bowel disease patients in Rhode Island. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue Scale. Patients were administered instruments measuring HRQOL, overall disability and work impairment, and depression. RESULTS Fatigue was prevalent in 26.4% of 220 subjects. Cohen's d effect sizes for fatigue were large: Short-Form 36 Health Survey mental health component (CD 1.5, UC 1.4) and physical health component (CD 1.4, UC 1.4), EuroQol-5D valuation of current health state (CD 1.2, UC 1.0), Inflammatory Bowel Disease Questionnaire (CD 1.9, UC 1.6) and Patient Health Questionnaire depression scale (CD 1.8, UC 1.7). Fatigued patients reported more work impairment (Score difference: CD 29.5%, UC 23.8%) and activity impairment (score difference: CD 32.3%, UC 25.7%) on the Work Productivity and Activity Impairment Questionnaire. Fatigue's association with all scores remained highly significant despite controlling for disease activity. CONCLUSIONS Fatigue is strongly associated with poor HRQOL, disability and depression similarly in CD and UC even when controlling for disease activity. Fatigue's association with a wide range of patient-reported outcome measures suggests that monitoring fatigue is a simple way to screen for overall disruption in patient life.
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Affiliation(s)
- B L Cohen
- Division of Gastroenterology, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - H Zoëga
- Division of Gastroenterology, Icahn School of Medicine at Mount SinaiNew York, NY, USA,Faculty of Medicine, Center of Public Health Sciences, University of IcelandReykjavik, Iceland
| | - S A Shah
- The Warren Alpert Medical School of Brown University, Gastroenterology Associates, Inc.Providence, RI, USA
| | - N LeLeiko
- Division of Pediatric Gastroenterology, Nutrition, and Liver Disease, Warren Alpert Medical School of Brown University, Hasbro Children's Hospital/Rhode Island HospitalProvidence, RI, USA
| | - S Lidofsky
- The Warren Alpert Medical School of Brown University, Gastroenterology Associates, Inc.Providence, RI, USA
| | - R Bright
- Division of Gastroenterology, Rhode Island HospitalProvidence, RI, USA
| | - N Flowers
- Centers for Disease Control and PreventionAtlanta, GA, USA
| | - M Law
- Division of Gastroenterology, Rhode Island HospitalProvidence, RI, USA
| | - H Moniz
- Division of Gastroenterology, Rhode Island HospitalProvidence, RI, USA
| | - M Merrick
- Crohn's & Colitis Foundation of AmericaNew York, NY, USA
| | - B E Sands
- Division of Gastroenterology, Icahn School of Medicine at Mount SinaiNew York, NY, USA
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Current World Literature. Curr Opin Rheumatol 2012; 24:342-9. [DOI: 10.1097/bor.0b013e328352d26c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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