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Ross L, Nikpour M. Composite measures to assess disease damage, disease severity and treatment response in systemic sclerosis clinical trials. Curr Opin Rheumatol 2023; 35:334-340. [PMID: 37650689 DOI: 10.1097/bor.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to summarize the composite outcome measures available to assess disease damage, severity and treatment response in systemic sclerosis (SSc). RECENT FINDINGS There have been many recent efforts to rigorously develop and validate composite outcome measures to assess the totality of the impact of SSc on patients. All initiatives have used both consensus and data-driven methods. Recently developed are a SSc-specific damage index, a patient-reported disease impact questionnaire (ScleroID) and a treatment response index (ACR-CRISS). SUMMARY Multiorgan, composite measures are being increasingly applied to assess treatment efficacy in clinical trials. Although a fully validated, disease-specific composite measure is not yet available, there has been significant recent progress towards developing measures of treatment response, damage and overall impact of SSc for application in randomized controlled trials.
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Affiliation(s)
- Laura Ross
- Department of Medicine at St Vincent's Hospital, University of Melbourne
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- Department of Medicine at St Vincent's Hospital, University of Melbourne
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Raimondi G, Samela T, Fania L, Abeni D. Item-specific patterns of the Skindex-17 in individuals with different levels of Hidradenitis Suppurativa severity: a network analysis study. Front Public Health 2023; 11:1284365. [PMID: 38026379 PMCID: PMC10646184 DOI: 10.3389/fpubh.2023.1284365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Recent studies are stressing the idea that the level of Hidradenitis Suppurativa (HS) severity does not always correspond to the same illness load. In fact, it was found that there was no significant association between Skindex-17 and clinical severity of HS, and that some items of the Skindex-17 might be more related to HS severity than others. Objective The aim of the current study was to explore the associations between different levels of clinical severity of HS (mild, moderate, severe) and the Skindex-17 single-item responses in a large sample of adults patients. Methods A cross-sectional study with a sample include 547 consecutive HS patients, approaching for the first time the specific dermatologic evaluation. Eligible criteria included age ≥ 18 years, HS diagnosis formulated contextually by the same expert clinician, and providing informed consent. All participants completed the Skindex-17 and were evaluated for the disease clinical severity with the International Hidradenitis Suppurativa Severity Score System. A Network Analysis was conducted, which represents a powerful methodological approach in clinical research. It allows to study specific patterns and the structure of complex system in order to better understand how the elements of the system interact with each-other. Three different Network Analyses were conducted for each group of HS clinical severity by including the items of the Skindex-17 as the nodes of each network. Results Among 547 patients, 40% (219) were female and mean age was of 32.70 (±11.41). Different patterns among items of the Skindex-17 for the three clinical severity groups emerged, meaning that in each group different items are more crucial than others. The psychosocial subscale of the Skindex-17 is the most relevant when assessing the Quality of Life of individuals with different levels of HS severity, however, with the progression of the disease, individuals place attention also on two different aspects of the symptoms subscale of the Skindex-17, irritation and pain, which in turn perfectly reflect the severity of HS, from a clinical perspective. Conclusion These results provide new insights on the association between levels of HS severity and related Quality of Life, measured with the Skindex-17.
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Affiliation(s)
- Giulia Raimondi
- Clinical Epidemiology Unit, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Tonia Samela
- Clinical Epidemiology Unit, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
- Clinical Psychology Unit, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
| | - Luca Fania
- Dermatology Unit, IDI-IRCSS, Rome, Italy
| | - Damiano Abeni
- Clinical Epidemiology Unit, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
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Kirren Q, Daste C, Foissac F, Abdoul H, Alami S, Carrier ME, Kwakkenbos L, Lefèvre-Colau MM, Rannou F, Papelard A, Roren A, Thombs BD, Mouthon L, Nguyen C. Differences in Disability Perception in Systemic Sclerosis: A Mirror Survey of Patients and Health Care Providers. J Clin Med 2023; 12:jcm12041359. [PMID: 36835895 PMCID: PMC9959687 DOI: 10.3390/jcm12041359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Differences in disability perception between patients and care providers may impact outcomes. We aimed to explore differences in disability perception between patients and care providers in systemic sclerosis (SSc). We conducted a cross-sectional internet-based mirror survey. SSc patients participating in the online SPIN Cohort and care providers affiliated with 15 scientific societies were surveyed using the Cochin Scleroderma International Classification of Functioning, Disability and Health (ICF)-65 questionnaire, including 65 items (from 0 to 10), representing 9 domains of disability. Mean differences between patients and care providers were calculated. Care providers' characteristics associated with a mean difference ≥ 2 of 10 points were assessed in multivariate analysis. Answers were analyzed for 109 patients and 105 care providers. The mean age of patients was 55.9 (14.7) years and the disease duration was 10.1 (7.5) years. For all domains of the ICF-65, care providers' rates were higher than those of patients. The mean difference was 2.4 (1.0) of 10 points. Care providers' characteristics associated with this difference were organ-based specialty (OR = 7.0 [2.3-21.2]), younger age (OR = 2.7 [1.0-7.1]) and following patients with disease duration ≥5 years (OR = 3.0 [1.1-8.7]). We found systematic differences in disability perception between patients and care providers in SSc.
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Affiliation(s)
- Quentin Kirren
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
| | - Camille Daste
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Université Paris Cité, 75004 Paris, France
| | - Frantz Foissac
- Unité de Recherche Clinique—Centre d’Investigation Clinique Paris Descartes Necker/Cochin, Hôpital Tarnier, 75014 Paris, France
- EA 7323, Évaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université Paris Cité, 75014 Paris, France
| | - Hendy Abdoul
- Unité de Recherche Clinique—Centre d’Investigation Clinique Paris Descartes Necker/Cochin, Hôpital Tarnier, 75014 Paris, France
| | - Sophie Alami
- Cabinet d’Études Sociologiques Interlis, 75006 Paris, France
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University Nijmegen, 6525 XZ Nijmegen, The Netherlands
| | - Marie-Martine Lefèvre-Colau
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Université Paris Cité, 75004 Paris, France
| | - François Rannou
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, Université Paris Cité, 75006 Paris, France
| | - Agathe Papelard
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
| | - Alexandra Roren
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Université Paris Cité, 75004 Paris, France
- Département Universitaire des Sciences de la Rééducation et de la Réadaptation, Faculté de Santé, Université Paris Cité, 75006 Paris, France
| | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Departments of Psychiatry, McGill University, Montreal, QC H3A 1G1, Canada
- Departments of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC H3A 1G1, Canada
- Departments of Medicine, McGill University, Montreal, QC H3A 1G1, Canada
- Departments of Psychology, McGill University, Montreal, QC H3A 1G1, Canada
- Departments of Educational and Counselling Psychology, McGill University, Montreal, QC H3A 1G1, Canada
- Biomedical Ethics Unit, McGill University, Montreal, QC H3A 1G1, Canada
| | - Luc Mouthon
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Médecine Interne, Hôpital Cochin, AP-HP, Centre-Université de Paris, 75014 Paris, France
| | - Christelle Nguyen
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, Université Paris Cité, 75006 Paris, France
- Correspondence: ; Tel.: +33-158-412-945
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Floris A, Rozza D, Zanetti A, Carrara G, Bellis E, Cauli A, Iagnocco A, Scirè CA, Piga M. Musculoskeletal ultrasound may narrow the gap between patients and physicians in the assessment of rheumatoid arthritis disease activity. Rheumatology (Oxford) 2022; 62:116-123. [PMID: 35482548 DOI: 10.1093/rheumatology/keac255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/10/2022] [Accepted: 04/10/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To investigate the association between patient-physician discordance in the assessment of disease activity and residual US synovitis/tenosynovitis in a cohort of patients with RA in clinical remission. METHODS A post hoc analysis of the STARTER study, promoted by the Musculoskeletal-US (MSUS) Study Group of the Italian Society for Rheumatology, was performed using data from 361 consecutive patients with RA in clinical remission. The global assessment of disease activity by each patient (PGA) and evaluator/physician (EGA) was recorded on a 100-mm visual analogue scale. The PGA-EGA discordance was classified as positive (PGA>EGA) or negative (PGA<EGA) using a cut-off of ±10 mm. The association of discordance with greyscale (GS) and power Doppler (PD) synovitis (S) and tenosynovitis (T) scores was evaluated through logistic regression analysis. The odds ratio for each point of the scores, adjusted for prespecified confounders (adjOR), was calculated. RESULTS The mean (s.d.) PGA and EGA scores were 6.1 (7.1) and 8.8 (12) mm, respectively, with a median (IQR) absolute difference of 4 (0-10) mm. Positive and negative discordances were recorded in 39 (10.8%) and 65(18.0%) patients, respectively. The GS-S (adjOR 1.099) and PD-S (adjOR 1.167) scores were associated with positive discordance (P < 0.01), while the GS-T (adjOR 1.083), GS-S (adjOR 1.063) and PD-S (adjOR 1.089) scores were associated with negative discordance (P < 0.05). The PGA-EGA discordance did not predict flares at 6 and 12 months. CONCLUSIONS Patient-physician discordance is associated with the lack of US remission in patients with RA and may represent a further indication for MSUS.
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Affiliation(s)
- Alberto Floris
- Rheumatology Unit, Department of Medicine and Public Health, Azienda Ospedaliero-Universitaria and University of Cagliari, Monserrato, Italy
| | - Davide Rozza
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Anna Zanetti
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Emanuela Bellis
- Day Hospital Multidisciplinare Ospedale di Borgomanero e Ambulatori di Reumatologia, ASL Novara, Novara, Italy
| | - Alberto Cauli
- Rheumatology Unit, Department of Medicine and Public Health, Azienda Ospedaliero-Universitaria and University of Cagliari, Monserrato, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Carlo Alberto Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Matteo Piga
- Rheumatology Unit, Department of Medicine and Public Health, Azienda Ospedaliero-Universitaria and University of Cagliari, Monserrato, Italy
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Ross L, Nikpour M, D'Aoust J, Khanna D, Merkel PA, Pauling JD, Baron M. Patient and Physician Global Assessments of Disease Status in Systemic Sclerosis. Arthritis Care Res (Hoboken) 2022. [PMID: 36342397 DOI: 10.1002/acr.25056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
Global assessments of disease by both patients and physicians are widely used in clinical studies of systemic sclerosis (SSc). They are commonly secondary end points in randomized controlled trials (RCTs) and are considered important items in composite measures of treatment response. A comprehensive literature review was conducted of the formats, wording, and clinimetric properties of the patient global assessment of disease status (PtGA) and physician global assessment of disease status (PhGA) used in RCTs of SSc. Marked heterogeneity was found in the wording and measurement scales of the global assessments applied in RCTs. These instruments were not developed using rigorous methodology and have not been fully validated. There is a pressing need for standardization and validation of patient and physician global assessment tools in SSc to enable universal application of these measures across RCTs in SSc.
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Affiliation(s)
- Laura Ross
- The University of Melbourne at St Vincent's Hospital and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- The University of Melbourne at St Vincent's Hospital and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Julie D'Aoust
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | - Murray Baron
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Lynæs C, Lynæs M, Simon LS, Tugwell P, D'Agostino MA, Strand V, Juhl CB, Nielsen SM, De Witt M, Beaton D, Maxwell LJ, Meara AS, Christensen R. Physicians’ vs patients’ global assessments of disease activity in rheumatology and musculoskeletal trials: A meta-research project with focus on reasons for discrepancies. Semin Arthritis Rheum 2022; 56:152074. [DOI: 10.1016/j.semarthrit.2022.152074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
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7
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Becker MO, Dobrota R, Garaiman A, Debelak R, Fligelstone K, Tyrrell Kennedy A, Roennow A, Allanore Y, Carreira PE, Czirják L, Denton CP, Hesselstrand R, Sandqvist G, Kowal-Bielecka O, Bruni C, Matucci-Cerinic M, Mihai C, Gheorghiu AM, Mueller-Ladner U, Sexton J, Kvien TK, Heiberg T, Distler O. Development and validation of a patient-reported outcome measure for systemic sclerosis: the EULAR Systemic Sclerosis Impact of Disease (ScleroID) questionnaire. Ann Rheum Dis 2021; 81:507-515. [PMID: 34824049 DOI: 10.1136/annrheumdis-2021-220702] [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: 05/05/2021] [Accepted: 11/09/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) are important for clinical practice and research. Given the high unmet need, our aim was to develop a comprehensive PROM for systemic sclerosis (SSc), jointly with patient experts. METHODS This European Alliance of Associations for Rheumatology (EULAR)-endorsed project involved 11 European SSc centres. Relevant health dimensions were chosen and prioritised by patients. The resulting Systemic Sclerosis Impact of Disease (ScleroID) questionnaire was subsequently weighted and validated by Outcome Measures in Rheumatology criteria in an observational cohort study, cross-sectionally and longitudinally. As comparators, SSc-Health Assessment Questionnaire (HAQ), EuroQol Five Dimensional (EQ-5D), Short Form-36 (SF-36) were included. RESULTS Initially, 17 health dimensions were selected and prioritised. The top 10 health dimensions were selected for the ScleroID questionnaire. Importantly, Raynaud's phenomenon, impaired hand function, pain and fatigue had the highest patient-reported disease impact. The validation cohort study included 472 patients with a baseline visit, from which 109 had a test-retest reliability visit and 113 had a follow-up visit (85% female, 38% diffuse SSc, mean age 58 years, mean disease duration 9 years). The total ScleroID score showed strong Pearson correlation coefficients with comparators (SSc-HAQ, 0.73; Patient's global assessment, Visual Analogue Scale 0.77; HAQ-Disability Index, 0.62; SF-36 physical score, -0.62; each p<0.001). The internal consistency was strong: Cronbach's alpha was 0.87, similar to SSc-HAQ (0.88) and higher than EQ-5D (0.77). The ScleroID had excellent reliability and good sensitivity to change, superior to all comparators (intraclass correlation coefficient 0.84; standardised response mean 0.57). CONCLUSIONS We have developed and validated the EULAR ScleroID, which is a novel, brief, disease-specific, patient-derived, disease impact PROM, suitable for research and clinical use in SSc.
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Affiliation(s)
- Mike O Becker
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Rucsandra Dobrota
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Alexandru Garaiman
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Rudolf Debelak
- Department of Psychology, Psychological Methods, Evaluation and Statistics, University of Zurich, Zurich, Switzerland.,Department of Psychology, Psychological Methodology, University of Leipzig, Leipzig, Germany
| | | | - Ann Tyrrell Kennedy
- Federation of the European Scleroderma Associations (FESCA) aisbl, Tournai, Belgium
| | - Annelise Roennow
- Federation of European Scleroderma Associations (FESCA), Saint Maur, Belgium
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
| | - Patricia E Carreira
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - Christopher P Denton
- Centre for Rheumatology, University College London, Royal Free Campus, London, UK
| | | | | | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy.,IRCCS San Raffaele Hospital, Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), Milan, Italy
| | - Carina Mihai
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland.,Department of Internal Medicine and Rheumatology, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ana Maria Gheorghiu
- Department of Internal Medicine and Rheumatology, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Turid Heiberg
- Regional Research Support, Oslo University Hospital, Oslo, Norway
| | - Oliver Distler
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
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DiRenzo DD, Smith TR, Frech TM, Shah AA, Pauling JD. Effect of Coping Strategies on Patient and Physician Perceptions of Disease Severity and Disability in Systemic Sclerosis. J Rheumatol 2021; 48:1569-1573. [PMID: 33934078 DOI: 10.3899/jrheum.201612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) results in impaired function, disability, and reduced health-related quality of life. We investigated the effect of coping strategies on the patient global assessment of health (PtGA) and Health Assessment Questionnaire-Disability Index (HAQ-DI), after controlling for clinical characteristics and disease activity. We also explored the relationship between coping strategies and the correlation between the PtGA and physician global assessment (PGA) in SSc. METHODS We undertook posthoc analyses using baseline data obtained from the Raynaud Symptom Study (RSS). The PtGA, Coping Strategies Questionnaire, Pain Catastrophizing Scale, and Scleroderma Health Assessment Questionnaire were collected alongside the PGA, clinical characteristics, and patient demographics. Multivariable linear regression models and correlations were used to evaluate the relationship between coping strategies with the PtGA, HAQ-DI, and PGA. RESULTS Of the 107 patients with SSc enrolled in the RSS, there were sufficient data available for the analysis of 91 participants. The mean PtGA was 40/100 (SD 27) and the mean HAQ-DI was 0.87/3.0 (SD 0.73). After controlling for clinical and patient demographics, pain catastrophizing and maladaptive coping skills were significantly associated with the PtGA and HAQ-DI scores (P < 0.05 for both), but not the PGA. CONCLUSION The effect of coping strategies on PtGA and HAQ-DI (but not PGA in SSc) could influence the result of composite measures incorporating these outcome measures. Interventions to improve patient coping skills may support increased resilience and improve patient-perceived functional status and PtGA in SSc.
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Affiliation(s)
- Dana D DiRenzo
- DDD is supported by the Jerome L. Greene Foundation. D.D. DiRenzo, MD, MHS, A.A. Shah, MD, MHS, Johns Hopkins Division of Rheumatology, Baltimore, Maryland, USA; T.R. Smith, PhD, Department of Mathematical Sciences, University of Bath, Bath, UK; T.M. Frech, MD, MS, University of Utah, Salt Lake City, Utah, USA; J.D. Pauling, BMedSci, BMBS, PhD, FRCP, Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), and Department of Pharmacy and Pharmacology, University of Bath, Bath, UK. A.A. Shah and J.D. Pauling are joint senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Pauling, Consultant Rheumatologist & Senior Lecturer, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases (part of the Royal United Hospitals Bath NHS Foundation Trust), Combe Park, Avon, Bath, BA1 3NG, UK. . Accepted for publication April 14, 2021
| | - Theresa R Smith
- DDD is supported by the Jerome L. Greene Foundation. D.D. DiRenzo, MD, MHS, A.A. Shah, MD, MHS, Johns Hopkins Division of Rheumatology, Baltimore, Maryland, USA; T.R. Smith, PhD, Department of Mathematical Sciences, University of Bath, Bath, UK; T.M. Frech, MD, MS, University of Utah, Salt Lake City, Utah, USA; J.D. Pauling, BMedSci, BMBS, PhD, FRCP, Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), and Department of Pharmacy and Pharmacology, University of Bath, Bath, UK. A.A. Shah and J.D. Pauling are joint senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Pauling, Consultant Rheumatologist & Senior Lecturer, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases (part of the Royal United Hospitals Bath NHS Foundation Trust), Combe Park, Avon, Bath, BA1 3NG, UK. . Accepted for publication April 14, 2021
| | - Tracy M Frech
- DDD is supported by the Jerome L. Greene Foundation. D.D. DiRenzo, MD, MHS, A.A. Shah, MD, MHS, Johns Hopkins Division of Rheumatology, Baltimore, Maryland, USA; T.R. Smith, PhD, Department of Mathematical Sciences, University of Bath, Bath, UK; T.M. Frech, MD, MS, University of Utah, Salt Lake City, Utah, USA; J.D. Pauling, BMedSci, BMBS, PhD, FRCP, Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), and Department of Pharmacy and Pharmacology, University of Bath, Bath, UK. A.A. Shah and J.D. Pauling are joint senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Pauling, Consultant Rheumatologist & Senior Lecturer, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases (part of the Royal United Hospitals Bath NHS Foundation Trust), Combe Park, Avon, Bath, BA1 3NG, UK. . Accepted for publication April 14, 2021
| | - Ami A Shah
- DDD is supported by the Jerome L. Greene Foundation. D.D. DiRenzo, MD, MHS, A.A. Shah, MD, MHS, Johns Hopkins Division of Rheumatology, Baltimore, Maryland, USA; T.R. Smith, PhD, Department of Mathematical Sciences, University of Bath, Bath, UK; T.M. Frech, MD, MS, University of Utah, Salt Lake City, Utah, USA; J.D. Pauling, BMedSci, BMBS, PhD, FRCP, Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), and Department of Pharmacy and Pharmacology, University of Bath, Bath, UK. A.A. Shah and J.D. Pauling are joint senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Pauling, Consultant Rheumatologist & Senior Lecturer, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases (part of the Royal United Hospitals Bath NHS Foundation Trust), Combe Park, Avon, Bath, BA1 3NG, UK. . Accepted for publication April 14, 2021
| | - John D Pauling
- DDD is supported by the Jerome L. Greene Foundation. D.D. DiRenzo, MD, MHS, A.A. Shah, MD, MHS, Johns Hopkins Division of Rheumatology, Baltimore, Maryland, USA; T.R. Smith, PhD, Department of Mathematical Sciences, University of Bath, Bath, UK; T.M. Frech, MD, MS, University of Utah, Salt Lake City, Utah, USA; J.D. Pauling, BMedSci, BMBS, PhD, FRCP, Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), and Department of Pharmacy and Pharmacology, University of Bath, Bath, UK. A.A. Shah and J.D. Pauling are joint senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Pauling, Consultant Rheumatologist & Senior Lecturer, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases (part of the Royal United Hospitals Bath NHS Foundation Trust), Combe Park, Avon, Bath, BA1 3NG, UK. . Accepted for publication April 14, 2021
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9
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Ross L, Stevens W, Wilson M, Huq M, Strickland G, Walker J, Sahhar J, Ngian GS, Roddy J, Youssef P, Proudman S, Nikpour M. Performance of the 2017 EUSTAR activity index in an scleroderma cohort. Clin Rheumatol 2020; 39:3701-3705. [PMID: 32696281 DOI: 10.1007/s10067-020-05126-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022]
Abstract
Assessment of disease activity in systemic sclerosis (SSc) is limited by the absence of a fully validated, multisystem measure of disease activity. The European Scleroderma Trials and Research Group (EUSTAR) SSc activity index (EScSG-AI) was recently revised, and a validation study within the EUSTAR cohort was performed. In this study, we evaluated the performance of the revised EScSG-AI in an external Australian cohort. The association between the EScSG-AI and the physician global assessment of disease activity (PhGA), both collected prospectively at each annual visit over up to 12 years follow-up, was evaluated using Pearson's correlation coefficient and Cohen's kappa coefficient. Generalized linear modelling and time-dependent Cox regression analysis were performed to determine the association of disease activity measured by the EScSG-AI and the summed Medsger Severity Scale (MSS) and death, respectively. There was a moderate correlation between EScSG-AI and PhGA scores (r 0.42, p < 0.001) and moderate association between rising EScSG-AI and summed MSS (r 0.60, p < 0.001). High disease activity, measured by the EScSG-AI at any time during follow-up, was associated with a hazard ratio of 2.07 (95% CI 1.51-2.79) for mortality. The EScSG-AI has a moderate correlation with physician-assessed SSc disease activity. This suggests that the criterion and construct validity of the EScSG-AI are yet to be demonstrated in an external cohort of SSc patients. Key Points •There remains no gold standard measure of SSc disease activity. •The revised 2017 EUSTAR SSc disease activity index shows moderate correlation with physician-rated global disease activity. •Significant work remains to develop a validated multisystem measure of disease activity in SSc.
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Affiliation(s)
- Laura Ross
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Australia.,Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Michelle Wilson
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Molla Huq
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Australia
| | - Gemma Strickland
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre, Adelaide, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health & Monash University, Melbourne, Australia.,Department of Medicine, Monash Health & Monash University, Melbourne, Australia
| | - Gene-Siew Ngian
- Department of Rheumatology, Monash Health & Monash University, Melbourne, Australia.,Department of Medicine, Monash Health & Monash University, Melbourne, Australia
| | - Janet Roddy
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - Peter Youssef
- Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Medicine, University of Sydney, Sydney, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Australia. .,Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia.
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10
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Rendell VR, Siy AB, Stafford LMC, Schmocker RK, Leverson GE, Winslow ER. Severity of Postoperative Complications From the Perspective of the Patient. J Patient Exp 2019; 7:1568-1576. [PMID: 33457616 PMCID: PMC7786740 DOI: 10.1177/2374373519893199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Although provider-derived surgical complication severity grading systems exist, little is known about the patient perspective. Objective: To assess patient-rated complication severity and determine concordance with existing grading systems. Methods: A survey asked general surgery patients to rate the severity of 21 hypothetical postoperative events representing grades 1 to 5 complications from the Accordion Severity Grading System. Concordance with the Accordion scale was examined. Separately, descriptive ratings of 18 brief postoperative events were ranked. Results: One hundred sixty-eight patients returned a mailed survey following their discharge from a general surgery service. Patients rated grade 4 complications highest. Grade 1 complications were rated similarly to grade 5 and higher than grades 2 and 3 (P ≤ .01). Patients rated one event not considered an Accordion scale complication higher than all but grade 4 complications (P < .001). The brief events also did not follow the Accordion scale, other than the grade 6 complication ranking highest. Conclusion: Patient-rated complication severity is discordant with provider-derived grading systems, suggesting the need to explore important differences between patient and provider perspectives.
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Affiliation(s)
- Victoria R Rendell
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Schmocker is now with the Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA. Winslow is now with the Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Alexander B Siy
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Schmocker is now with the Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA. Winslow is now with the Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Linda M Cherney Stafford
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Schmocker is now with the Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA. Winslow is now with the Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Ryan K Schmocker
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Schmocker is now with the Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA. Winslow is now with the Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Glen E Leverson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Schmocker is now with the Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA. Winslow is now with the Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Emily R Winslow
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Schmocker is now with the Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA. Winslow is now with the Medstar Georgetown Transplant Institute, Washington, DC, USA
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11
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LAUDES Study: impact of digital ulcers on hand functional limitation, work productivity and daily activities, in systemic sclerosis patients. Rheumatol Int 2019; 39:1875-1882. [DOI: 10.1007/s00296-019-04436-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/24/2019] [Indexed: 01/01/2023]
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12
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Castrejon I, Shakoor N, Chua JR, Block JA. Discordance of global assessment by patients and physicians is higher in osteoarthritis than in rheumatoid arthritis: a cross-sectional study from routine care. Rheumatol Int 2018; 38:2137-2145. [PMID: 30293155 DOI: 10.1007/s00296-018-4166-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/25/2018] [Indexed: 11/24/2022]
Abstract
The study compares patient-physician discordance in global assessment in patients with osteoarthritis (OA) versus patients with rheumatoid arthritis (RA) seen in routine care. This is a cross-sectional study conducted at an academic rheumatology center at which all patients are asked to complete a Multi-Dimensional Health Assessment Questionnaire (MDHAQ), which includes a patient global assessment (PATGL). Rheumatologists are encouraged to complete a physician questionnaire, which includes a physician global assessment (DOCGL). Patients with either OA or RA were identified using ICD9 codes and classified as positive discordance (PATGL-DOCGL ≥ 2), negative discordance (PATGL-DOCGL≤ - 2), and concordance (absolute difference between the two assessments < 2). Discordance was assessed by diagnosis. Agreement between patient and physician global assessments was evaluated using intraclass correlations. Logistic regression was performed to identify explanatory variables for positive discordance. The analysis included 243 OA and 216 RA patients. Mean PATGL was higher in OA versus RA (5.4 versus 4.2, p = 0.005), while mean DOCGL was similar (4.0 versus 3.8, p = 0.23) leading to a higher patient-physician discordance in OA (1.35 versus 0.43, p < 0.001). Positive discordance occurred in 34% of OA versus 18% of RA patients (p < 0.001). Intraclass correlation coefficients were 0.43 in OA versus 0.60 in RA patients. In logistic regressions, pain was the only statistically significant explanatory variable for discordance in both OA (OR 1.34, 95% CI 1.12-1.78) and RA (OR 1.47 95% CI 1.04-2.07). Patients with OA are more likely to be discordant with their rheumatologists than patients with RA because of a higher PATGL. Similarly to RA, the most important explanatory variable for discordance was higher pain.
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Affiliation(s)
- Isabel Castrejon
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA.
| | - Najia Shakoor
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
| | - Jacquelin R Chua
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
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13
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Ross L, Baron M, Nikpour M. The challenges and controversies of measuring disease activity in systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2018; 3:115-121. [PMID: 35382236 PMCID: PMC8892866 DOI: 10.1177/2397198318765061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/15/2018] [Accepted: 02/22/2018] [Indexed: 09/01/2023]
Abstract
Major alteration of the natural history of systemic sclerosis is limited with current treatments, and the development of novel therapies has been hampered, in part, by the lack of fully validated multi-system outcome measures. There remains a lack of consensus as to the very definition of systemic sclerosis disease activity, complicating efforts to measure activity in clinical trials. Previously published multi-system measures of disease status are yet to be fully validated according to the Outcome Measures in Rheumatology (OMERACT) filter. There is currently significant research interest in developing new systemic sclerosis-specific measures to better describe and compare patient cohorts and measure therapeutic responses in clinical trials. An accurate measure of disease activity in systemic sclerosis will facilitate the enrichment of clinical trials with patients who have active disease, targeting a group of patients most likely to benefit from therapeutic intervention. In addition, following on from successes in other rheumatic conditions, a state of low disease activity, measured by an activity index, may become a clinical trial end point and therapeutic target. The Scleroderma Clinical Trials Consortium has undertaken to develop a definition of disease activity and fully validate a new systemic sclerosis activity index. The Scleroderma Clinical Trials Consortium Activity Index will be developed using consensus and data-driven methods and is envisaged to be widely used in research and clinical settings.
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Affiliation(s)
- Laura Ross
- Department of Medicine, University of
Melbourne at St Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
- Department of Rheumatology, St Vincent’s
Hospital Melbourne, Melbourne, VIC, Australia
| | - Murray Baron
- Division of Rheumatology, Jewish General
Hospital, McGill University, Montreal, QC, Canada
| | - Mandana Nikpour
- Department of Medicine, University of
Melbourne at St Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
- Department of Rheumatology, St Vincent’s
Hospital Melbourne, Melbourne, VIC, Australia
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14
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El Miedany Y, El Gaafary M, El Aroussy N, Bahlas S, Hegazi M, Palmer D, Youssef S. Toward electronic health recording: evaluation of electronic patient reported outcome measures (e-PROMs) system for remote monitoring of early systemic lupus patients. Clin Rheumatol 2017; 36:2461-2469. [PMID: 28567555 DOI: 10.1007/s10067-017-3675-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 04/27/2017] [Accepted: 05/08/2017] [Indexed: 01/06/2023]
Abstract
The study aimed to assess the value of evaluation of electronic patient reported outcome measures (e-PROMs) in the assessment and management of SLE disease activity flares, its association with adherence to therapy as well as organ damage. A randomized, controlled crossover study was carried out over a 24-month duration. One hundred forty-seven SLE patients meeting the revised American College of Rheumatology (ACR) criteria were enrolled. Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was used to assess disease activity, whereas organ damage was scored using the Systemic Lupus International Collaborating Clinics (SLICC)/ACR Damage Index. In the first 12 months, the patients were assessed every 3 months. At 12 months, the patients were randomized into a cohort of 73 patients who continued their care in the same style and 74 patients who completed an online e-PROMs questionnaire on monthly basis for another 12-month period. The data captured were then retrospectively analyzed at the end of the 24-month study period. At the end of the first year of the study, the mean SLEDAI and SDI scores were 8.72 (6.1) and 1.9 (2.2). At the end of the second year, the mean SLEDAI and SDI scores in the e-PROMs cohort were 3.1 (2.6) and 1.2 (1.3), whereas in the control group, the scores were 7.63 (6.7) and 1.8 (2.3), respectively (p < 0.01). Adjusting for possible confounding variables, the number of flares, regardless of their severity, was associated with damage accrual (OR 2.03, 95% CI 1.34 to 2.83, p < 0.001). Adherence to therapy was significantly (p < 0.1) higher in the e-PROMs group. e-PROMs was equivalent to PROMs paper format and has a potential disease-modifying effect as it facilitated close monitoring of disease activity with an option of management escalation whenever indicated.
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Affiliation(s)
- Y El Miedany
- Rheumatology, Darent Valley Hospital, Darenth Wood Road, Dartford, England, DA2 8DA, UK.
- Rheumatology & Rehab, School of Medicine St. Abbassia, Ain Shams University, Cairo, 11381, Egypt.
| | - M El Gaafary
- Community and Public Health, School of Medicine St. Abbassia, Ain Shams University, Cairo, 11381, Egypt
| | - Nadia El Aroussy
- Rheumatology & Rehab, School of Medicine St. Abbassia, Ain Shams University, Cairo, 11381, Egypt
| | - S Bahlas
- Rheumatology Department, King Abdulaziz University, Jeddah, 21441, Saudi Arabia
| | - M Hegazi
- Medicine Department, Al Adan Hospital, KW52853, Hadeya, Kuwait
| | - D Palmer
- Rheumatology, North Middlesex University Hospitals, Sterling Way, London, N18 1QX, UK
| | - S Youssef
- Rheumatology & Rehab, School of Medicine St. Abbassia, Ain Shams University, Cairo, 11381, Egypt
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15
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Nevskaya T, Baron M, Pope JE. Predictive value of European Scleroderma Group Activity Index in an early scleroderma cohort. Rheumatology (Oxford) 2017; 56:1111-1122. [PMID: 28340090 DOI: 10.1093/rheumatology/kex015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Indexed: 11/13/2022] Open
Abstract
Objective To estimate the effect of disease activity, as measured by the European Scleroderma Research Group Activity Index (EScSG-AI), on the risk of subsequent organ damage in a large systemic sclerosis (SSc) cohort. Methods Of 421 SSc patients from the Canadian Scleroderma Research Group database with disease duration of ⩽ 3 years, 197 who had no evidence of end-stage organ damage initially and available 3 year follow-up were included. Disease activity was assessed by the EScSG-AI with two variability measures: the adjusted mean EScSG-AI (the area under the curve of the EScSG-AI over the observation period) and persistently active disease/flare. Outcomes were based on the Medsger severity scale and included accrual of a new severity score (Δ ⩾ 1) overall and within organ systems or reaching a significant level of deterioration in health status. Results After adjustment for covariates, the adjusted mean EScSG-AI was the most consistent predictor of risk across the study outcomes over 3 years in dcSSc: disease progression defined as Δ ⩾ 1 in any major internal organ, significant decline in forced vital capacity and diffusing capacity of carbon monoxide, severity of visceral disease and HAQ Disability Index worsening. In multivariate analysis, progression of lung disease was predicted solely by adjusted mean EScSG-AI, while the severity of lung disease was predicted the adjusted mean EScSG-AI, older age, modified Rodnan skin score (mRSS) and initial severity. The EScSG-AI was associated with patient- and physician-assessed measures of health status and overpowered the mRSS in predicting disease outcomes. Conclusion Disease activity burden quantified with the adjusted mean EScSG-AI predicted the risk of deterioration in health status and severe organ involvement in dcSSc. The EScSG-AI is more responsive when done repeatedly and averaged.
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Affiliation(s)
- Tatiana Nevskaya
- Division of Rheumatology, St. Joseph's Health Care, University of Western Ontario, London, ON
| | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Janet E Pope
- Division of Rheumatology, St. Joseph's Health Care, University of Western Ontario, London, ON
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Moore-Reed SD, Kibler WB, Bush H, Uhl TL. Level of patient-physician agreement in assessment of change following conservative rehabilitation for shoulder pain. Shoulder Elbow 2017; 9:127-132. [PMID: 28405224 PMCID: PMC5384533 DOI: 10.1177/1758573216658799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/14/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Assessment of health-related status has been shown to vary between patients and physicians, although the degree of patient-physician discordance in the assessment of the change in status is unknown. METHODS Ninety-nine patients with shoulder dysfunction underwent a standardized physician examination and completed several self-reported questionnaires. All patients were prescribed the same physical therapy intervention. Six weeks later, the patients returned to the physician, when self-report questionnaires were re-assessed and the Global Rating of Change (GROC) was completed by the patient. The physician completed the GROC retrospectively. To determine agreement between patient and physician, intra-class correlation (ICC) coefficient and Pearson's r using the 15-point GROC and weighted kappa using a consolidated three-point GROC were calculated. RESULTS Utilizing the 15-point GROC, complete agreement was observed in 37 of 99 patients (37%). ICC and Pearson's r between patient and physician were 0.62 and 0.63, respectively. Utilizing a consolidated three-point GROC, complete agreement was observed in 76 of 99 patients (77%). Weighted kappa was 0.62. CONCLUSIONS Assessment of change reported by the patient demonstrates moderate to good agreement with physician assessment. These findings indicate that the GROC does reflect and represent similar assessment of change in health status by patients and physicians. This can aid discussion of both past treatment results and future treatment plans.
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Affiliation(s)
- Stephanie D. Moore-Reed
- Department of Kinesiology, California State University, Fresno, CA, USA,Stephanie D. Moore-Reed, ATC, 5275 N Campus Dr M/S SG28 Fresno, CA 93740, USA.
| | | | - Heather Bush
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Tim L. Uhl
- Division of Athletic Training, University of Kentucky, Lexington, KY, USA
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17
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LoCasale RJ, Datto C, Wilson H, Yeomans K, Coyne KS. The Burden of Opioid-Induced Constipation: Discordance Between Patient and Health Care Provider Reports. J Manag Care Spec Pharm 2016; 22:236-45. [PMID: 27003553 PMCID: PMC10397844 DOI: 10.18553/jmcp.2016.22.3.236] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Opioid-induced constipation (OIC), a common side effect of opioid treatment for chronic pain, affects patient health-related quality of life (HRQL) and may prompt some patients to lower the dose or alter adherence to their opioid medication, compromising pain relief. Although health care providers (HCPs) are aware of the potential for OIC, patients may not inform their HCPs of their OIC symptoms, and HCPs may not initiate conversation regarding OIC if their patients' pain is controlled. Patients often try to address OIC symptoms on their own by using natural approaches or over-the-counter options. When OIC is discussed in an office visit, HCPs typically recommend conventional laxatives to relieve symptoms, but the efficacy of this approach is unproven and often suboptimal. In many areas of medicine, HCP perceptions of the impact of adverse effects of treatment on a patient's HRQL do not align with the patient's experience. OBJECTIVES To (a) describe HCP-reported understanding of his or her patients' experiences with OIC and (b) evaluate the level of agreement or discordance in perception between patients and their HCPs of OIC's impact on clinical outcomes. METHODS This was a prospective, longitudinal, observational cohort study conducted in the United States, Canada, Germany, and the United Kingdom (NCT01928953) in patients aged 18 to 85 years who had been receiving daily opioid therapy for ≥ 4 weeks for chronic noncancer pain with presence of OIC in the past 2 weeks. Data were collected from retrospective chart reviews, HCP questionnaires, and web-based patient surveys. Eligible patients enrolled online and completed the Patient Assessment of Constipation-Symptoms, the Work Productivity and Activity Impairment Questionnaire-Specific Health Problem, the EuroQOL 5 Dimensions, and the Global Assessment of Treatment Benefit, Satisfaction, and Willingness to Continue standardized questionnaires. The patient-reported component included 1 baseline survey and 8 follow-up surveys over 24 weeks. HCPs completed a web-based survey at baseline and at week 24 to assess their perceptions of OIC burden, treatment patterns, laxative use, and overall treatment satisfaction. The correspondence of patient- and HCP-reported data was evaluated for all similar outcomes from these 2 databases. RESULTS Patients (N = 489) reported a mean (SD) number of bowel movements (BMs) per week and spontaneous BMs per week of 3.7 (2.9) and 1.4 (2.3), respectively, at baseline. Most (87%) reported chronic pain of ≥ 2 years duration; 65% had used opioids for ≥ 2 years; and the mean pain score at baseline was 6.3, consistent with a moderate-to-severe pain population. Most (97%) patients at baseline reported any gastrointestinal-related symptom of at least moderate intensity, with 82% reporting the same intensity of any symptom at week 24. Of the 405 patients who had seen their HCPs in the past month, 63% reported that they had spoken to their HCPs about constipation, and 62% reported that their HCPs had asked them if they had constipation in the past month. The proportion of agreement between HCPs and their patients on the presence of constipation at baseline was 61%. Similar average pain ratings between HCPs and patients (5.9 vs. 6.0) at week 24 suggested clear communication regarding the level of pain experienced by the patient; however, OIC symptoms, laxative use and effectiveness, and impact of OIC on pain management and HRQL were not fully appreciated by HCPs. CONCLUSIONS The importance and severity of OIC are perceived differently by patients and their HCPs, a discordance that complicates pain management and demonstrates a need for greater communication. These disparate perceptions indicate a need for clinical education and coordination of care by HCPs to improve understanding and proactively manage OIC in patients with chronic noncancer pain.
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Affiliation(s)
- Robert J LoCasale
- 1 Group Director of Quality, Design & Analytics, Global Medicines Development, Payer & Real World Evidence, AstraZeneca Pharmaceuticals, Gaithersburg, Maryland
| | - Catherine Datto
- 2 U.S. Medical Affairs Medical Lead, AstraZeneca Pharmaceuticals, Wilmington, Delaware
| | - Hilary Wilson
- 3 Research Scientist, Research, Evidera, Bethesda, Maryland
| | - Karen Yeomans
- 4 Senior Manager and Senior Research Scientist, United BioSource Corporation, Montreal, QC, Canada
| | - Karin S Coyne
- 5 Vice President, Research, Evidera, Bethesda, Maryland
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18
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The association of sociodemographic and objectively-assessed disease variables with fatigue in systemic sclerosis: an analysis of 785 Canadian Scleroderma Research Group Registry patients. Clin Rheumatol 2016; 36:373-379. [DOI: 10.1007/s10067-016-3501-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
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19
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Harel D, Hudson M, Iliescu A, Baron M, Steele R. Summed and Weighted Summary Scores for the Medsger Disease Severity Scale Compared with the Physician’s Global Assessment of Disease Severity in Systemic Sclerosis. J Rheumatol 2016; 43:1510-8. [DOI: 10.3899/jrheum.151440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 12/27/2022]
Abstract
Objective.To develop a weighted summary score for the Medsger Disease Severity Scale (DSS) and to compare its measurement properties with those of a summed DSS score and a physician’s global assessment (PGA) of severity score in systemic sclerosis (SSc).Methods.Data from 875 patients with SSc enrolled in a multisite observational research cohort were extracted from a central database. Item response theory was used to estimate weights for the DSS weighted score. Intraclass correlation coefficients (ICC) and convergent, discriminative, and predictive validity of the 3 summary measures in relation to patient-reported outcomes (PRO) and mortality were compared.Results.Mean PGA was 2.69 (SD 2.16, range 0–10), mean DSS summed score was 8.60 (SD 4.02, range 0–36), and mean DSS weighted score was 8.11 (SD 4.05, range 0–36). ICC were similar for all 3 measures [PGA 6.9%, 95% credible intervals (CrI) 2.1–16.2; DSS summed score 2.5%, 95% CrI 0.4–6.7; DSS weighted score 2.0%, 95% CrI 0.1–5.6]. Convergent and discriminative validity of the 3 measures for PRO were largely similar. In Cox proportional hazards models adjusting for age and sex, the 3 measures had similar predictive ability for mortality (adjusted R2 13.9% for PGA, 12.3% for DSS summed score, and 10.7% DSS weighted score).Conclusion.The 3 summary scores appear valid and perform similarly. However, there were some concerns with the weights computed for individual DSS scales, with unexpected low weights attributed to lung, heart, and kidney, leading the PGA to be the preferred measure at this time. Further work refining the DSS could improve the measurement properties of the DSS summary scores.
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Discordance between patient and physician assessments of global disease activity in rheumatoid arthritis and association with work productivity. Arthritis Res Ther 2016; 18:114. [PMID: 27209012 PMCID: PMC4875609 DOI: 10.1186/s13075-016-1004-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Discordance between patient and physician ratings of rheumatoid arthritis (RA) severity occurs in clinical practice and correlates with pain scores and measurements of joint disease. However, information is lacking on whether discordance impacts patients' ability to work. We evaluated the discordance between patient and physician ratings of RA disease activity before and after treatment with etanercept and investigated the associations between discordance, clinical outcomes, and work productivity. METHODS In the PRESERVE clinical trial, patients with moderate RA received open-label etanercept 50 mg once weekly plus methotrexate for 36 weeks. Baseline and week-36 disease characteristics and clinical and work productivity outcomes were categorized according to week-36 concordance category, defined as positive discordance (patient global assessment - physician global assessment ≥2), negative discordance (patient global assessment - physician global assessment ≤ -2), and concordance (absolute difference between the two disease activity assessments = 0 or 1). Correlations between discordance, clinical outcomes, and predictors of discordance were determined. RESULTS At baseline, 520/762 (68.2 %) patient and physician global assessment scores were concordant, 194 (25.5 %) were positively discordant, and 48 (6.3 %) were negatively discordant. After 36 weeks of therapy, 556/763 (72.9 %) scores were concordant, 189 (24.8 %) were positively discordant, and 18 (2.4 %) were negatively discordant. Patients with week-36 concordance had the best 36-week clinical and patient-reported outcomes, and overall, the greatest improvement between baseline and week 36. Baseline pain, swollen joint count, duration of morning stiffness, fatigue, and patient general health significantly correlated with week-36 discordance, p < 0.0001 to p < 0.05. Additionally, baseline pain, patient general health, and C-reactive protein were predictors of week-36 discordance (odds ratios 1.22, 1.02, and 0.98, respectively). For the employed patients, percent impairment while working and percent overall work impairment were highest (greatest impairment) at baseline and 36 weeks in the group with positive discordance. CONCLUSIONS The percentage of patients with concordance increased after 36 weeks of treatment with etanercept, with concordant patients demonstrating the greatest improvement in clinical and patient-reported outcomes. Discordance correlated with several measures of disease activity and was associated with decreased work productivity. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00565409 . Registered 28/11/2007.
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Wiese AB, Berrocal VJ, Furst DE, Seibold JR, Merkel PA, Mayes MD, Khanna D. Correlates and responsiveness to change of measures of skin and musculoskeletal disease in early diffuse systemic sclerosis. Arthritis Care Res (Hoboken) 2014; 66:1731-9. [PMID: 24692361 DOI: 10.1002/acr.22339] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/25/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Skin and musculoskeletal involvement are frequently present early in diffuse cutaneous systemic sclerosis (dcSSc). The current study examined the correlates for skin and musculoskeletal measures in a 1-year longitudinal observational study. METHODS Patients with dcSSc were recruited at 4 US centers and enrolled in a 1-year study. Prespecified and standardized measures included physician and patient assessments of skin involvement, modified Rodnan skin score (MRSS), durometer score, Health Assessment Questionnaire disability index, serum creatine phosphokinase, tender joint counts, and presence/absence of tendon friction rubs, small joint contractures, and large joint contractures. Additionally, physician and patient global health assessments and health-related quality of life assessments were recorded. Correlations were computed among the baseline global assessments, skin variables, and musculoskeletal variables. Using the followup physician and patient anchors, effect sizes were calculated. RESULTS A total of 200 patients were studied: 75% were women, mean ± SD age was 50.0 ± 11.9 years, and mean ± SD disease duration from first non-Raynaud's phenomenon symptom was 1.6 ± 1.4 years. Physician global health assessment had large correlations with MRSS (r = 0.60) and physician-reported skin involvement visual analog scale in the last month (r = 0.74), whereas patient global assessment had large correlations with MRSS, the Short Form 36 health survey physical component scale, skin interference, and skin involvement in the last month (r = 0.37-0.72). Four of 9 skin variables had moderate to large effect sizes (0.51-1.09). CONCLUSION Physician and patient global assessments have larger correlations with skin measures compared to musculoskeletal measures. From a clinical trial perspective, skin variables were more responsive to change than musculoskeletal variables over a 1-year period, although both provide complementary information.
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Castrejón I, Yazici Y, Samuels J, Luta G, Pincus T. Discordance of Global Estimates by Patients and Their Physicians in Usual Care of Many Rheumatic Diseases: Association With 5 Scores on a Multidimensional Health Assessment Questionnaire (MDHAQ) That Are Not Found on the Health Assessment Questionnaire (H. Arthritis Care Res (Hoboken) 2014; 66:934-42. [DOI: 10.1002/acr.22237] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 11/12/2013] [Indexed: 01/14/2023]
Affiliation(s)
- Isabel Castrejón
- New York University School of Medicine and New York University Hospital for Joint Diseases; New York
| | - Yusuf Yazici
- New York University School of Medicine and New York University Hospital for Joint Diseases; New York
| | - Jonathan Samuels
- New York University School of Medicine and New York University Hospital for Joint Diseases; New York
| | | | - Theodore Pincus
- New York University School of Medicine and New York University Hospital for Joint Diseases; New York
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Ho YY, Baron M, Recklies AD, Roughley PJ, Mort JS. Cells from the skin of patients with systemic sclerosis secrete chitinase 3-like protein 1. BBA CLINICAL 2014; 1:2-11. [PMID: 26675476 PMCID: PMC4633946 DOI: 10.1016/j.bbacli.2013.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 12/22/2022]
Abstract
Background The chitinase-like protein, Chi3L1, is associated with increased fibrotic activity as well as inflammatory processes. The capacity of skin cells from systemic sclerosis (SSc) patients to produce Chi3L1, and the stimulation of its synthesis by cytokines or growth factors known to be associated with SSc, was investigated. Methods Cells were isolated from forearm and/or abdomen skin biopsies taken from SSc patients and normal individuals and stimulated with cytokines and growth factors to assess Chi3L1 expression. Chi3L1-expressing cells were characterized by immunohistochemical staining. Results Chi3L1 was not secreted by skin cells from normal individuals nor was its synthesis induced by any of the cytokines or growth factors investigated. In contrast, Chi3L1 secretion was induced by OSM or IL-1 in cells from all forearm biopsies of SSc patients, and endogenous secretion in the absence of cytokines was detected in several specimens. Patients with Chi3L1-producing cells at both the arm and abdomen had a disease duration of less than 3 years. Endogenous Chi3L1 production was not a property of the major fibroblast population nor of myofibroblasts, but rather was related to the presence of stem-like cells not present in normal skin. Other cells, however, contributed to the upregulation of Chi3L1 by OSM. Conclusions The emergence of cells primed to respond to OSM with increased Chi3L1 production appears to be associated with pathological processes active in SSc. General significance The presence of progenitor cells expressing the chilectin Chi3L1 in SSc skin appears to play a role in the initiation of the disease process. Cells isolated from the skin of scleroderma patients secrete Chi3L1. Chi3L1 production is stimulated by oncostatin M or interleukin 1. Patients with Chi3L1 producing cells have disease duration of < 3 years. Chi3L1 production is a property of stem-like cells not present in normal skin. Other cells contribute to Chi3L1 upregulation by oncostatin M.
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Key Words
- Chi3L1, chitinase 3-like protein 1
- Chitinase 3-like protein 1
- Cytokine
- DAPI, 4′,6-diamidino-2-phenylindole
- ECM, extracellular matrix
- IL, interleukin
- OSM, oncostatin M
- Oncostatin M
- PDGF, platelet-derived growth factor
- SBTI, soybean trypsin inhibitor
- SSc, systemic sclerosis (scleroderma)
- Scleroderma
- Stem cell
- Systemic sclerosis
- TGFβ, transforming growth factor-β
- TIE2, tyrosine kinase with Ig and EGF homology domains-2
- mRSS, modified Rodnan skin score
- αSMA, α-smooth muscle actin
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Affiliation(s)
- Yuen Yee Ho
- Shriners Hospital for Children, Department of Surgery, McGill University, 1529 Cedar Avenue, Montréal, Quebec H3G 1A6, Canada
| | - Murray Baron
- Department of Rheumatology, Jewish General Hospital, 3755 Cote Ste Catherine Road, Montréal, Quebec H3T 1E2, Canada
| | - Anneliese D Recklies
- Shriners Hospital for Children, Department of Surgery, McGill University, 1529 Cedar Avenue, Montréal, Quebec H3G 1A6, Canada
| | - Peter J Roughley
- Shriners Hospital for Children, Department of Surgery, McGill University, 1529 Cedar Avenue, Montréal, Quebec H3G 1A6, Canada
| | - John S Mort
- Shriners Hospital for Children, Department of Surgery, McGill University, 1529 Cedar Avenue, Montréal, Quebec H3G 1A6, Canada
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Comparison of Physician and Patient Global Assessments Over Time in Patients With Rheumatoid Arthritis. J Clin Rheumatol 2013; 19:317-23. [DOI: 10.1097/rhu.0b013e3182a2164f] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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de Achaval S, Kallen MA, Mayes MD, Lopez-Olivo MA, Suarez-Almazor ME. Use of the Patient-generated Index in systemic sclerosis to assess patient-centered outcomes. J Rheumatol 2013; 40:1337-43. [PMID: 23772081 DOI: 10.3899/jrheum.120978] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the content and construct validity of an individualized patient-reported instrument, the Patient-generated Index (PGI), in patients with systemic sclerosis (SSc), and to compare its performance to that of other instruments and to the Patient-reported Outcomes Measurement Information System (PROMIS) framework. METHODS Patients identified the 5 most important life areas affected by SSc, which we categorized into domains of the PROMIS framework (mental, physical, and social). Correlations were obtained between PGI and the Health Assessment Questionnaire (HAQ), the Medical Outcomes Study Short Form-36 (SF-36), and the Symptom Burden Index (SBI) scores. RESULTS Sixty-two patients with SSc completed the PGI: 87% women, 69% white, mean age 53 years, mean disease duration 8 years, and 63% with diffuse disease. A total of 258 individual life area responses were recorded: 54% in social health (social function and relationship subcomponents); 28% in physical health (physical function, symptoms, general physical health); and 19% in mental health (consisting largely of the affect subcomponent). Patient PGI responses were categorized into 6 of the 7 subcomponents of the PROMIS framework; substance use/alcohol was not identified. Statistically significant correlations ranging in absolute value from 0.26 to 0.50 were observed between the PGI and the HAQ, SF-36 summary component scores, and the large majority of SF-36 subscales and SBI components. CONCLUSION The PGI is a personalized instrument that adequately assessed a wide range of health-related quality of life outcomes within the PROMIS framework. The PGI captured additional constructs not yet defined within the framework that are important for patients with SSc.
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Affiliation(s)
- Sofia de Achaval
- University of Texas MD Anderson Cancer Center, Department of General Internal Medicine, Houston, Texas 77030, USA
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Kelsey CE, Torok KS. The Localized Scleroderma Cutaneous Assessment Tool: responsiveness to change in a pediatric clinical population. J Am Acad Dermatol 2013; 69:214-20. [PMID: 23562760 DOI: 10.1016/j.jaad.2013.02.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 01/24/2013] [Accepted: 02/03/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lack of agreement on how to accurately capture disease outcomes in localized scleroderma (LS) has hindered the development of efficacious treatment protocols. The LS Cutaneous Assessment Tool (LoSCAT), consisting of the modified LS Skin Severity Index (mLoSSI) and the LS Damage Index, has potential for use in clinical trials. OBJECTIVE The goal of this article is to further evaluate the clinical responsiveness of the LoSCAT. Based on the modifiable nature of disease activity versus damage, we expected the mLoSSI to be responsive to change. METHODS At 2 study visits, a physician completed the LoSCAT and Physician Global Assessment (PGA) of Disease Activity and of Disease Damage for 29 patients with LS. Spearman correlations were used to examine the relationships between the change in the LoSCAT and the PGA scores. To evaluate contrasted group validity, patients were grouped according to disease activity classification and change scores of groups were compared. Minimal clinically important differences were calculated and compared with the standard error of measurement. RESULTS Change in the mLoSSI score correlated strongly with change in the PGA of Disease Activity score, whereas change in the LS Damage Index score correlated weakly with change in the PGA of Disease Damage score. The mLoSSI and PGA of Disease Activity exhibited contrasted group validity. Minimal clinically important differences for the activity measures were greater than the respective standard errors of measurement. LIMITATIONS Only 2 study visits were included in analysis. CONCLUSION This study gives further evidence that the LoSCAT, specifically the mLoSSI, is a responsive, valid measure of activity in LS and should be used in future treatment studies.
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Affiliation(s)
- Christina E Kelsey
- Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15224, USA.
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Harel D, Thombs BD, Hudson M, Baron M, Steele R. Measuring fatigue in SSc: a comparison of the Short Form-36 Vitality subscale and Functional Assessment of Chronic Illness Therapy–Fatigue scale. Rheumatology (Oxford) 2012; 51:2177-85. [DOI: 10.1093/rheumatology/kes206] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pope J. Measures of systemic sclerosis (scleroderma): Health Assessment Questionnaire (HAQ) and Scleroderma HAQ (SHAQ), physician- and patient-rated global assessments, Symptom Burden Index (SBI), University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Scale (UCLA SCTC GIT) 2.0, Baseline Dyspnea Index (BDI) and Transition Dyspnea Index (TDI) (Mahler's Index), Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR), and Raynaud's Condition Score (RCS). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S98-111. [PMID: 22588774 DOI: 10.1002/acr.20598] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Janet Pope
- University of Western Ontario, London, Ontario, Canada.
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