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Seabury J, Varma A, Weinstein J, Rosero SJ, Engebrecht C, Khosa S, Zizzi C, Wagner ES, Alexandrou D, Cohen BL, Dilek N, Heatwole JM, Lynch DR, Park CC, Wells M, Subramony SH, Heatwole CR. Friedreich Ataxia Caregiver-Reported Health Index: Development of a Novel, Disease-Specific Caregiver-Reported Outcome Measure. Neurol Clin Pract 2024; 14:e200303. [PMID: 38751829 PMCID: PMC11092940 DOI: 10.1212/cpj.0000000000200300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/05/2024] [Indexed: 05/18/2024]
Abstract
Background and Objectives The Friedreich ataxia (FRDA) scientific community needs access to patient-centered outcome measures that satisfy regulatory guidelines and are capable of tracking clinically meaningful changes in FRDA disease burden. The objective of this research was to develop a novel, disease-specific caregiver-reported outcome measure for use in FRDA research and clinical care. Methods In prior work, we conducted qualitative interviews and a cross-sectional study of FRDA caregivers and patients to determine the symptoms of greatest importance to individuals with FRDA. We designed the Friedreich Ataxia Caregiver-Reported Health Index (FACR-HI) to serially measure the symptoms of greatest importance to patients and utilized factor analysis, beta testing, reliability testing, and cross-sectional subgroup analysis to further evaluate and optimize this disease-specific outcome measure. Results The FACR-HI was designed to measure total disease burden and disease burden in 18 symptomatic domains. The FACR-HI total score demonstrated high internal consistency (Cronbach's α = 0.98) and test-retest reliability (intraclass correlation coefficient = 0.96). Beta interview participants found the FACR-HI to be highly relevant, comprehensive, and easy to use. FACR-HI total and subscale scores were associated with functional staging for ataxia scores and speech impairment. Discussion Initial evaluation of the FACR-HI supports its content validity, test-retest reliability, and construct validity as a caregiver-reported outcome measure for assessing how pediatric individuals with FRDA feel and function. The FACR-HI provides a potential mechanism to quantify changes in multifactorial FRDA disease burden during future clinical trials.
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Affiliation(s)
- Jamison Seabury
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Anika Varma
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Jennifer Weinstein
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Spencer J Rosero
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Charlotte Engebrecht
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Shaweta Khosa
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Christine Zizzi
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Ellen S Wagner
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Danae Alexandrou
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Brittany L Cohen
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Nuran Dilek
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - John M Heatwole
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - David R Lynch
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Courtney C Park
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - McKenzie Wells
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - S H Subramony
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Chad R Heatwole
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
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Varma A, Weinstein J, Seabury J, Rosero S, Wagner E, Zizzi C, Kaat A, Luebbe E, Dilek N, Heatwole J, Saubermann L, Temple L, Rogoff S, Heatwole C. The Crohn's Disease-Health Index: Development and Evaluation of a Novel Outcome Measure. J Clin Gastroenterol 2024:00004836-990000000-00260. [PMID: 38277500 DOI: 10.1097/mcg.0000000000001976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/26/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE We sought to develop and validate the Crohn's Disease-Health Index (CD-HI), a disease-specific, patient-reported outcome measure that serially measures Crohn's disease (CD) symptomatic burden in adults with CD. BACKGROUND As therapeutic interventions are tested among patients with CD, responsive outcome measures are needed to track disease progression and therapeutic gain during clinical trials. PATIENTS AND METHODS We conducted a national cross-sectional study of individuals with CD to identify the most prevalent and impactful symptoms of CD. The most relevant symptoms were included in the CD-HI. We used factor analysis, qualitative patient interviews, test-retest reliability evaluation, and known group validity testing to evaluate and optimize the CD-HI. RESULTS The CD-HI contains 12 subscales that comprehensively measure CD burden using the patient's perspective. Fifteen adults with CD beta tested the CD-HI and found the instrument to be clear, easy to use, and relevant to them. Twenty-three adults with CD participated in an assessment of test-retest reliability, which indicated high reliability of individual questions, subscales, and the full instrument (intraclass correlation coefficient = 0.84 for the full instrument). The CD-HI and its subscales demonstrated a high internal consistency (Cronbach α = 0.98 for the full instrument). The CD-HI distinguished between groups of individuals with CD known to differ in disease severity. CONCLUSIONS This research supports the use of the CD-HI as a valid, sensitive, reliable, and relevant patient-reported outcome to determine the multifactorial disease burden of those with CD, assess the relevance and merit of future CD therapies, and support drug labeling claims.
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Affiliation(s)
- Anika Varma
- Center for Health + Technology, University of Rochester
| | | | | | | | - Ellen Wagner
- Center for Health + Technology, University of Rochester
| | | | | | - Elizabeth Luebbe
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nuran Dilek
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John Heatwole
- Department of Colorectal Surgery, University of Rochester
| | | | | | - Scott Rogoff
- Department of Medicine and Pediatrics, University of Rochester
| | - Chad Heatwole
- Center for Health + Technology, University of Rochester
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Trucco F, Salmin F, Lizio A, Coratti G, Albamonte E, Frisoni MC, Mauro L, Carraro E, Palazzo G, Lops J, Cattaneo C, Pozzi S, Casiraghi J, Di Bari A, Berti B, Stanca G, Ricci M, Pane M, Heatwole C, Dilek N, Mercuri E, Sansone VA. Assessing Prevalence and Characteristics of Oro-bulbar Involvement in Children and Adults with SMA Type 2 and 3 Using a Multimodal Approach. Dysphagia 2023; 38:1568-1580. [PMID: 37289231 PMCID: PMC10611831 DOI: 10.1007/s00455-023-10584-z] [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: 01/13/2023] [Accepted: 04/21/2023] [Indexed: 06/09/2023]
Abstract
Bulbar and jaw muscles are impaired in patients with Spinal Muscular Atrophy (SMA) but the assessment of their severity and progression are limited by the lack of age-appropriate and disease-specific measures. We investigated mastication and swallowing in children and adults with SMA, sitters and walkers. In a 2-year multicentre cross-sectional prospective study, lip and tongue strength (Iowa Oral Performance Instrument), chewing and swallowing (Test of Masticating and Swallowing Solids), active mouth opening (aMMO) were compared to age-appropriate normative data. The perceived burden of oro-bulbar involvement (SMA-Health Index) was recorded. 78 patients were included, 45 children (median age 7.4 years),22 adults (median age 26.8 years) on nusinersen and 11 untreated (median age 32.7 years). Forty-three percent children had reduced mouth opening, 50% had prolonged total time to eat. These issues were more prominent in sitters than in walkers (p = 0.019, p = 0.014). Sixty-six percent needed increased swallows for bolus clearance. Nusinersen treated adults had median aMMO, tongue strength and total time at TOMASS values within normal range (z score: -1.40, -1.22, -1.32, respectively) whereas untreated adults had reduced aMMO (z score: -2.68) and tongue strength (z score: -2.20). Only a minority of children (2/17) and treated adults (5/21) reported burden in swallowing or mastication compared to all untreated adults (5/5). After 16 months, mastication and swallowing were stable in treated children and adults, whether sitters or walkers. The reported multimodal approach to assess oro-bulbar functions demonstrate that swallowing and mastication are impaired in SMA despite patients' perception. These results suggest a trend towards stabilization of oro-bulbar function in patients on long-term treatment with nusinersen.
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Affiliation(s)
- Federica Trucco
- Neurorehabilitation Unit, The NeMo Clinical Center in Milan, University of Milan, ASST Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, UK
- Dept Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | | | - Andrea Lizio
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | - Giorgia Coratti
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Luca Mauro
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | - Elena Carraro
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | | | - Jessica Lops
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | | | - Susanna Pozzi
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | | | | | - Beatrice Berti
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Stanca
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Martina Ricci
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marika Pane
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Chad Heatwole
- Center for Health and Technology (CHeT), The University of Rochester Medical Center, Rochester, NY, USA
| | - Nuran Dilek
- Center for Health and Technology (CHeT), The University of Rochester Medical Center, Rochester, NY, USA
| | - Eugenio Mercuri
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valeria Ada Sansone
- Neurorehabilitation Unit, The NeMo Clinical Center in Milan, University of Milan, ASST Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy.
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Belter L, Peterson I, Jarecki J. Evaluating Perceived Fatigue within an Adult Spinal Muscular Atrophy Population. Neurol Ther 2023; 12:2161-2175. [PMID: 37856000 PMCID: PMC10630176 DOI: 10.1007/s40120-023-00552-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by progressive muscle weakness and atrophy. While chronic fatigue is a common manifestation of SMA, the field lacks comprehensive data to assess the extent of its impact. Cure SMA, an SMA patient advocacy organization, conducted an online survey of its adults with SMA community members to measure the impact of fatigue. METHODS All survey respondents were asked to complete questions on demographics, use of SMA treatment, and quality of life, but respondents were randomized to receive three of the following fatigue instruments: the Modified Fatigue Impact Scale (MFIS), Multidimensional Fatigue Inventory (MFI), Fatigue Severity Scale (FSS), PedsQL™ Multidimensional Fatigue (PedsQL MF) Scale, and Spinal Muscular Atrophy Health Index (SMA-HI) fatigue modules. Scales were evaluated for reliability and overall fatigue scores were evaluated by multivariate regression models to determine which variables were related to the final scores of each instrument. RESULTS A total of 253 adults completed the online survey. When measured against the general population, statistically significant differences were found among adults with SMA for certain variables within each measurement instrument. However, there did not appear to be differences in fatigue levels among key subgroups within the SMA population. CONCLUSIONS This was the first use of more than two fatigue questionnaires simultaneously in SMA. The lack of a consistent relationship between SMA severity and fatigue levels was surprising. This may be related to the lack of specificity of the instruments for this population. An SMA-specific scale is needed to evaluate differences in fatigue impact across the SMA population.
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Affiliation(s)
- Lisa Belter
- Cure SMA, 925 Busse Rd., Elk Grove Village, IL, 60056, USA.
| | - Ilse Peterson
- Faegre Drinker Biddle & Reath LLP, Washington, DC, USA
| | - Jill Jarecki
- Cure SMA, 925 Busse Rd., Elk Grove Village, IL, 60056, USA
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Lee YJ, Kim AR, Lee JM, Shim YK, Cho JS, Ryu HW, Kwon S, Chae JH. Impact of nusinersen on the health-related quality of life and caregiver burden of patients with spinal muscular atrophy with symptom onset after age 6 months. Muscle Nerve 2023; 68:404-413. [PMID: 37602664 DOI: 10.1002/mus.27950] [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: 01/31/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION/AIMS Novel disease-modifying approaches for spinal muscular atrophy (SMA) have highlighted the patient's perspective on functional changes over time. In this study, we evaluated the impact of nusinersen on the health-related quality of life (HRQoL) of patients with later-onset SMA and the caregiver burden. METHODS We assessed the changes in HRQoL using the Pediatric Quality of Life Inventory 4.0 Generic Core Scale (PedsQL GCS) and the Pediatric Quality of Life Inventory 3.0 Neuromuscular Module (PedsQL NMM) during 26 months of treatment. Caregiver burden was assessed using the Assessment of Caregiver Experience with Neuromuscular Disease. We also assessed motor function using the Hammersmith Functional Motor Scale-Expanded (HFMSE) and the Revised Upper Limb Module score. RESULTS Twenty-four patients and their caregivers were included. The median age of patients at treatment onset was 148.8 (6.8 to 269.4) months. A significant improvement was observed in psychosocial health in proxy-reported PedsQL (P = .023). However, the physical health scores of the PedsQL GCS and About my neuromuscular disorder subscores of the PedsQL NMM did not change, although there was a significant increase in HFMSE scores. Regarding the caregiver burden, the financial burden was reduced, whereas time burden increased. A higher HFMSE score was associated with better self-reported PedsQL GCS total scores (P < .001). DISCUSSION Our results provide insights into the multifaceted implications of disease-modifying therapies for SMA through patient-reported outcome measures (PROMs). PROMs should be taken into consideration to assess the clinical significance of the functional changes identified by clinician-reported scales.
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Affiliation(s)
- Yun Jeong Lee
- Department of Pediatrics, Kyungpook National University Hospital and School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital and School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jong-Mok Lee
- Department of Neurology, Kyungpook National University Hospital and School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Young Kyu Shim
- Department of Pediatrics, Korea University Ansan Hospital, Seoul, South Korea
| | - Jae So Cho
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hye Won Ryu
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Soonhak Kwon
- Department of Pediatrics, Kyungpook National University Children's Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, South Korea
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Seabury J, Rosero S, Varma A, Weinstein J, Engebrecht C, Dilek N, Heatwole J, Alexandrou D, Cohen B, Larkindale J, Lynch DR, Park C, Subramony SH, Wagner E, Walther S, Wells M, Zizzi C, Heatwole C. Friedreich's Ataxia-Health Index: Development and Validation of a Novel Disease-Specific Patient-Reported Outcome Measure. Neurol Clin Pract 2023; 13:e200180. [PMID: 37646046 PMCID: PMC10462051 DOI: 10.1212/cpj.0000000000200180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/02/2023] [Indexed: 09/01/2023]
Abstract
Background and Objectives To develop a valid, disease-specific, patient-reported outcome (PRO) measure for adolescents and adults with Friedreich ataxia (FA) for use in therapeutic trials. Methods We conducted semistructured qualitative interviews and a national cross-sectional study of individuals with FA to determine the most prevalent and burdensome symptoms and symptomatic themes to this population. These symptoms and symptomatic themes were included as questions in the first version of the Friedreich's Ataxia-Health Index (FA-HI). We subsequently used factor analysis, beta interviews with 17 individuals with FA, and test-retest reliability assessments with 20 individuals with FA to evaluate, refine, and optimize the FA-HI. Finally, we determined the capability of the FA-HI to differentiate between subgroups of FA participants with varying levels of disease severity. Results Participants with FA identified 18 symptomatic themes of importance to be included as subscales in the FA-HI. The FA-HI demonstrates high internal consistency and test-retest reliability, and it was identified by participants as highly relevant, comprehensive, and easy to complete. FA-HI total and subscale scores statistically differentiated between subgroups of participants with varying levels of disease burden. Discussion Initial evaluation of the FA-HI supports its validity and reliability as a PRO for assessing how individuals with FA feel and function.
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Affiliation(s)
- Jamison Seabury
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Spencer Rosero
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Anika Varma
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Jennifer Weinstein
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Charlotte Engebrecht
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Nuran Dilek
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - John Heatwole
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Danae Alexandrou
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Brittany Cohen
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Jane Larkindale
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - David R Lynch
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Courtney Park
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Sub H Subramony
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Ellen Wagner
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Susan Walther
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - McKenzie Wells
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Christine Zizzi
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Chad Heatwole
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
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7
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Varma A, Weinstein J, Seabury J, Rosero S, Engebrecht C, Wagner E, Zizzi C, Luebbe EA, Dilek N, McDermott MP, Kissel J, Sansone V, Heatwole C. The Facioscapulohumeral Muscular Dystrophy-Health Index: Development and evaluation of a disease-specific outcome measure. Muscle Nerve 2023; 68:422-431. [PMID: 37610084 DOI: 10.1002/mus.27951] [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: 01/25/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION/AIMS As promising therapeutic interventions are tested among patients with facioscapulohumeral muscular dystrophy (FSHD), there is a clear need for valid and reliable outcome tools to track disease progression and therapeutic gain in clinical trials and for clinical monitoring. Our aim was to develop and validate the Facioscapulohumeral Muscular Dystrophy-Health Index (FSHD-HI) as a multifaceted patient-reported outcome measure (PRO) designed to measure disease burden in adults with FSHD. METHODS Through initial interviews with 20 individuals and a national cross-sectional study with 328 individuals with FSHD, we identified the most prevalent and impactful symptoms in FSHD. The most relevant symptoms were included in the FSHD-HI. We used patient interviews, test-retest reliability evaluation, known groups validity testing, and factor analysis to evaluate and optimize the FSHD-HI. RESULTS The FSHD-HI contains 14 subscales that measure FSHD disease burden from the patient's perspective. Fourteen adults with FSHD participated in semistructured beta interviews and found the FSHD-HI to be clear, usable, and relevant to them. Thirty-two adults with FSHD participated in test-retest reliability assessments, which demonstrated the high reliability of the FSHD-HI total score (intraclass correlation coefficient = 0.924). The final FSHD-HI and its subscales also demonstrated a high internal consistency (Cronbach α = 0.988). DISCUSSION The FSHD-HI provides researchers and clinicians with a reliable and valid mechanism to measure multifaceted disease burden in patients with FSHD. The FSHD-HI may facilitate quantification of therapeutic effectiveness, as demonstrated by its use as a secondary and exploratory measure in several clinical trials.
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Affiliation(s)
- Anika Varma
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Jennifer Weinstein
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Jamison Seabury
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Spencer Rosero
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Charlotte Engebrecht
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Ellen Wagner
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Christine Zizzi
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Elizabeth A Luebbe
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Nuran Dilek
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Michael P McDermott
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
- Department of Neurology, University of Rochester, Rochester, New York, USA
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - John Kissel
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Valeria Sansone
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- The NEMO Clinical Center, Milan, Italy
| | - Chad Heatwole
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
- Department of Neurology, University of Rochester, Rochester, New York, USA
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8
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Heirani Moghaddam S, Sen D, Carson M, Mackowiak R, Markley R, Manson GA. The Impact of Limited Previous Motor Experience on Action Possibility Judgments in People with Spinal Muscle Atrophy. Brain Sci 2023; 13:1256. [PMID: 37759857 PMCID: PMC10526987 DOI: 10.3390/brainsci13091256] [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: 08/09/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
Previous studies have shown that people with limited motor capabilities may rely on previous motor experience when making action possibility judgments for others. In the present study, we examined if having limited previous motor experience, as a consequence of spinal muscle atrophy (SMA), alters action possibility judgments. Participants with SMA and neurologically healthy (NH) sex- and age-matched controls performed a perceptual-motor judgment task using the Fitts's law paradigm. Participants observed apparent motion videos of reciprocal aiming movements with varying levels of difficulty. For each movement, participants predicted the shortest movement time (MT) at which a neurologically healthy young adult could accurately perform the task. Participants with SMA predicted significantly longer MTs compared to controls; however, the predicted MTs of both SMA and NH participants exhibited a Fitts's law relationship (i.e., the predicted MTs significantly increased as movement difficulty increased). Overall, these results provide evidence that participants with SMA who have limited, or no motor experience may make more conservative action possibility judgments for others. Critically, our finding that the pattern of action possibility judgments was not different between SMA and NH groups suggests that limited previous motor experience may not completely impair action possibility judgments.
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Affiliation(s)
| | - Dilara Sen
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Megan Carson
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Robert Mackowiak
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Rachel Markley
- Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Gerome Aleandro Manson
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
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9
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Rodriguez-Torres RS, Uher D, Gay EL, Coratti G, Dunaway Young S, Rohwer A, Muni Lofra R, De Vivo DC, Hirano M, Glynn NW, Montes J. Measuring Fatigue and Fatigability in Spinal Muscular Atrophy (SMA): Challenges and Opportunities. J Clin Med 2023; 12:jcm12103458. [PMID: 37240564 DOI: 10.3390/jcm12103458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Fatigue, a common symptom, together with the characteristic of performance fatigability, are well-documented features of SMA that impact quality of life and function. Importantly, establishing associations between multidimensional self-reported fatigue scales and patient performance has proven difficult. This review was conducted to evaluate the various patient-reported fatigue scales applied in SMA, with the objective of considering the limitations and advantages of each measure. Variable use of fatigue-related nomenclature, including conflicting terminology interpretation, has affected assessment of physical fatigue attributes, specifically perceived fatigability. This review encourages the development of original patient-reported scales to enable perceived fatigability assessment, providing a potential complementary method of evaluating treatment response.
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Affiliation(s)
- Rafael S Rodriguez-Torres
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - David Uher
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10115, USA
| | - Emma L Gay
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Giorgia Coratti
- Pediatric Neurology Unit, Catholic University, 00135 Rome, Italy
- Centro Clinico Nemo, U.O.C. Neuropsichiatria Infantile Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Sally Dunaway Young
- Department of Neurology and Clinical Neurosciences, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Annemarie Rohwer
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Robert Muni Lofra
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 7RU, UK
| | - Darryl C De Vivo
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Michio Hirano
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Nancy W Glynn
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jacqueline Montes
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
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Vázquez-Costa JF, Branas-Pampillón M, Medina-Cantillo J, Povedano M, Pitarch-Castellano I, López-Lobato M, Fernández-Ramos JA, Lafuente-Hidalgo M, Rojas-García R, Caballero-Caballero JM, Málaga I, Eirís-Puñal J, De Lemus M, Cattinari MG, Cabello-Moruno R, Díaz-Abós P, Sánchez-Menéndez V, Rebollo P, Maurino J, Madruga-Garrido M. Validation of a Set of Instruments to Assess Patient- and Caregiver-Oriented Measurements in Spinal Muscular Atrophy: Results of the SMA-TOOL Study. Neurol Ther 2023; 12:89-105. [PMID: 36269538 PMCID: PMC9837344 DOI: 10.1007/s40120-022-00411-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/04/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Outcome measures traditionally used in spinal muscular atrophy (SMA) clinical trials are inadequate to assess the full range of disease severity. The aim of this study was to assess the psychometric properties of a set of existing questionnaires and new items, gathering information on the impact of SMA from the patient and caregiver perspectives. METHODS This was a multicenter, prospective, noninterventional study including patients with a confirmed diagnosis of 5q-autosomal-recessive SMA aged 8 years and above, or their parents (if aged between 2 and 8 years). The set of outcome measurements included the SMA Independence Scale (SMAIS) patient and caregiver versions, the Neuro-QoL Fatigue Computer Adaptive Test (CAT), the Neuro-QoL Pain Short Form-Pediatric Pain, the PROMIS adult Pain Interference CAT, and new items developed by Fundación Atrofia Muscular España: perceived fatigability, breathing and voice, sleep and rest, and vulnerability. Reliability, construct validity, discriminant validity, and sensitivity to change (4 months from baseline) were measured. RESULTS A total of 113 patients were included (59.3% 2-17 years old, 59.3% male, and 50.4% with SMA type II). Patients required moderate assistance [mean patient and caregiver SMAIS (SD) scores were 31.1 (12.8) and 7.6 (11.1), respectively]. Perceived fatigability was the most impacted domain, followed by vulnerability. Cronbach's alpha coefficient for perceived fatigability, breathing and voice, and vulnerability total scores were 0.92, 0.88, and 0.85, respectively. The exploratory factor analysis identified the main factors considered in the design, except in the sleep and rest domain. All questionnaires were able to discriminate between the Clinical Global Impression-Severity scores and SMA types. Sensitivity to change was only found for the SMAIS caregiver version and vulnerability items. CONCLUSIONS This set of outcome measures showed adequate reliability, construct validity, and discriminant validity and may constitute a valuable option to measure symptom severity in patients with SMA.
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Affiliation(s)
- Juan F Vázquez-Costa
- Neuromuscular Unit, Department of Neurology, Hospital Universitari I Politècnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | | | - Julita Medina-Cantillo
- Rehabilitation and Physical Unit Department, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Mónica Povedano
- Department of Neurology, IDIBELL, Hospital de Bellvitge, Barcelona, Spain
| | | | - Mercedes López-Lobato
- Neuromuscular Research Unit, Department of Pediatric Neurology, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | | | - Miguel Lafuente-Hidalgo
- Child Neurology Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, Saragossa, Spain
| | - Ricard Rojas-García
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Ignacio Málaga
- Child Neurology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Jesús Eirís-Puñal
- Department of Pediatric Neurology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Mencía De Lemus
- Fundacion Atrofia Muscular Espinal España (FundAME), Madrid, Spain
| | | | - Rosana Cabello-Moruno
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain
| | - Paola Díaz-Abós
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain
| | | | | | - Jorge Maurino
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain
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11
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Slayter J, Casey L, O’Connell C. Patient Reported Outcome Measures in Adult Spinal Muscular Atrophy: A Scoping Review and Graphical Visualization of the Evidence. J Neuromuscul Dis 2023; 10:239-250. [PMID: 36530090 PMCID: PMC10041426 DOI: 10.3233/jnd-221595] [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: 11/24/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Spinal Muscular Atrophy (SMA) is a hereditary neuromuscular disease with an estimated prevalence of 1/10 000 births. SMA is increasingly recognized as a multi-system disease with a need to study additional under-recognized health domains such as quality of life, fatigue, bulbar function, respiratory function, and independence. OBJECTIVE Identify and assess reported evidence from the literature investigating Patient Reported Outcome Measures (PROMs) in adults with SMA. Develop a novel method drawing from network theory to graphically depict the literature, PROMs, and supporting psychometric evidence. METHODS A scoping review was completed following PRISM-ScR, COSMIN and JBI scoping review guidelines. Literature investigating PROMs in adult SMA or neuromuscular disease was identified from peer-reviewed and grey databases. A network graph was derived from extracted data. RESULTS 5292 articles were retrieved, 81 articles met inclusion criteria; corresponding to 31 unique PROMs. Only two PROMs were developed specifically for SMA. Few PROMs covered multiple domains of health. Most PROMs were incompletely validated, focusing on concurrent validity, and few assessed responsiveness or internal consistency. CONCLUSIONS PROMs are emerging tools for monitoring and assessing adults with SMA. Despite their potential benefits, additional validation studies should be completed prior to their use for clinical decision-making. Network graphics may represent a technique to aid in the visualization of evidence supporting a scoping review.
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Affiliation(s)
- Jeremy Slayter
- Dalhousie Medicine New Brunswick, Faculty of Medicine, Dalhousie University, Saint John, NB, Canada
- Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, NB, Canada
| | - Lauren Casey
- Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, NB, Canada
| | - Colleen O’Connell
- Dalhousie Medicine New Brunswick, Faculty of Medicine, Dalhousie University, Saint John, NB, Canada
- Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, NB, Canada
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12
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Rosero S, Weinstein J, Seabury J, Zizzi C, Wagner E, Varma A, Heatwole J, Alexandrou D, Ms ND, Johnson BA, Heatwole C. Disease Burden in Children With Spinal Muscular Atrophy: Results From a Large Cross-Sectional Study. J Child Neurol 2022; 38:52-63. [PMID: 36537125 DOI: 10.1177/08830738221135918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background:To facilitate advances in spinal muscular atrophy therapeutic research, it is important to determine the impact and prevalence of symptoms experienced by children with spinal muscular atrophy. Methods: We conducted qualitative interviews with caregivers of children with spinal muscular atrophy. From these interviews, we generated a survey inquiring about 260 symptoms of importance grouped into 17 symptomatic themes. Results: Sixteen caregivers of children with spinal muscular atrophy aged from 4 months to 12 years participated in initial interviews, and 77 caregivers completed the survey. Higher symptom prevalence was associated with spinal muscular atrophy type, SMN2 copy number, and functional status. Hip, thigh, or knee weakness had the greatest reported impact on the lives of children with spinal muscular atrophy. Conclusions: This research provides one of the largest data sets regarding disease burden in children with spinal muscular atrophy. The most prevalent symptoms are not identical to those with the greatest impact. This unique insight into the most impactful symptoms will help focus therapeutic development in spinal muscular atrophy.
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Affiliation(s)
- Spencer Rosero
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA
| | - Jennifer Weinstein
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA
| | - Jamison Seabury
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA
| | - Christine Zizzi
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA.,6740Princeton University, Princeton, NJ, USA
| | - Ellen Wagner
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA
| | - Anika Varma
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA
| | - John Heatwole
- 321918Pittsford Sutherland High School, Pittsford, NY, USA
| | - Danae Alexandrou
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA
| | - Nuran Dilek Ms
- Department of Biostatistics and Computational Biology, 6927The University of Rochester, Rochester, NY, USA
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, 6927The University of Rochester, Rochester, NY, USA
| | - Chad Heatwole
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA.,Department of Neurology, 6927The University of Rochester, Rochester, NY, USA
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13
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Brumfield OS, Zizzi CE, Dilek N, Alexandrou DG, Glidden AM, Rosero S, Weinstein J, Seabury J, Kaat A, McDermott MP, Dorsey ER, Heatwole CR. The Huntington's Disease Health Index: Initial Evaluation of a Disease-Specific Patient Reported Outcome Measure. J Huntingtons Dis 2022; 11:217-226. [PMID: 35527560 DOI: 10.3233/jhd-210506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND When developed properly, disease-specific patient reported outcome measures have the potential to measure relevant changes in how a patient feels and functions in the context of a therapeutic trial. The Huntington's Disease Health Index (HD-HI) is a multifaceted disease-specific patient reported outcome measure (PROM) designed specifically to satisfy previously published FDA guidance for developing PROMs for product development and labeling claims. OBJECTIVE In preparation for clinical trials, we examine the validity, reliability, clinical relevance, and patient understanding of the Huntington's Disease Health Index (HD-HI). METHODS We partnered with 389 people with Huntington's disease (HD) and caregivers to identify the most relevant questions for the HD-HI. We subsequently utilized two rounds of factor analysis, cognitive interviews with fifteen individuals with HD, and test-retest reliability assessments with 25 individuals with HD to refine, evaluate, and optimize the HD-HI. Lastly, we determined the capability of the HD-HI to differentiate between groups of HD participants with high versus low total functional capacity score, prodromal versus manifest HD, and normal ambulation versus mobility impairment. RESULTS HD participants identified 13 relevant and unique symptomatic domains to be included as subscales in the HD-HI. All HD-HI subscales had a high level of internal consistency and reliability and were found by participants to have acceptable content, relevance, and usability. The total HD-HI score and each subscale score statistically differentiated between groups of HD participants with high versus low disease burden. CONCLUSION Initial evaluation of the HD-HI supports its validity and reliability as a PROM for assessing how individuals with HD feel and function.
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Affiliation(s)
- Olivia S Brumfield
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Christine E Zizzi
- Center for Health + Technology, University of Rochester, Rochester, NY, USA.,School of Public and International Affairs, Princeton University, Princeton, NJ, USA
| | - Nuran Dilek
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Danae G Alexandrou
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Alistair M Glidden
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Spencer Rosero
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Jennifer Weinstein
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Jamison Seabury
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Aaron Kaat
- Department of Medical Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael P McDermott
- Department of Neurology, University of Rochester, Rochester, NY, USA.,Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - E Ray Dorsey
- Center for Health + Technology, University of Rochester, Rochester, NY, USA.,Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Chad R Heatwole
- Center for Health + Technology, University of Rochester, Rochester, NY, USA.,Department of Neurology, University of Rochester, Rochester, NY, USA
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14
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Mazzella A, Cruz R, Belter L, Curry M, Dilek N, Zizzi C, Heatwole C, Jarecki J. Assessing perspectives of disease burden and clinically meaningful changes using the Spinal Muscular Atrophy Health Index in adolescents and young adults. Muscle Nerve 2022; 66:276-281. [PMID: 35616549 DOI: 10.1002/mus.27644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION/AIMS Spinal muscular atrophy (SMA) treatment may increase survival and improve physical function among adolescents and young adults. Validated patient-reported outcome measures are needed to understand which treatment benefits are clinically meaningful and to develop targeted resources for this population. To date, use of the SMA Health Index (SMA-HI) in pediatric and young adult populations has been limited. Here, we report results from a survey of adolescents and young adults with SMA to quantifiably understand individuals' perceptions of disease burden. METHODS Participants aged 12-25 y with a self-reported diagnosis of SMA completed an online survey containing demographic questions and the SMA-HI, a patient-reported outcome measure that assesses individuals' perceptions of disease burden in 15 symptomatic areas. RESULTS Eighty-eight participants completed the survey. Total SMA-HI scores and SMA-HI subscale scores including shoulder and arm function; back, chest, and abdominal function; activity participation; hand and finger strength; swallowing function; gastrointestinal function; respiratory function; mobility and ambulation, and total disease burden were significantly higher (greater disease burden) in patients with poorer motor function and severe SMA. SMA-HI total and subscale scores were generally lower in adolescents (12-17 y old) versus adults (18-25 y old), suggesting a possible progression of symptomatic disease burden over time. DISCUSSION This study demonstrates the utility of the SMA-HI for measuring clinically relevant disease burden in adolescents and young adults with SMA. This study demonstrates how disease burden varies by age, SMA type, and other demographics.
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Affiliation(s)
| | | | | | - Mary Curry
- Cure SMA, Elk Grove Village, Illinois, USA
| | - Nuran Dilek
- University of Rochester, Rochester, New York, USA
| | | | - Chad Heatwole
- Cure SMA, Elk Grove Village, Illinois, USA.,University of Rochester, Rochester, New York, USA
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15
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Trundell D, Skalicky A, Staunton H, Hareendran A, Le Scouiller S, Barrett L, Cooper O, Gorni K, Seabrook T, Jethwa S, Cano S. Development of the SMA independence scale-upper limb module (SMAIS-ULM): A novel scale for individuals with Type 2 and non-ambulant Type 3 SMA. J Neurol Sci 2022; 432:120059. [PMID: 34896922 DOI: 10.1016/j.jns.2021.120059] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The amount of assistance required to perform daily activities for individuals with Type 2 and non-ambulant Type 3 spinal muscular atrophy (SMA) is often cited as meaningful for quality of life, and important to routinely assess. METHODS The SMA Independence Scale (SMAIS), a patient-reported outcome measure for individuals with SMA aged ≥12 years, and an observer-reported outcome measure for caregivers of individuals aged ≥2 years, was developed and evaluated in two phases. In Phase 1, 30 draft items were developed following review of the literature. Semi-structured interviews were then conducted with individuals with SMA and caregivers to establish content validity, resulting in a 29-item measure. In Phase 2, classical test theory and Rasch measurement theory methods were used to examine the cross-sectional and longitudinal measurement performance of the SMAIS in two independent datasets. RESULTS Phase 1 qualitative findings supported the relevance, acceptability, and comprehensibility of 29 items. In Phase 2, psychometric analyses indicated that the five response options were poorly discriminated and were thus collapsed to three options for subsequent analyses. Items showed statistical misfit, implying that the SMAIS was not assessing a single underlying construct. Based on conceptual evaluation of the items, and assessment of item performance, a more targeted 22-item upper limb score was derived. Reliability and validity analyses confirmed acceptable measurement properties of this score. CONCLUSIONS Qualitative and quantitative analyses support the use of the 22-item SMAIS-Upper Limb Module in individuals with Type 2 and non-ambulant Type 3 SMA, aged ≥2 years.
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Affiliation(s)
- Dylan Trundell
- Roche Products Ltd, Hexagon Place, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW, UK.
| | - Anne Skalicky
- Evidera, Broderick Building, 615 2nd Ave., Suite 500, Seattle, WA 98104, USA.
| | - Hannah Staunton
- Roche Products Ltd, Hexagon Place, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW, UK.
| | - Asha Hareendran
- Evidera, The Ark, 201 Talgarth Rd, Hammersmith, London, W6 8BJ, UK.
| | - Stephanie Le Scouiller
- Roche Products Ltd, Hexagon Place, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW, UK.
| | - Louise Barrett
- Modus Outcomes, Suite 210b, Spirella Building, Letchworth Garden City, SG6 4ET, UK.
| | - Owen Cooper
- Evidera, The Ark, 201 Talgarth Rd, Hammersmith, London, W6 8BJ, UK.
| | - Ksenija Gorni
- PDMA Neuroscience and Rare Disease, F. Hoffmann-La Roche Ltd, 4070 Basel, Switzerland.
| | - Tim Seabrook
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland.
| | - Sangeeta Jethwa
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland.
| | - Stefan Cano
- Modus Outcomes, Suite 210b, Spirella Building, Letchworth Garden City, SG6 4ET, UK.
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