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Mills TJ, Price E, Aggarwal VR, Del Galdo F, Walker L. Clinician and patient experiences of managing and living with oral and dental manifestations of scleroderma: A scoping review. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2024; 9:86-98. [PMID: 38910600 PMCID: PMC11188842 DOI: 10.1177/23971983231193515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/20/2023] [Indexed: 06/25/2024]
Abstract
Oral and dental manifestations of scleroderma are extremely common, yet they are often overlooked within rheumatology and poorly understood within dentistry. Previous research has indicated the need to understand the oral and dental experiences of people living with scleroderma and those involved in their care. This scoping review aims, for the first time, to comprehensively map what is known regarding the identification and management of oral and dental manifestations of scleroderma, how these are experienced by people living with scleroderma, and to explore key characteristics of barriers and enablers to good oral and dental care in scleroderma. A scoping review was conducted using six databases (Embase, PubMed, PsychINFO, ASSIA, Scopus and SSCI), according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses - extension for Scoping Review. Grey literature was also included. Studies were eligible for inclusion if the full text and abstract were available in English, published between 2002 and 2022, and focused on the concept of oral and dental care in adults with scleroderma, either relating to identification and management, enablers and barriers to best practice, or patient experiences and well-being. Qualitative research which seeks to understand patients' lived experiences was a notable gap in the literature. Similarly, there was a significant lack of focus on the oral and dental manifestations of scleroderma in rheumatology. Three key features were identified which would facilitate best practice in research and clinical contexts: the necessity of multidisciplinary care; the necessity of centralising patient experience; and the necessity of mitigating barriers to dental care. We conclude that increased awareness of scleroderma within dentistry and streamlining referral procedures between the disciplines of dentistry and rheumatology, to enable the early identification and management of scleroderma, are crucial.
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Affiliation(s)
- Tyler J Mills
- Faculty of Health Sciences, University of Hull, Hull, UK
| | | | | | | | - Liz Walker
- Faculty of Health Sciences, University of Hull, Hull, UK
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Farhat MM, Guerreschi P, Morell-Dubois S, Deken V, Labreuche J, Sanges S, Sobanski V, Hachulla E, Cottencin O, Launay D. Perception of aesthetic impairment in patients with systemic sclerosis determined using a semi-quantitative scale and its association with disease characteristics. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2024; 9:124-133. [PMID: 38910601 PMCID: PMC11188849 DOI: 10.1177/23971983241231620] [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: 09/11/2023] [Accepted: 01/22/2024] [Indexed: 06/25/2024]
Abstract
Background Systemic sclerosis is a fibrotic disease. Body image assessments could be key in optimizing care; however, data are scarce. The main objective was to assess the perception of aesthetic impairment using a visual aesthetic evaluation scale in patients with systemic sclerosis compared with healthy subjects. The secondary objectives were to assess associations between the perception of aesthetic impairment and scores on standardized questionnaires for aesthetic impairment as well as clinical, psychological/quality of life, and functional parameters of patients with systemic sclerosis. Methods This study evaluated and compared the perception of aesthetic impairment in two populations: patients with systemic sclerosis from a referral center at Lille Hospital, France, and healthy controls. Results This study included 88 patients (69 (78.4%) women) with a median age of 52 years and 88 controls (49 (55.7%) women) with a median age of 45 years. The perception of aesthetic impairment assessed using the aesthetic evaluation scale was poorer in systemic sclerosis patients than in controls (3.7 ± 0.3 vs 2.8 ± 0.3, p = 0.028) and was statistically correlated with assessments using the adapted satisfaction with appearance, a specific aesthetic impact assessment questionnaire for patients with systemic sclerosis. Patients with anxiety or depressive symptoms had significantly higher aesthetic evaluation scale scores. Systemic sclerosis patients with facial involvement and pitting scars had a worse perception of aesthetic impairment. Compared with healthy controls, systemic sclerosis patients had a worse perception of aesthetic impairment, especially systemic sclerosis patients with anxiety or depression and those with facial and hand involvement. Conclusion The aesthetic evaluation scale appears to be an easy-to-use tool to evaluate body image. Correlations of the aesthetic evaluation scale score with psychological and quality of life parameters reflect the importance of these parameters for body image evaluation and its complex assessment. Trial registration Clinical Trial NCT03271320 (Registered 9 January 2017, https://www.clinicaltrials.gov/ct2/show/NCT03271320?term=NCT03271320&cntry=FR&draw=2&rank=1).
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Affiliation(s)
- Méryem-Maud Farhat
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Pierre Guerreschi
- Plastic Surgery Department, University Hospital of Lille, Lille, France
- Competence Center for Clefts and CranioFacial Malformations, Lille, France
| | - Sandrine Morell-Dubois
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Valérie Deken
- Univ. Lille, CHU Lille, EA2694—Santé publique: épidémiologie et qualité des soins, Lille, France
| | - Julien Labreuche
- Univ. Lille, CHU Lille, EA2694—Santé publique: épidémiologie et qualité des soins, Lille, France
| | - Sebastien Sanges
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Vincent Sobanski
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Eric Hachulla
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Olivier Cottencin
- INSERM U-1172. Univ Lille. LiNC. PSY team, CHU Lille Department of Psychiatry and Addiction Medicine, Lille, France
| | - David Launay
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
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Almeida TG, Ferreira AR, da Silva FS, Chaves CC, Assunção BN, Martins PS, das Dores AS, de Moura RM, Andrade JA, Santos FP, Ferreira GA, Calderaro DC. Oral health education for systemic sclerosis patients: A booklet report. PEC INNOVATION 2023; 2:100154. [PMID: 37214513 PMCID: PMC10194248 DOI: 10.1016/j.pecinn.2023.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023]
Abstract
Purpose/objectives Systemic sclerosis (SSc) is a rare chronic autoimmune disease characterized by vascular abnormalities and connective tissue disorders. In 2021, the multidisciplinary team of the university hospital recognized a demand for oral health information among SSc patients. This study aims to describe the development of an SSc oral health booklet and its validation by people with SSc. Methods For the development of the booklet, the project creators employed the action research methodology involving ten stages. SSc patients evaluated the material by filling out a digital form. Results One hundred and thirty-one people with SSc evaluated the booklet. It received an average score of 9.73 (SD: 0.80) in relevance, 9.82 (SD: 0.47) in explicitness, and 9.49 (SD: 0.93) in aesthetics. The final version was emailed to the participants and posted on social media. Innovation This is the first booklet that deeply addresses these issues in Portuguese and constitutes a soft technology to instruct and assist patients with SSc. Conclusion The production of high-quality educational materials on oral health for patients with SSc is necessary. The online distribution increased its reach and had great importance in the context of the COVID-19 pandemic.
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Affiliation(s)
- Thalles G. Almeida
- Universidade Federal de Minas Gerais, Medical School. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Alessandra R.H. Ferreira
- Universidade Federal de Minas Gerais, Medical School. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Felipe S. da Silva
- Universidade Federal de Minas Gerais, Medical School. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Caio C. Chaves
- Universidade Federal de Minas Gerais, Medical School. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Bárbara N. Assunção
- Faculdade Ciências Médicas de Minas Gerais, Medical School. Alameda Ezequiel Dias, 275 - Centro, Belo Horizonte 30130-110, MG, Brazil
| | - Priscila S. Martins
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Alessandra S. das Dores
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Regina M.F. de Moura
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Júnia A. Andrade
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Flávia P.S.T. Santos
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Gilda A. Ferreira
- Universidade Federal de Minas Gerais, Medical School. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Débora C. Calderaro
- Universidade Federal de Minas Gerais, Medical School. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
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Haegens LL, Huiskes VJB, van der Ven J, van den Bemt BJF, Bekker CL. Factors Influencing Preferences of Patients With Rheumatic Diseases Regarding Telehealth Channels for Support With Medication Use: Qualitative Study. JMIR Form Res 2023; 7:e45086. [PMID: 37471137 PMCID: PMC10401190 DOI: 10.2196/45086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/04/2023] [Accepted: 05/04/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Patients with rheumatic diseases are known to experience drug-related problems at various times during their treatment. As these problems can negatively influence patients' health, they should be prevented or resolved as soon as possible, for which patients might benefit from additional support. Telehealth has the potential to continuously provide information and offers the possibility to easily contact a health care provider in order to support patients with medication use. Knowledge of factors influencing the patient's preference for telehealth channels can improve the actual use of telehealth channels. OBJECTIVE This study aims to identify factors that influence the preferences of patients with rheumatic diseases regarding telehealth channels for support with medication use. METHODS A qualitative study with face-to-face interviews was performed among patients with an inflammatory rheumatic disease in the Netherlands. A total of 4 telehealth channels were used: a frequently asked questions page, a digital human, an app for SMS text messaging with health care providers, and an app for video-calling with health care providers. Using a semistructured interview guide based on domains of the Capability, Opportunity, Motivation, and Behavior (COM-B) model, participants were questioned about (1) their general opinion on the 4 telehealth channels, (2) factors influencing preference for individual telehealth channels, and (3) factors influencing preference for individual telehealth channels in relation to the other available channels. Interviews were recorded, transcribed, and categorically analyzed. RESULTS A total of 15 patients were interviewed (female: n=8, 53%; male: n=7, 47%; mean age 55, SD 16.8 years; median treatment duration of 41, IQR 12-106 months). The following 3 categories of factors influencing patient preference regarding telehealth channels were identified: (1) problem-related factors included problems needing a visual check, problems specifically related to the patient, and urgency of the problem; (2) patient-related factors included personal communication preference and patient characteristics; and (3) channel-related factors included familiarity with the telehealth channel, direct communication with a health care provider, methods of searching, and conversation history. CONCLUSIONS Preference for telehealth channels is influenced by factors related to the problem experienced, the patient experiencing the problem, and telehealth channel characteristics. As the preference for telehealth channels varies between these categories, multiple telehealth channels should be offered to enable patients to tailor the support with their medication use to their needs.
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Affiliation(s)
- Lex L Haegens
- Department of Research and Innovation, Sint Maartenskliniek, Ubbergen, Netherlands
| | | | - Jeffrey van der Ven
- Department of Research and Innovation, Sint Maartenskliniek, Ubbergen, Netherlands
| | - Bart J F van den Bemt
- Department of Research and Innovation, Sint Maartenskliniek, Ubbergen, Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Ubbergen, Netherlands
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
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5
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Mattsson M, Hesselstrand R, Gunnarsson K, Dyrsmeds E, Holmner M, Nordin A, Boström C. The validity and reliability of the Swedish version of the Satisfaction with appearance scale for individuals with systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2023; 8:53-63. [PMID: 36743814 PMCID: PMC9896191 DOI: 10.1177/23971983221107858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022]
Abstract
Background Systemic sclerosis (SSc) can lead to visible changes in appearance which could generate concerns among patients. Thus, valid questionnaires that capture these concerns are valuable to identify and communicate appearance concerns. Objective To determine aspects of the validity and reliability of the Swedish version of the Satisfaction with Appearance scale for individuals with SSc (SWAP-Swe in SSc). Methods Content validity was assessed by interviews. In a cross-sectional design, construct validity was evaluated by comparing the self-reported questionnaire SWAP-Swe in SSc to the Scleroderma Health Assessment Questionnaire (SSc HAQ), Patient Health Questionnaire-8 (PHQ-8), RAND-36, modified Rodnan skin score (mRSS), disease duration and age using Spearman's rank correlations (rs ). Internal consistency was evaluated by Cronbach's alpha coefficient and corrected item-to-total correlations. Test-retest reliability was investigated using the intraclass correlation coefficient (ICC). Results Eleven patients and 10 health professionals participated in the assessment of content validity. For the other aspects of validity and reliability 134 patients (median age 62 years, women 81%, limited cutaneous SSc 75%) participated. Overall, the content validity was satisfactory. The SWAP-Swe in SSc correlated with SSc HAQ (HAQ-DI rs = 0.50, visual analogue scales rs = 0.24-0.41), PHQ-8 (rs = 0.46), RAND-36 (rs = -0.21 to -0.47), mRSS (rs = 0.28), disease duration (rs = -0.01) and age (rs = -0.15). The Cronbach's alpha coefficient was 0.92, corrected item-to-total correlations ⩾ 0.45 and the ICC 0.82. Conclusion The SWAP-Swe in SSc showed satisfactory content validity, sufficient and good internal consistency and sufficient test-retest reliability. It was more strongly associated with self-reported questionnaires than with physician-assessed skin involvement and age, indicating that appearance concerns in SSc seem to be multidimensional as earlier reported. Our study contributes with a thorough investigation of validity and reliability including aspects that have not been investigated before. However, evaluation of more validity aspects of the SWAP-Swe in SSc is suggested.
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Affiliation(s)
- Malin Mattsson
- Department of Neurobiology, Care
Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Physiotherapy, Sunderby
Hospital, Luleå, Sweden
- Malin Mattsson, Department of
Physiotherapy, Sunderby Hospital, 971 80 Luleå, Sweden.
| | - Roger Hesselstrand
- Department of Clinical Sciences, Lund
University, Lund, Sweden
- Department of Rheumatology, Skåne
University Hospital, Lund, Sweden
| | - Karin Gunnarsson
- Division of Rheumatology, Department of
Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm,
Sweden
| | - Elisabet Dyrsmeds
- Division of Rheumatology, Karolinska
University Hospital, Stockholm, Sweden
| | - Monica Holmner
- The Swedish Rheumatism Association
National Association for Systemic Sclerosis, Stockholm, Sweden
| | - Annica Nordin
- Division of Rheumatology, Department of
Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm,
Sweden
| | - Carina Boström
- Department of Neurobiology, Care
Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women’s Health and Health Professionals
Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University
Hospital, Stockholm, Sweden
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Kocher A, Simon M, Dwyer AA, Blatter C, Bogdanovic J, Künzler-Heule P, Villiger PM, Dan D, Distler O, Walker UA, Nicca D. Patient Assessment Chronic Illness Care (PACIC) and its associations with quality of life among Swiss patients with systemic sclerosis: a mixed methods study. Orphanet J Rare Dis 2023; 18:7. [PMID: 36624535 PMCID: PMC9828378 DOI: 10.1186/s13023-022-02604-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The Chronic Care Model (CCM) is a longstanding and widely adopted model guiding chronic illness management. Little is known about how CCM elements are implemented in rare disease care or how patients' care experiences relate to health-related quality of life (HRQoL). We engaged patients living with systemic sclerosis (SSc) to assess current care according to the CCM from the patient perspective and their HRQoL. METHODS We employed an explanatory sequential mixed methods design. First, we conducted a cross-sectional quantitative survey (n = 101) using the Patient Assessment of Chronic Illness Care (PACIC) and Systemic Sclerosis Quality of Life (SScQoL) questionnaires. Next, we used data from individual patient interviews (n = 4) and one patient focus group (n = 4) to further explore care experiences of people living with SSc with a focus on the PACIC dimensions. RESULTS The mean overall PACIC score was 3.0/5.0 (95% CI 2.8-3.2, n = 100), indicating care was 'never' to 'generally not' aligned with the CCM. Lowest PACIC subscale scores related to 'goal setting/tailoring' (mean = 2.5, 95% CI 2.2-2.7) and 'problem solving/contextual counselling' (mean = 2.9, 95% CI 2.7-3.2). No significant correlations were identified between the mean PACIC and SScQoL scores. Interviews revealed patients frequently encounter major shortcomings in care including 'experiencing organized care with limited participation', 'not knowing which strategies are effective or harmful' and 'feeling left alone with disease and psychosocial consequences'. Patients often responded to challenges by 'dealing with the illness in tailored measure', 'taking over complex coordination of care' and 'relying on an accessible and trustworthy team'. CONCLUSIONS The low PACIC mean overall score is comparable to findings in patients with common chronic diseases. Key elements of the CCM have yet to be systematically implemented in Swiss SSc management. Identified gaps in care related to lack of shared decision-making, goal-setting and individual counselling-aspects that are essential for supporting patient self-management skills. Furthermore, there appears to be a lack of complex care coordination tailored to individual patient needs.
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Affiliation(s)
- Agnes Kocher
- Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland. .,Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Michael Simon
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.5734.50000 0001 0726 5157Department of Nursing, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew A. Dwyer
- grid.208226.c0000 0004 0444 7053Boston College, Connell School of Nursing, Chestnut Hill, MA USA ,grid.32224.350000 0004 0386 9924Center for Nursing Research, Massachusetts General Hospital Munn, Boston, MA USA
| | - Catherine Blatter
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Jasmina Bogdanovic
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Patrizia Künzler-Heule
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.413349.80000 0001 2294 4705Department of Gastroenterology/Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland ,grid.413349.80000 0001 2294 4705Department of Nursing, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Diana Dan
- grid.9851.50000 0001 2165 4204Service of Rheumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Oliver Distler
- grid.7400.30000 0004 1937 0650Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich A. Walker
- grid.410567.1Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.7400.30000 0004 1937 0650Department of Global and Public Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
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Antinozzi C, Grazioli E, De Santis M, Motta F, Sgrò P, Mari F, Mauri C, Parisi A, Caporossi D, Duranti G, Ceci R, Di Luigi L, Dimauro I. The Preventive Role of Physical Activity in Systemic Sclerosis: A Cross-Sectional Study on the Correlation with Clinical Parameters and Disease Progression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10303. [PMID: 36011938 PMCID: PMC9407825 DOI: 10.3390/ijerph191610303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
Although exercise is associated with improved health in many medical conditions, little is known about the possible influences of physical activity (PA) habits pre- and post- a diagnosis of systemic sclerosis (SSc) on disease activity and progression. This cross-sectional study assessed, for the first time, self-reported pre- and post-diagnostic PA levels with the aim to verify if changes in these levels were correlated with demographic/anthropometric data (e.g., weight, height, gender, age, BMI), disease duration, diagnostic/clinical parameters (e.g., skin involvement, pulmonary hemodynamic/echocardiographic data, disease activity) related to disease activity and progression, and quality of life in a population-based sample of patients with SSc. Adult participants (n = 34, age 56.6 ± 13.3 years) with SSc (limited cutaneous SSc, lcSSc, n = 20; diffuse cutaneous SSc, dcSSc, n = 9; sine scleroderma SSc, n = 5) were enrolled at the Division of Rheumatology and Clinical Immunology of the Humanitas Research Hospital. All medical data were recorded during periodic clinical visits by a rheumatologist. Moreover, all subjects included in this study completed extensive questionnaires to evaluate their health-related quality of life (HRQOL), and others related to health-related physical activity performed before (PRE) and after (POST) the diagnosis of disease. The linear regression analysis has shown that either a high Sport_index or Leisure_index in the PRE-diagnostic period was correlated with lower disease duration in dcSSc patients. Physical load during sport activity and leisure time accounted for ~61.1% and ~52.6% of the individual variation in disease duration, respectively. In lcSSc patients, a high PRE value related to physical load during sporting activities was correlated with a low pulmonary artery systolic pressure (sPAP) and the POST value of the Work_index was positively correlated with the left ventricular ejection fraction (LVEF), and negatively with creatine kinase levels (CK). Interestingly, the univariate analysis showed that Work_index accounts for ~29.4% of the variance in LVEF. Our analysis clearly reinforces the concept that high levels of physical load may play a role in primary prevention-delaying the onset of the disease in those subjects with a family history of SSc-as well as in secondary prevention, improving SSc management through a positive impact on different clinical parameters of the disease. However, it remains a priority to identify a customized physical load in order to minimize the possible negative effects of PA.
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Affiliation(s)
- Cristina Antinozzi
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Elisa Grazioli
- Unit of Physical Exercise and Sport Sciences, Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
- Department of Experimental and Clinical Medicine, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Maria De Santis
- IRCCS Humanitas Research Hospital—Division of Rheumatology and Clinical Immunology, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Francesca Motta
- IRCCS Humanitas Research Hospital—Division of Rheumatology and Clinical Immunology, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Paolo Sgrò
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Federico Mari
- Unit of Bioengineering and Neuromechanics of Movement, Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Caterina Mauri
- Unit of Physical Exercise and Sport Sciences, Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Attilio Parisi
- Unit of Physical Exercise and Sport Sciences, Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Daniela Caporossi
- Unit of Biology and Human Genetic, Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Guglielmo Duranti
- Unit of Biochemistry of Movement, Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Roberta Ceci
- Unit of Biochemistry of Movement, Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Luigi Di Luigi
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Ivan Dimauro
- Unit of Biology and Human Genetic, Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
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8
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Murphy SL, Poole JL, Chen YT, Lescoat A, Khanna D. Rehabilitation Interventions in Systemic Sclerosis: A Systematic Review and Future Directions. Arthritis Care Res (Hoboken) 2022; 74:59-69. [PMID: 34165263 PMCID: PMC8695630 DOI: 10.1002/acr.24737] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/13/2021] [Accepted: 06/22/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To systematically review evidence of rehabilitation interventions for improving outcomes in systemic sclerosis (SSc) and to evaluate evidence quality. METHODS Several electronic databases were searched to identify studies in which rehabilitation professionals delivered, supervised, or participated in interventions for individuals with SSc. Randomized controlled trials (RCTs) or non-randomized trials, one-arm trials, and prospective quasi-experimental studies with interventions were included if they had ≥10 participants. Quality appraisal was conducted by 2 independent raters using the Physiotherapy Evidence Database (PEDro) Scale. RESULTS A total of 16 good or excellent quality studies (15 RCTs, 1 prospective quasi-experimental study) were included. Most rehabilitation interventions focused on hands/upper extremities, followed by multicomponent, orofacial, and directed self-management. Sample sizes varied between 20-267 participants (median 38). In 50% of studies, participants in intervention groups significantly improved compared to controls. Most studies demonstrated within-group improvements in intervention groups. Interventions varied in content, delivery, length, and dose and outcome measures collected. CONCLUSION Existing evidence provides some support for rehabilitation in SSc, such as interventions that focus on hand and upper extremity outcomes or are multicomponent, although there is high study heterogeneity. The evidence base would benefit from interventions testing similar replicable components, use of common outcome measures, and incorporation of delivery modes that enable larger sample sizes. There are challenges in recruiting participants due to the rarity of SSc and high disease burden, as participants' involvement in rehabilitation studies requires active participation over time. Intervention studies designed to reduce participation barriers may facilitate translation of effective interventions into practice.
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Affiliation(s)
- Susan L. Murphy
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
- VA Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center, GRECC, Ann Arbor, MI USA
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Janet L. Poole
- Department of Occupational Therapy, University of New Mexico, Albuquerque, New Mexico, USA
| | - Yen T. Chen
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Alain Lescoat
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Dinesh Khanna
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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9
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Hoffmann-Vold AM, Bendstrup E, Dimitroulas T, Hesselstrand R, Morais A, Peltomaa R, Smith V, Welling J, Vonk MC, Wuyts WA. Identifying unmet needs in SSc-ILD by semi-qualitative in-depth interviews. Rheumatology (Oxford) 2021; 60:5601-5609. [PMID: 33587103 PMCID: PMC8788003 DOI: 10.1093/rheumatology/keab154] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/03/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Interstitial lung disease is frequent in SSc (SSc-ILD) and associates with significantly reduced quality of life. Here we aimed to analyse patient pathways, and experiences of patients and healthcare providers (HCPs) in order to identify unmet needs in the management of SSc-ILD patients. METHODS Semi-structured qualitative interviews conducted in eight European countries looked at HCP (n = 95) and patient perspectives (n = 47) using two sets of 70 research questions. Pre-diagnostic, diagnostic and post-diagnostic phases of the patient pathway were systematically explored. RESULTS (i) In the pre-diagnostic phase several gaps were identified by HCPs and patients in all participating countries: limited disease knowledge among primary care physicians and specialists, lack of accurate patient information, and delayed and/or inappropriate referral. (ii) The diagnostic phase is in most countries coordinated by rheumatologists, who are also the main point of care. Depending on the local health system, organization of multidisciplinary collaboration varies. HCPs issued lack of national guidelines, while patients stated difficulties obtaining disease-related information. (iii) In the post-diagnostic phase, HCPs and patients indicated lack of curative treatment, specialized nurses, and paramedical and psychological support. Patients and caregivers additionally expressed the need for clear information on SSc-ILD. CONCLUSION Lack of disease specific knowledge, gaps in national healthcare systems and insufficient information and support for patients and caregivers were identified as unmet needs to ensure timely diagnosis, provide better patient management and to improve quality of life in SSc-ILD patients.
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Affiliation(s)
| | - Elisabeth Bendstrup
- Department of Respiratory Disease and Allergy, Centre for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Roger Hesselstrand
- Section of Rheumatology, Department of Clinical Sciences, Skåne University Hospital, Lund, Sweden
| | - Antonio Morais
- Department of Pulmonology Centro Hospitalar, Universitário de São João, Faculdade de Medicina do Porto, Porto, Portugal
| | - Ritva Peltomaa
- Department of Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University; Department of Rheumatology, Ghent University Hospital; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Gent, Belgium
| | - Joep Welling
- FESCA Federation of European Scleroderma Associations, NVLE, Utrecht
| | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wim A Wuyts
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
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10
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Liem S, van Leeuwen NM, Vliet Vlieland T, Boerrigter G, van den Ende C, de Pundert L, Schriemer MR, Spierings J, Vonk MC, de Vries-Bouwstra JK. Physical therapy in patients with systemic sclerosis: physical therapists' perspectives on current delivery and educational needs. Scand J Rheumatol 2021; 51:394-401. [PMID: 34263718 DOI: 10.1080/03009742.2021.1937306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To assess the perspectives of physical therapists treating patients with systemic sclerosis (SSc) on their current practice and educational needs.Method: In July 2019, 405 SSc patients attending a multidisciplinary SSc programme received a survey on physical therapy. Patients who indicated having received physical therapy in the past 2 years were asked to invite their treating physical therapist to complete a questionnaire including sociodemographic characteristics, referral process, content of treatment, perceived knowledge and skills, and educational needs (mostly yes/no answers).Results: Forty-eight of 80 possibly eligible physical therapists treating SSc patients returned the questionnaire [median age 44 years (interquartile range 35-58); 52% female; median number of SSc patients currently treated: 1 (range 1-4)]. Eighty-one per cent (n = 39) of physical therapists had received a referral, with 69% (n = 27/39) judging its content as insufficient. The most often provided types of exercises were range of motion (96%), muscle-strengthening (85%), and aerobic (71%) exercises, followed by hand (42%) and mouth (10%) exercises. Concerning manual treatment, 65% performed either massage or passive mobilization. Regarding competences, 65% indicated feeling capable of treating SSc patients. Nevertheless, 85% expressed the need for an information website on physical therapy in SSc, and 77% for postgraduate education on SSc.Conclusion: Primary care physical therapists treating patients with SSc used a wide range of treatment modalities. Although most stated that they treated very few patients, the majority felt capable of treating SSc patients. Nevertheless, the large majority expressed a need for additional information and educational activities concerning SSc.
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Affiliation(s)
- Sie Liem
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - N M van Leeuwen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tpm Vliet Vlieland
- Department of Orthopedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Gmw Boerrigter
- Department of Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Chm van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laj de Pundert
- Department of Physical Therapy, HagaZiekenhuis, The Hague, The Netherlands
| | - M R Schriemer
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.,NVLE, Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - J Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J K de Vries-Bouwstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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11
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Abstract
Work disability is highly prevalent in the systemic sclerosis (SSc) population; yet, it is an area of research that continues to be underrecognized and underexplored. In this chapter, we review the burden of this work disability by exploring the reported prevalence of work loss, the risk factors associated with reduced work participation, the impact on work productivity outcomes, and the economic consequences of work disability in individuals with SSc. Finally, we discuss the potential challenges in the workplace and strategies that may foster employment retention in this population. We subsequently present a conceptual framework for work disability in the context of SSc, which incorporates our understanding of the various work disability concepts and the potential facilitators that may accelerate a worker toward complete work loss.
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Affiliation(s)
- Jennifer J Y Lee
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Monique A M Gignac
- Institute for Work and Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sindhu R Johnson
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, Toronto Western Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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12
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Stöcker JK, Vonk MC, van den Hoogen FHJ, Nijhuis-van der Sanden MWG, Spierings J, Staal JB, Satink T, van den Ende CHM. Opening the black box of non-pharmacological care in systemic sclerosis: a cross-sectional online survey of Dutch health professionals. Rheumatol Int 2020; 41:1299-1310. [PMID: 33355711 PMCID: PMC8164617 DOI: 10.1007/s00296-020-04765-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022]
Abstract
The objective is to describe the spectrum of the health professional (HP) treatment approach for systemic sclerosis (SSc) from the perspective of Dutch HPs, including alignment of treatment goals set by HPs with self-reported referral reasons, coverage of patient-reported unmet care needs, and quality of communication between HPs and rheumatologists. Dutch HPs were invited through their patients with SSc to complete an anonymous online survey. The survey covered referral reasons, treatment goals, and interventions of the last patient treated, as well as the perceived quality of communication between HPs and rheumatologists. Referral reasons and treatment targets were linked to the International Classification of Functioning, Disability and Health following the refined ICF Linking Rules. Seventy-nine HPs from 8 professions (including 58 physiotherapists, 73%) completed the survey. One hundred and thirty-three different referral reasons were reported, yielding 58 different ICF codes, with 41 (70.7%) being linked to the ICF domain “body structures and functions.” The reported interventions focused on body functions/structures (27.9%), training of daily activities (25.6%), education and advice (26.3%), and psychosocial interventions (20.2%). The quality of communication between HPs and rheumatologists was perceived as low. Our findings revealed numerous treatment options offered by Dutch HPs addressing the unmet care needs of patients with SSc. There is an overlap in the content of the various HP disciplines, and HP treatment goals are not sufficiently aligned with referrals of rheumatologists. HP treatment offer seemed inefficiently organized, possibly precluding rheumatologists from making targeted referrals. Communication between rheumatologists and HPs should be improved.
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Affiliation(s)
- Juliane K Stöcker
- Department of Rheumatology, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands.
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands.
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank H J van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Julia Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Bart Staal
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ton Satink
- Research Group Neuro Rehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
- European Masters of Science in Occupational Therapy, Amsterdam, The Netherlands
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Abdouh I, Porter S, Fedele S, Elgendy N, Ni Riordain R. Web-based information on the treatment of the mouth in systemic sclerosis. BMC Rheumatol 2020; 4:61. [PMID: 33292857 PMCID: PMC7684884 DOI: 10.1186/s41927-020-00160-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To categorise the content and assess the quality and readability of the web-based information regarding treatment of the mouth in systemic sclerosis. METHODS An online search using three different search terms regarding the treatment of the mouth in SSc was undertaken using the Google search engine. The first 100 websites from each search were selected for analysis. Data recorded included DISCERN instrument scores along with the Journal of the American Medical Association (JAMA) benchmarks and the presence of the Health on the Net seal (HON). Flesch Reading Ease Scores, Flesch-Kincaid Grade Level, the Simplified Measure of Gobbledygook Index and Coleman-Liau index were calculated to assess readability. RESULTS Fifty seven of the first websites remained for analysis after applying appropriate exclusion criteria. The mean overall DISCERN score was 2.37 (±1.01). Only 4 websites (7%) achieved all four JAMA benchmarks. Only 12 websites (21.1%) displayed the HON seal. The reading level was found to be difficult to very difficult among the majority of websites. CONCLUSION The overall quality of the available online information concerning the treatment of the mouth of systemic sclerosis is questionable and requires a high level of reading skill. Further efforts should be directed toward establishing higher quality, reliable online information sources on the treatment of oral disease relevant to patients with systemic sclerosis.
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Affiliation(s)
- Ismail Abdouh
- Oral Medicine, UCL Eastman Dental Institute, University Street, London, WC1E 6DE, UK. .,Oral Medicine, College of Dentistry, Taibah University, Al Munawarah, Al Madinah, Saudi Arabia.
| | - Stephen Porter
- Oral Medicine, UCL Eastman Dental Institute, University Street, London, WC1E 6DE, UK
| | - Stefano Fedele
- Oral Medicine, UCL Eastman Dental Institute, University Street, London, WC1E 6DE, UK.,Oral Theme UCLH/UCL NIHR, Biomedical Research Centre, London, UK
| | - Nadia Elgendy
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Richeal Ni Riordain
- Oral Medicine, UCL Eastman Dental Institute, University Street, London, WC1E 6DE, UK.,Cork University Dental School and Hospital, University College Cork, Cork, Ireland
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14
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Denton CP, Laird B, Moros L, Luna Flores JL. Things left unsaid: important topics that are not discussed between patients with systemic sclerosis, their carers and their healthcare professionals-a discourse analysis. Clin Rheumatol 2020; 40:1399-1407. [PMID: 32915347 PMCID: PMC7943486 DOI: 10.1007/s10067-020-05371-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/13/2020] [Accepted: 08/24/2020] [Indexed: 01/07/2023]
Abstract
Introduction Systemic sclerosis (SSc) is a rare condition that can be complicated by interstitial lung fibrosis (SSc-ILD)—a major cause of mortality. This study explored information and communication needs of patients with SSc-ILD and their carers to understand what they are and whether they are met. Methods Qualitative research was performed, including in-depth individual interviews and observed conversations between pairs of patients, physicians and nurses, and between patients and physicians discussing experiences of SSc-ILD. The study was performed in Germany, Italy, Spain, the UK and the USA. Participants included 42 SSc-treating physicians, 21 patients with diagnosed SSc-ILD, 16 specialist nurses and five carers. Results Prognosis and mortality were the main unspoken topics acknowledged by patients, carers and healthcare professionals. Patients and carers felt afraid to ask physicians about mortality, and most physicians reported avoiding the question because their duty was to give patients hope and avoid causing additional distress. Patients often felt unable to ask physicians about relationships, family and work because of time constraints or because they felt these were not topics physicians would be concerned about. Often, specialist nurses felt that they had insufficient knowledge to provide adequate support. Conclusion Key topics, including mortality and prognosis, are rarely openly discussed, leaving patients uncertain and anxious about the future. By communicating about difficult but important topics, physicians and nurses could help patients and carers manage and plan their lives. This study shows that a multi-professional team-based communication approach is likely to better address patient needs and priorities. Key Points • Key topics in SSc or SSc-ILD, such as mortality and prognosis, are rarely openly discussed in clinical consultations. • By communicating difficult but important topics, physicians and nurses could help patients manage their disease and plan their lives. • A multi-professional team-based communication approach is likely to better address patient needs and priorities and could be easily implemented without the need for significant additional resources.
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Affiliation(s)
- Christopher P Denton
- Division of Medicine, Department of Inflammation, Centre for Rheumatology and Connective Tissue Diseases, Royal Free and University College Medical School, University College London, London, UK.
| | | | - Lizette Moros
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
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15
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Spierings J, van den Ende CHM, Schriemer RM, Bernelot Moens HJ, van der Bijl EA, Bonte-Mineur F, de Buck MPD, de Kanter MAE, Knaapen-Hans HKA, van Laar JM, Mulder UDJ, Potjewijd J, de Pundert LAJ, Schoonbrood THM, Schouffoer AA, Stel AJ, Vercoutere W, Voskuyl AE, de Vries-Bouwstra JK, Vonk MC. How do patients with systemic sclerosis experience currently provided healthcare and how should we measure its quality? Rheumatology (Oxford) 2020; 59:1226-1232. [PMID: 31539063 PMCID: PMC7244783 DOI: 10.1093/rheumatology/kez417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/31/2019] [Indexed: 11/14/2022] Open
Abstract
Objectives To gain insight into SSc patients’ perspective on quality of care and to survey their preferred quality indicators. Methods An online questionnaire about healthcare setting, perceived quality of care (CQ index) and quality indicators, was sent to 2093 patients from 13 Dutch hospitals. Results Six hundred and fifty patients (mean age 59 years, 75% women, 32% limited cutaneous SSc, 20% diffuse cutaneous SSc) completed the questionnaire. Mean time to diagnosis was 4.3 years (s.d. 6.9) and was longer in women compared with men (4.8 (s.d. 7.3) vs 2.5 (s.d. 5.0) years). Treatment took place in a SSc expert centre for 58%, regional centre for 29% or in both for 39% of patients. Thirteen percent of patients was not aware of whether their hospital was specialized in SSc. The perceived quality of care was rated with a mean score of 3.2 (s.d. 0.5) (range 1.0–4.0). There were no relevant differences between expert and regional centres. The three prioritized process indicators were: good patient-physician interaction (80%), structural multidisciplinary collaboration (46%) and receiving treatment according to SSc guidelines (44%). Absence of disease progression (66%), organ involvement (33%) and digital ulcers (27%) were the three highest rated outcome indicators. Conclusion The perceived quality of care evaluated in our study was fair to good. No differences between expert and regional centres were observed. Our prioritized process and outcome indicators can be added to indicators suggested by SSc experts in earlier studies and can be used to evaluate the quality of care in SSc.
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Affiliation(s)
- Julia Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek.,Department of Rheumatology, Radboud University Medical Center, Nijmegen
| | - Rita M Schriemer
- NVLE, Dutch patient organization for systemic autoimmune diseases, Utrecht
| | | | | | | | | | | | | | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Udo D J Mulder
- Department of Internal Medicine, division Vascular Medicine, University of Groningen, Groningen
| | - Judith Potjewijd
- Department of Clinical immunology, Maastricht University Medical Center+, Maastricht
| | | | | | | | - Alja J Stel
- Department of Rheumatology, University Medical Center Groningen, Groningen
| | - Ward Vercoutere
- Department of Rheumatology, Zuyderland Medical Center, Heerlen
| | - Alexandre E Voskuyl
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, loc. VUMC, Amsterdam
| | | | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen
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16
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F. Landim S, B. Bertolo M, Del Rio AP, Sachetto Z, Zonzini Gaino J, L. Poole J, de P. Magalhães E. Sustained efficacy of a concise self-management programme for hands in systemic sclerosis: a longitudinal case–control observational study. Rheumatology (Oxford) 2020; 59:3330-3339. [DOI: 10.1093/rheumatology/keaa140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/17/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
In a longitudinal case–control observational study, we evaluated the benefits of a self-management programme for hands developed for patients with SSc.
Methods
Patients with SSc included in the intervention group (IG) received a concise self-management programme with emphasis on hand exercises and were evaluated during 24 weeks regarding hand pain, hand function, range of motion, grip and tip and key pinch strength. Results were compared with a control group (CG) with no intervention using an analysis of variance for repeated measures with variables transformed into ranks (P ≤ 0.05). Effect sizes were calculated using Cohen’s test.
Results
Of 90 patients who were evaluated, seven were excluded at enrolment and 26 were excluded during the follow-up. Data from 57 subjects (IG 40, CG 17) were used for analysis. Groups were similar at baseline, except for the Scleroderma HAQ and tip and key pinch strength. Outcome improvements were noted only in the IG (P ≤ 0.05, large effect size). In the CG, variables did not change or had even worsened (hand grip strength and finger motion).
Conclusions
This self-management programme based on hand exercises for SSc resulted in pain reduction and hand function, strength and range of motion improvement. It can be a simple and useful intervention, especially when a regular rehabilitation programme is not available.
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Affiliation(s)
- Sibila F. Landim
- Department of Orthopedics and Rheumatology, University of Campinas-Unicamp, Campinas, SP, Brazil
| | - Manoel B. Bertolo
- Department of Orthopedics and Rheumatology, University of Campinas-Unicamp, Campinas, SP, Brazil
| | - Ana Paula Del Rio
- Department of Orthopedics and Rheumatology, University of Campinas-Unicamp, Campinas, SP, Brazil
| | - Zoraida Sachetto
- Department of Orthopedics and Rheumatology, University of Campinas-Unicamp, Campinas, SP, Brazil
| | - Juliana Zonzini Gaino
- Department of Orthopedics and Rheumatology, University of Campinas-Unicamp, Campinas, SP, Brazil
| | - Janet L. Poole
- Department of Pediatrics, Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, USA
| | - Eduardo de P. Magalhães
- Department of Orthopedics and Rheumatology, University of Campinas-Unicamp, Campinas, SP, Brazil
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17
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Kwakkenbos L, Carboni-Jiménez A, Carrier ME, Pépin M, Peláez S, Malcarne VL, El-Baalbaki G, Thombs BD. Reasons for not participating in scleroderma patient support groups: a comparison of results from the North American and European scleroderma support group surveys. Disabil Rehabil 2019; 43:1279-1286. [PMID: 31522575 DOI: 10.1080/09638288.2019.1656292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Many people with scleroderma rely on peer-led support groups as a coping resource. Reasons for not attending support groups in scleroderma have been investigated only in North American participants. This study assesses reasons for nonattendance in European countries and compares results with previously published North American findings. MATERIALS AND METHODS The same 21-item survey as used in the North American sample assessed possible reasons for not attending scleroderma support groups. Proportions of items rated Important or Very Important were compared between samples. RESULTS Consistent with the North American survey findings (N = 242), the two items most commonly rated as (Very) Important reasons for nonattendance among 228 European participants were (1) already having enough support (57%), and (2) not knowing of any local scleroderma support groups (58%). Compared to North American non-attenders, European patients were significantly more likely to rate not knowing enough about what happens at support groups (46% vs 19%), not having reliable ways to get to meetings (35% vs 17%), and being uncomfortable sharing experiences with a group (22% vs 11%) as (Very) Important reasons for nonattendance. CONCLUSIONS Improving access to European support groups, providing education about support groups and group leader training may encourage participation.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals might help develop local support groups for people with systemic sclerosis (scleroderma) to address the lack of access to these groups for many patients.The need for transportation and limited local accessibility may also be addressed by implementing online systemic sclerosis support groups.Professionals in the field of rehabilitation may work with people with systemic sclerosis and patient organizations to provide education about support groups to improve support group attendance in Europe.
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Affiliation(s)
- Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, The Netherlands
| | - Andrea Carboni-Jiménez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Mia Pépin
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Sandra Peláez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Educational and Counselling Psychology, McGill University, Montréal, QC, Canada
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University, San Diego, CA, USA.,Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, USA
| | - Ghassan El-Baalbaki
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Educational and Counselling Psychology, McGill University, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada.,Department of Psychology, McGill University, Montréal, QC, Canada
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Kocher A, Simon M, Dwyer AA, Villiger PM, Künzler-Heule P, De Geest S, Berben L, Nicca D. Developing a rare disease chronic care model: Management of systemic sclerosis (MANOSS) study protocol. J Adv Nurs 2019; 75:3774-3791. [PMID: 31452216 DOI: 10.1111/jan.14185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/26/2019] [Accepted: 08/13/2019] [Indexed: 12/19/2022]
Abstract
AIM The aim of the management of systemic sclerosis (MANOSS) study described in this protocol is to develop a chronic care model, based on a contextual analysis and stakeholder involvement, for patients living with the rare disease systemic sclerosis (SSc) in Switzerland. DESIGN Applying an implementation science approach, this study starts with an explanatory sequential mixed method study for contextual analysis, followed by broad stakeholder involvement for model development and a Delphi study to reach consensus. METHODS First, a quantitative cross-sectional survey with patients and healthcare professionals (HPs) will be conducted to identify current practice patterns of chronic illness management and technology readiness. Second, qualitative interviews with patients, family members and HPs will be performed to gain a deeper understanding of care needs identified in the quantitative survey. Third, a model of care will be co-created with input from patients, HPs and other experts. The eHealth enhanced Chronic Care Model will serve as a guiding framework. The new model and corresponding outcome parameters will be refined using a Delphi-study approach to reach consensus on a testable model of care for persons living with SSc. The protocol has received research ethics committee approval in September 2018 by the Swiss Ethics Committee. DISCUSSION The MANOSS study's participatory approach is essential for contextual fit of the model for patients with SSc in this setting. Subsequent feasibility testing and implementation are planned to evaluate the model's value in relation to health disparities faced by this patient population. IMPACT Patients living with this rare disease lack access to coordinated, specialized care and self-management support from qualified HPs. Reengineering of current care, with consideration for technological opportunities, is warranted to meet patients' and families' needs.
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Affiliation(s)
- Agnes Kocher
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Rheumatology, Immunology and Allergology, Inselspital Bern University Hospital, Bern, Switzerland
| | - Michael Simon
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Nursing Research Unit, Inselspital Bern University Hospital, Bern, Switzerland
| | - Andrew A Dwyer
- Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Peter M Villiger
- Department of Rheumatology, Immunology and Allergology, Inselspital Bern University Hospital, Bern, Switzerland
| | - Patrizia Künzler-Heule
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Gastroenterology/Hepatology and Department of Nursing Development, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Sabina De Geest
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU-Leuven, Belgium
| | - Lut Berben
- Division of Nursing, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Department of Nursing Development, University Children's Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,University Hospital Basel, Basel, Switzerland
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19
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Mooney J, Graham K, Watts RA. Impact of caring for someone with a rare rheumatic condition, views from patients and informal carers-the need for cat-like vigilance. Rheumatol Adv Pract 2019; 3:rkz003. [PMID: 31431991 PMCID: PMC6649977 DOI: 10.1093/rap/rkz003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/25/2019] [Indexed: 12/22/2022] Open
Abstract
Objective ANCA-associated vasculitis (AAV) is a rare multisystem disease. Modern therapeutic protocols have turned AAV from an acute, frequently fatal disease into a chronic disease requiring long-term immunosuppression. Patients must often manage substantial burdens related to chronic illness and treatment-related side effects, requiring help from informal carers. This study aimed to explore the experience of patients and of informal carers of patients with AAV about the impact of managing a rare rheumatic condition. Methods A qualitative approach using semi-structured interviews was used. Interviews were conducted with a purposeful sample of 18 pairs of patients with AAV and their informal carers. The interviews were used to explore the participants' experience and effects of caring. The interviews were recorded and transcribed as verbatim text and analysed using the framework technique. Results Eighteen patients (seven female; disease: 10 granulomatosis with polyangiitis; four microscopic polyangiitis; four eosinophilic granulomatosis with polyangiitis; age range 34-78 years; disease duration 1-20 years). Caregiver and patient perspectives were shared. The emerging themes were the physical and psychological impacts of the disease, the need for constant vigilance and fear of the future. Conclusion Both patients and carers faced a range of challenges in managing a rare condition, including the seriousness of the illness, dealing with the emotional toll and knowing what to expect. This study offers insight into the experiences of patients and informal carers, and health-care professionals should address individuals' fears and expectations for recovery.
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Affiliation(s)
- Janice Mooney
- School of Health and Social Care, University of Staffordshire, Stafford, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Karly Graham
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Richard A Watts
- Norwich Medical School, University of East Anglia, Norwich, UK
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20
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Semalulu T, Beattie KA, Larché MJ. Assessing the Educational Needs of Canadians with Systemic Sclerosis. J Rheumatol 2019; 46:658-659. [PMID: 30936286 DOI: 10.3899/jrheum.180554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | | | - Maggie J Larché
- Department of Medicine, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
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21
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Optimal care for systemic sclerosis patients: recommendations from a patient-centered and multidisciplinary mixed-method study and working conference. Clin Rheumatol 2018; 38:1007-1015. [DOI: 10.1007/s10067-018-4358-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 12/13/2022]
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22
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Contatore OA, Malfitano APS, Barros NFD. CUIDADOS EM SAÚDE: SOCIABILIDADES CUIDADORAS E SUBJETIVIDADES EMANCIPADORAS. PSICOLOGIA & SOCIEDADE 2018. [DOI: 10.1590/1807-0310/2018v30177179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Resumo Embora predominem as aplicações técnico/tecnológicas na assistência à saúde como parâmetro e qualificação das ações de cuidado cresce a valorização de uma atenção que abranja mais amplamente a vida dos sujeitos, frente ao reconhecimento que o apoio social e a preocupação afetiva são constitutivos e fundamentais para a efetivação do cuidado. Objetivou-se apreender as reflexões sobre o cuidado à saúde enfocando os aspectos de sociabilidade e de subjetividade. Para tanto, realizou-se uma revisão sistemática de literatura, entre 2003 e 2013, em dez bases de dados. De 262 artigos identificados, foram selecionados 36 que enfocam a subjetividade nas ações de cuidado. Há um questionamento acerca do potencial de cuidado biomédico e suas limitações para atender às múltiplas demandas implícitas nos processos de saúde e doença. Conclui-se que a subjetividade e, em seu interior, a sociabilidade, são partes intrínsecas das ações de cuidado.
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23
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Sołowiej-Chmiel J, Sierakowska M. Functioning in the emotional sphere and ways of coping with chronic connective tissue disease. Reumatologia 2018; 56:321-327. [PMID: 30505015 PMCID: PMC6263309 DOI: 10.5114/reum.2018.79504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/03/2018] [Indexed: 11/17/2022] Open
Abstract
Chronic illness is a strong stressor, and its occurrence in human life forces the individual to make adaptive changes. The aim of the study was to evaluate the reactions, behaviors, and emotional states of a person in the face of systemic connective tissue disease and ways of coping with this difficult situation. The method of choice was an individual case study. The subject was a 41-year-old patient, diagnosed with diffuse systemic sclerosis (dSSc) 8 years previously. The patient was characterized by lowered self-esteem, the presence of depressive symptoms, low level of hope for success, a reduced sense of competence, a tendency to use stress coping strategies focused on emotions and dominance of anxiety and tension. Emotional stress coping strategies, low level of hope for success, and non-acceptance attitude predispose the person suffering from systemic sclerosis (SSc) to exhibit depressive symptoms.
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Affiliation(s)
- Justyna Sołowiej-Chmiel
- General Psychiatric Division V with Detoxification Subunit for Addicted to Psychoactive Substances, Psychiatric Hospital in Choroszcz, Poland
| | - Matylda Sierakowska
- Department of Integrated Medical Care, Medical University of Białystok, Poland
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24
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Stöcker JK, Cup EHC, Vonk MC, van den Hoogen FHJ, Nijhuis-van der Sanden MWG, Staal JB, van den Ende CHM. What moves the rheumatologist? Unravelling decision making in the referral of systemic sclerosis patients to health professionals: a qualitative study. Rheumatol Adv Pract 2018; 2:rky027. [PMID: 31431973 PMCID: PMC6649894 DOI: 10.1093/rap/rky027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/10/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Well-coordinated multidisciplinary non-pharmacological care is considered to be a cornerstone in the management of patients with systemic sclerosis. However, it has been discovered that unmet information and health care needs are common in patients with SSc. In addition, referrals by rheumatologists do not always correspond with potential treatment goals as identified by health professionals. The aim of this study was to gain insight into the current referral routine of rheumatologists in SSc patients and to identify and explore factors influencing rheumatologists' decisions about referral of SSc patients to health professionals. METHODS Qualitative semi-structured interviews were held with 13 rheumatologists specializing in SSc management from different hospitals in The Netherlands. RESULTS Our study identified rheumatologists' beliefs and local policy as influencing factors for referral to health professionals and a clear need for a better referral policy. Furthermore, a lack of knowledge about and low confidence in the competence of other disciplines were identified as barriers for referral to health professionals, which may possibly lead to undertreatment. CONCLUSION In the opinion of the majority of rheumatologists, adequate referral to health professionals requires an active role for the patient and increased visibility from health professionals.
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Affiliation(s)
- Juliane K Stöcker
- Department of Rheumatology, St. Maartenskliniek, Radboud University Medical Centre, Nijmegen, The Netherlands
- Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Edith H C Cup
- Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frank H J van den Hoogen
- Department of Rheumatology, St. Maartenskliniek, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - J Bart Staal
- Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Cornelia H M van den Ende
- Department of Rheumatology, St. Maartenskliniek, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
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25
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THE LEVEL OF KNOWLEDGE ABOUT THE RHEUMATOID ARTHRITIS IN TURKISH PATIENTS. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2018. [DOI: 10.21673/anadoluklin.325831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Morrisroe K, Stevens W, Proudman S, Nikpour M. A systematic review of the epidemiology, disease characteristics and management of systemic sclerosis in Australian adults. Int J Rheum Dis 2017; 20:1728-1750. [PMID: 29076640 DOI: 10.1111/1756-185x.13203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Australia has one of the highest prevalence rates of systemic sclerosis (SSc) worldwide. In order to highlight management deficiencies and key areas for further research, it is essential to understand its local epidemiological patterns, natural history, prognosis and mortality trends over time. METHODS To identify Australian SSc-specific information through a systematic review focusing on areas of epidemiology, disease characteristics, treatment, functional ability, disease burden and health-related quality of life (HRQoL). RESULTS MEDLINE, EMBASE and the Cochrane Library were searched on 14 September, 2016. All original full text articles on SSc in Australia were included. Of the 54 articles included in this review, the majority of studies recruited from South Australia, Victoria and New South Wales. The prevalence of SSc in Australia is increasing and is similar among the general population and the Aboriginal population. Despite improvements in care over the last three decades, morbidity and mortality remain high, with an overall standardized mortality ratio of 3.4 and a 10-year survival of 84% in a newly diagnosed patient. Cardiorespiratory manifestations are the leading cause of SSc-related death. Malignancy is the leading cause of non-SSc-related death. The role of autoantibodies in predicting disease subtype, visceral involvement and their use as a prognostic marker is becoming increasingly recognized. CONCLUSION Information on SSc in Australia, particularly unmet healthcare needs, HRQoL and economic burden, is limited. As a heterogenous condition, SSc requires a multi-disciplinary approach to care. Research aimed at quantifying HRQoL and burden of disease in Australia is essential for advocacy and resource allocation.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Vic., Australia.,Department of Rheumatology, St Vincent's Hospital, Melbourne, Vic., Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Vic., Australia
| | - Susanna Proudman
- Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Vic., Australia.,Department of Rheumatology, St Vincent's Hospital, Melbourne, Vic., Australia
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López-Bastida J, Linertová R, Oliva-Moreno J, Serrano-Aguilar P, Posada-de-la-Paz M, Kanavos P, Taruscio D, Schieppati A, Iskrov G, Péntek M, Delgado C, von der Schulenburg JM, Persson U, Chevreul K, Fattore G. Social/economic costs and health-related quality of life in patients with scleroderma in Europe. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17 Suppl 1:109-117. [PMID: 27038626 DOI: 10.1007/s10198-016-0789-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 01/13/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to determine the economic burden from a societal perspective and the health-related quality of life (HRQOL) of patients with systemic sclerosis (SSc; scleroderma) in Europe. METHODS We conducted a cross-sectional study of patients with SSc (involving both localised and systemic sclerosis) from Germany, Italy, Spain, France, the UK, Hungary and Sweden. Data on demographic characteristics, healthcare resource utilisation, informal care, labour productivity losses and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D) questionnaire. RESULTS A total of 589 patients completed the questionnaire. The rate of patients with localised scleroderma, limited cutan and diffuse cutan SSc were 28, 68 and 4 %, respectively. Average annual costs varied from country to country and ranged from € 4607 to € 30,797 (reference year: 2012). Estimated direct healthcare costs ranged from € 1413 to € 17,300; direct non-healthcare costs ranged from € 1875 to € 4684 and labour productivity losses ranged from € 1701 to € 14,444. The mean EQ-5D index score for adult SSc patients varied from 0.49 to 0.75 and the mean EQ-5D visual analogue scale score was between 58.72 and 65.86. CONCLUSION The main strengths of this study lie in our bottom-up approach to costing and our evaluation of SSs patients from a broad societal perspective. This type of analysis is very unusual in the international literature on rare diseases in comparison with other illnesses. We concluded that SSc patients incur considerable societal costs and experience substantial deterioration in HRQOL.
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Affiliation(s)
- Julio López-Bastida
- Universidad de Castilla-La Mancha, Talavera de la Reina, Toledo, Spain.
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
| | - Renata Linertová
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Las Palmas de Gran Canaria, Spain
| | - Juan Oliva-Moreno
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Universidad de Castilla-La Mancha, Toledo, Spain
| | - Pedro Serrano-Aguilar
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Evaluation and Planning Service at Canary Islands Health Service, Santa Cruz de Tenerife, Spain
| | - Manuel Posada-de-la-Paz
- Instituto de Investigación en Enfermedades Raras (IIER), SpainRDR and CIBERER, Madrid, Spain
| | - Panos Kanavos
- Health and Social Care Research Centre, London School of Economics and Political Science, London, UK
| | - Domenica Taruscio
- National Center for Rare Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Arrigo Schieppati
- Centro di Ricerche Cliniche per Malattie Rare Aldo e Cele Daccò, Istituto di Ricerche Farmacologiche Mario Negri, Ranica (Bergamo), Italy
| | - Georgi Iskrov
- Institute of Rare Diseases, Plovdiv, Bulgaria
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Claudia Delgado
- Federación Española de Enfermedades Raras (FEDER), Madrid, Spain
| | | | - Ulf Persson
- Swedish Institute for Health Economics, Lund, Sweden
| | - Karine Chevreul
- URC Eco Ile de France, AP-HP, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- INSERM, ECEVE, U1123, Paris, France
| | - Giovanni Fattore
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
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Meijs J, Schouffoer AA, Ajmone Marsan N, Kroft LJM, Stijnen T, Ninaber MK, Huizinga TWJ, Vliet Vlieland TPM, de Vries-Bouwstra JK. Therapeutic and diagnostic outcomes of a standardised, comprehensive care pathway for patients with systemic sclerosis. RMD Open 2016; 2:e000159. [PMID: 27042333 PMCID: PMC4800807 DOI: 10.1136/rmdopen-2015-000159] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 02/17/2016] [Accepted: 02/20/2016] [Indexed: 01/09/2023] Open
Abstract
Objectives To determine the outcomes, including number of medical interventions and initiation of immunosuppressive treatment of a standardised, comprehensive, diagnostic care pathway for patients with systemic sclerosis (SSc). Patient characteristics associated with need for medical interventions and with need for immunosuppressive treatment were determined. Methods Data were routinely gathered in connection with a 2-day care pathway combining multidisciplinary care and complete diagnostic work-up of organ involvement in SSc. The number of patients in whom the pathway resulted in medical interventions, and/or initiation of immunosuppressives was recorded. Patient characteristics and diagnostic tests results were compared between patients with and without medical interventions, and patients with and without initiation of immunosuppressives by means of multivariable logistic regression analyses. Results During a period of 44 months, 226 patients with SSc were referred to the care pathway. They included 186 (82%) women with mean age of 54 (SD 14.5) years, and median disease duration of 4 years (range 1–11); 73 (32%) of them had diffuse cutaneous SSc. Medical interventions were initiated in 191 (85%) patients, including initiation of immunosuppressive treatment in n=49 (22%). Presence of telangiectasias and higher erythrocyte sedimentation rate were associated with any medical intervention. Of commonly available variables, lower age, higher skin score and absence of anticentromere antibody were associated with initiation of immunosuppressives. Conclusions A standardised comprehensive 2-day care pathway for patients with SSc resulted in additional diagnostic or therapeutic interventions in 85% of the patients, regardless of SSc subtype and disease duration. In 22% of the patients, immunosuppressive treatment was initiated.
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Affiliation(s)
- Jessica Meijs
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Anne A Schouffoer
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Haga Hospital, The Hague, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Lucia J M Kroft
- Department of Radiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Theo Stijnen
- Department of Medical Statistics , Leiden University Medical Center , Leiden , The Netherlands
| | - Maarten K Ninaber
- Department of Pulmonology , Leiden University Medical Center , Leiden , The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
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Schouffoer A, Ndosi ME, Vliet Vlieland TPM, Meesters JJL. The educational needs of people with systemic sclerosis: a cross-sectional study using the Dutch version of the Educational Needs Assessment Tool (D-ENAT). Rheumatol Int 2015; 36:289-94. [PMID: 26321625 PMCID: PMC4723617 DOI: 10.1007/s00296-015-3352-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 08/19/2015] [Indexed: 11/11/2022]
Abstract
The Dutch Educational Needs Assessment Tool (D-ENAT) systematically assesses educational needs of patients with rheumatic diseases. The present study aims to describe the educational needs of Dutch patients with systemic sclerosis (SSc). The D-ENAT was sent to 155 SSc patients registered at the outpatient clinic of a university hospital. The D-ENAT consists of 39 items in seven domains. “Each domain has different number of items therefore we normalized each domain score: (domain score/maximum) × 100) and expressed in percentage to enable comparisons between domains.” A total D-ENAT score (0–156) is calculated by summing all 39 items. In addition, age, disease duration, gender, educational level, present information need (yes/no) and information need (1–4; wanting to know nothing–everything) were recorded. Univariate regression analysis was used to examine factors associated with the D-ENAT scores. The response rate was 103 out of 155 (66 %). The mean % of educational needs scores (0–100 %; lowest–highest) were 49 % for “D-ENAT total score,” 46 % for “Managing pain,” 41 % for “Movement,” 43 % for “Feelings,” 59 % for “Disease process,” 44 % for “Treatments from health professionals,” 61 % for “Self-help measures” and 51 % for “Support systems.” No associations between the D-ENAT total score and age, disease duration, gender and educational level were found. The D-ENAT demonstrated its ability to identify educational needs of Dutch SSc patients. SSc patients demonstrated substantial educational needs, especially in the domains: “Disease process” and “Self-help measures.” The validity and practical applicability of the D-ENAT to make an inventory of SSc patients’ educational needs require further investigation.
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Affiliation(s)
- Anne Schouffoer
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Haga Hospital, The Hague, The Netherlands
| | - Mwidimi E Ndosi
- Academic and Clinical Unit for Musculoskeletal Nursing, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jorit J L Meesters
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. .,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
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Abstract
Systemic sclerosis (SSc) is a chronic multi-system autoimmune disease associated with disability and reduced quality of life. There is no effective treatment or cure to SSc, so it is important improve global health of these patients and reduce morbidity and mortality associated with SSc. It was made a literature review about quality of life in patients with SSc, regarding the several factors that should be considered and evaluated when attending to SSc patients. It was also considered the validated scales and questionnaires used to measure outcomes in patients with SSc. We concluded that it is important to have an interdisciplinary approach to SSc patients considering the patient's cognitive representations of the disease and what they value most like mobility and hand function, pain, fatigue, sleep, depression and body image.
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Affiliation(s)
- Cristiana Almeida
- Department of Medicine, Centro Hospitalar Vila Nova Gaia/Espinho (CHVNG/E), Gaia, Portugal.
| | - Isabel Almeida
- Clinical Immunology Unit, Department of Medicine, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal; Multidisciplinary Unit for Biomedical Investigation (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Portugal.
| | - Carlos Vasconcelos
- Clinical Immunology Unit, Department of Medicine, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal; Multidisciplinary Unit for Biomedical Investigation (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Portugal.
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Cognitive-Behavioural Therapy Targeting Fear of Progression in an Interdisciplinary Care Program: A Case Study in Systemic Sclerosis. J Clin Psychol Med Settings 2014; 21:297-312. [DOI: 10.1007/s10880-014-9414-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Crossland V, Field R, Ainsworth P, Edwards CJ, Cherry L. Is there evidence to support multidisciplinary healthcare working in rheumatology? A systematic review of the literature. Musculoskeletal Care 2014; 13:51-66. [PMID: 25052547 DOI: 10.1002/msc.1081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Kocher A, Adler S, Spichiger E. Skin and mucosa care in systemic sclerosis--patients' and family caregivers' experiences and expectations of a specific education programme: a qualitative study. Musculoskeletal Care 2013; 11:168-178. [PMID: 23532980 DOI: 10.1002/msc.1051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Skin and mucosal manifestations such as skin thickening, pruritus, reduced microvascular circulation, digital lesions, appearance-related changes, and dryness of the eyes and mucosa are common in systemic sclerosis (SSc). A specific skin and mucosa care education programme for patients and their family caregivers should increase their self-efficacy and improve coping strategies. AIMS The aims of this qualitative study were to explore the participants' experiences of both everyday life with skin and mucosal manifestations and the programme itself, while identifying unmet needs for programme development. METHODS Narrative interviews were conducted with eight SSc patients and two family caregivers of individuals with SSc. Using qualitative content analysis techniques, the transcribed interviews were systematically summarized and categories inductively developed. RESULTS The findings illustrated participants' experiences of skin and mucosal symptoms and revealed them to be experts in finding the right therapy mix alone (before diagnosis) and also in collaboration with health professionals (after diagnosis). Participants emphasized that the programme gave them useful education on skin and mucosa care. They described how they had to cope alone with the lack of information on pathophysiology, people's reactions, and the impact on their family and working lives. Nevertheless, participants said that they maintained a positive attitude by not dwelling on future disabilities. CONCLUSIONS Patients and family caregivers benefited from the individualized and SSc-specific education on skin and mucosa care. Future improvements to the programme should focus on imparting understandable information on SSc pathophysiology, dealing with disfigurement and seeking reliable disease information, as well as facilitating peer support.
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Affiliation(s)
- Agnes Kocher
- Department of Rheumatology, Clinical Immunology and Allergology, Inselspital, Bern University Hospital, Switzerland
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Meijs J, Zirkzee EJM, Schouffoer AA, Henquet SM, Caljouw MAA, Stijnen T, Huizinga TWJ, Schuerwegh AJM, Vliet Vlieland TPM. Health-care utilization in Dutch systemic sclerosis patients. Clin Rheumatol 2013; 33:825-32. [DOI: 10.1007/s10067-013-2373-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/16/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
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Põlluste K, Kallikorm R, Lember M. Level of knowledge and sources of information about the rheumatoid arthritis in Estonian patients. Rheumatol Int 2013; 34:675-81. [PMID: 23588412 DOI: 10.1007/s00296-013-2753-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 04/07/2013] [Indexed: 11/28/2022]
Abstract
The objective of this paper was to find out how many patients with rheumatoid arthritis (RA) know about several aspects of disease, to explain the associations between the level of self-rated knowledge and patients' background and health status and to compare the importance of the main sources of information. A random sample (n = 1,259) of adult Estonian RA patients was selected from the Estonian Health Insurance Fund Database. The patients completed a self-administered questionnaire, which included information about their socio-demographic and disease characteristics, use of health services, information about the disease, and sources of information. Regression analysis was used to calculate the associations between the independent variables and level of self-rated knowledge about several aspects of RA. The results of the study indicated that the self-reported ratings of knowledge about the disease in Estonian RA patients were rather low. Health professionals were mentioned as the primary sources of information, but the longer disease history and more frequent use of health services as considerable predictors of higher ratings of knowledge refer to role of personal experience in obtaining knowledge about the disease as well.
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Affiliation(s)
- Kaja Põlluste
- Department of Internal Medicine, University of Tartu, L. Puusepa 6, Tartu, 51014, Estonia,
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van der Vaart R, Repping-Wuts H, Drossaert CHC, Taal E, Knaapen-Hans HKA, van de Laar MAFJ. Need for Online Information and Support of Patients With Systemic Sclerosis. Arthritis Care Res (Hoboken) 2013; 65:594-600. [DOI: 10.1002/acr.21875] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 10/03/2012] [Indexed: 12/27/2022]
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Kwakkenbos L, van den Hoogen FHJ, Custers J, Prins J, Vonk MC, van Lankveld WGJM, Becker ES, van den Ende CHM. Validity of the Fear of Progression Questionnaire-Short Form in patients with systemic sclerosis. Arthritis Care Res (Hoboken) 2012; 64:930-4. [DOI: 10.1002/acr.21618] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mura G, Bhat KM, Pisano A, Licci G, Carta MG. Psychiatric symptoms and quality of life in systemic sclerosis. Clin Pract Epidemiol Ment Health 2012; 8:30-5. [PMID: 22550545 PMCID: PMC3339425 DOI: 10.2174/1745017901208010030] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/01/2012] [Accepted: 03/01/2012] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Systemic sclerosis (SSc) is a rare conjunctive tissue disorder characterized by fibrosis of the skin and internal organs, and vascular obliteration phenomena. Patients with SSc often experience elevated symptoms of psychological distress, determined by the disfiguration, the pain, the fatigue sensation, and the difficult in daily life occupations. The characteristics of the disease may influence the perceived quality of life (QoL) in people with SSc. METHODS This is a narrative review aiming to define the amount of impairment of Quality of Life in patients with Systemic Sclerosis and the component of this impairment due to depressive or other psychiatric symptoms. The search of the significant articles was carried out in PubMed for the key words "Psychiatric symptoms and Systemic Sclerosis"; "Quality of life and Systemic Sclerosis"; "Depressive Disorders and Systemic Sclerosis". RESULTS Psychiatric symptoms are frequents in patients with SSc, but pain, fatigue, disability, body changes don't appear to explain the high prevalence of psychiatric comorbidity in SSc. Many studies founded a significant impairment in SSc patients' QoL, and despite the undeniable correlation between physical symptoms and SSc patients' QoL, mental health was found significantly impaired. DISCUSSION The high rate of depression seems to strictly correlate with poor quality of life, and this finding needs more research to establish the cause of such a correlation. Patients' point of view regarding their health-related QoL could help physicians to enlarge the knowledge about physical and mental correlates of the disease, and to fit therapies as patient required. Particular attention must be given to provide the patient with correct information, in order to mitigate the anxious state on disease course, and to enhance coping skills of the patients.
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Affiliation(s)
- G Mura
- Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU. Cagliari - Italy
| | - Krishna M Bhat
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, Texas, USA
| | - A Pisano
- Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU. Cagliari - Italy
| | - G Licci
- Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU. Cagliari - Italy
| | - MG Carta
- Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU. Cagliari - Italy
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Kwakkenbos L, van Lankveld WGJM, Vonk MC, Becker ES, van den Hoogen FHJ, van den Ende CHM. Disease-related and psychosocial factors associated with depressive symptoms in patients with systemic sclerosis, including fear of progression and appearance self-esteem. J Psychosom Res 2012; 72:199-204. [PMID: 22325699 DOI: 10.1016/j.jpsychores.2011.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 11/23/2011] [Accepted: 12/20/2011] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The prevalence of depressive symptoms is high in patients with systemic sclerosis (SSc, scleroderma). This study was conducted to determine which disease-related and psychosocial factors are associated with depressive symptoms, independent of sociodemographic factors. METHODS In total, 215 patients with SSc completed questionnaires on sociodemographics, physical functioning (HAQ-DI), pain (VAS), fatigue (CIS), psychosocial characteristics (CISS, ICQ, PRQ, ASE, FoP-Q-SF) and depressive symptoms (CES-D). Disease characteristics (disease duration, disease subtype, modified Rodnan Skin Score) were collected. Hierarchical linear regression analyses were conducted to assess associations with depressive symptoms. RESULTS The mean CES-D score was 12.9 (SD=9.7) and the prevalence of patients scoring>= 16 and>=19 were 32.1% and 25.1%, respectively. The variance explained by sociodemographics and disease characteristics was negligible (R(2)≤.09). Fatigue and pain were independently associated with depressive symptoms (R(2) change=.35). After adding psychological factors (R(2) change=.21), satisfaction with social support, emotion-focused coping and helplessness were also significantly associated with depressive symptoms. Higher fear of progression was associated with more depressive symptoms (P≤.01), and appearance self-esteem showed a marginally significant association (P=.08). CONCLUSION Depressive symptoms were common in the present sample of patients with SSc and were independently associated with pain, fatigue, social support, emotion-focused coping, helplessness and fear of progression. Results suggest that, in addition to assessment of disease characteristics, attention should be given also to psychosocial factors found to be associated with depressive symptoms. For the development and trialling of psychological interventions, fear of progression could be an important target.
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Affiliation(s)
- Linda Kwakkenbos
- Department of Rheumatology, Sint Maartenskliniek Nijmegen, The Netherlands.
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