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Jensen KY, Aagaard P, Suetta C, Nielsen JL, Schrøder HD, Grønset C, Simonsen C, Diederichsen LP. Quality of life in patients with myositis is associated with functional capacity, body composition, and disease activity-Baseline data from a randomized controlled trial. Int J Rheum Dis 2024; 27:e15132. [PMID: 38509721 DOI: 10.1111/1756-185x.15132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/22/2024] [Accepted: 03/09/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To investigate the potential associations between functional capacity, muscle strength, body composition, and disease-related measures and quality of life in patients with myositis. METHODS Baseline measures of functional capacity (functional index 3 (FI3), 2-minute walk test (2MWT), timed up and go (TUG) and 30-s sit-to-stand (30-STS)), muscle strength (incl. leg and handgrip strength), maximal leg extensor power, body composition (appendicular lean mass, fat percentage/mass) and disease-related measures (disease activity & damage core sets) were examined for their associations with quality of life (physical- and mental component summary scores, Short Form 36 questionnaire (SF-36)) by means of Spearman's correlation analysis. RESULTS A total of 32 patients with myositis were included. Positive correlations between SF-36 physical component summary score (PCS) and FI3, 30-STS, TUG, 2MWT, leg extensor power, leg strength, bench press strength, and handgrip strength were observed. In contrast, fat percentage and fat mass correlated negatively with PCS. In disease-related measures, Extramuscular global assessment, health assessment questionnaire, physician global damage, and patient global damage scores were negatively associated with SF-36 PCS. No correlations to the mental component summary score of SF-36 were observed. CONCLUSION All measures of functional capacity were positively related to the SF-36 physical component summary score, indicating higher functional capacity positively affects quality of life in patients with myositis. Health assessment questionnaire and patient global damage scores demonstrated the strongest correlations with SF-36 physical component summary scores, further supporting these patient-reported outcomes as viable monitoring tools in patients with myositis.
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Affiliation(s)
- Kasper Yde Jensen
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases (COPEACT), Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Charlotte Suetta
- Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jakob L Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik D Schrøder
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Charlotte Grønset
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Casper Simonsen
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Louise P Diederichsen
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases (COPEACT), Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
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Connolly CM, Gupta L, Fujimoto M, Machado PM, Paik JJ. Idiopathic inflammatory myopathies: current insights and future frontiers. THE LANCET. RHEUMATOLOGY 2024; 6:e115-e127. [PMID: 38267098 DOI: 10.1016/s2665-9913(23)00322-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/24/2023] [Accepted: 11/29/2023] [Indexed: 01/26/2024]
Abstract
Idiopathic inflammatory myopathies are a group of autoimmune diseases with a broad spectrum of clinical presentations, primarily characterised by immune-mediated muscle injury. Until recently, there was little insight into the pathogenesis of idiopathic inflammatory myopathies, which challenged the recognition of the breadth of heterogeneity of this group of diseases as well as the development of new therapeutics. However, the landscape of idiopathic inflammatory myopathies is evolving. In the past decade, advances in diagnostic tools have facilitated an enhanced understanding of the underlying disease mechanisms in idiopathic inflammatory myopathies, enabling the expansion of therapeutic trials. The fields of transcriptomics, prot§eomics, and machine learning offer the potential to gain greater insights into the underlying pathophysiology of idiopathic inflammatory myopathies. Harnessing insights gained from these sophisticated tools could contribute to the identification of differences at a molecular level among patients, accelerating the development of targeted, tailored therapies. Bolstered by the validation and standardisation of robust outcome measures, many promising therapies are in clinical trial development. Although challenges remain, there is great optimism in the field due to the progress in innovative diagnostics, outcome measures, and therapeutic approaches. In this Review, we discuss the expanding landscape of idiopathic inflammatory myopathies as the frontier of precision medicine becomes imminent.
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Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK; Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Manabu Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Pedro M Machado
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK; Centre for Rheumatology, University College London, London, UK; National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK; Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Knitza J, Kuhn S, Gupta L. Digital Approaches for Myositis. Curr Rheumatol Rep 2023; 25:259-263. [PMID: 37962833 PMCID: PMC10754733 DOI: 10.1007/s11926-023-01119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW This article serves as a comprehensive review, focusing on digital approaches utilized in the diagnosis, monitoring, and treatment of patients with idiopathic inflammatory myopathies (IIM). The authors critically assess the literature published in the last three years, evaluating the advancements and progress achieved in this specific domain. RECENT FINDINGS Remarkable strides have been made in the realm of digital diagnostic support, particularly in image analysis and clinical prediction models, showing promise in aiding the diagnosis of IIM. The field of remote patient monitoring has also witnessed significant advancements, revolutionizing the care process by offering more convenient, data-driven, and continuous monitoring for IIM patients. Various digital tools, such as wearables, video- and voice consultations, and electronic patient-reported outcomes, have been extensively explored and implemented to enhance patient care. Survey studies consistently reveal a high acceptance of telehealth services among patients. Additionally, internet-based studies have facilitated the efficient and rapid recruitment of IIM patients for research purposes. Moreover, the integration of sensors and exoskeletons has shown great potential in significantly improving the functionality and quality of life for individuals with muscle weakness caused by IIM. The integration of digital health solutions in the care of IIM patients is steadily gaining attention and exploration. Although the existing evidence is limited, it does indicate that patients can be adequately and safely supported through digital means throughout their entire healthcare journey. The growing interest in digital health technologies holds the promise of improving the overall management and outcomes for individuals with idiopathic inflammatory myopathies.
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Affiliation(s)
- Johannes Knitza
- Department of Internal Medicine 3, Rheumatology and Immunology Friedrich, Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
- AGEIS, Université Grenoble Alpes, Grenoble, France.
- Institute of Digital Medicine, University Hospital of Giessen and Marburg, Philipps-University Marburg, Marburg, Germany.
| | - Sebastian Kuhn
- Institute of Digital Medicine, University Hospital of Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
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Brandenbarg P, Hoekstra F, Barakou I, Seves BL, Hettinga FJ, Hoekstra T, van der Woude LHV, Dekker R, Krops LA. Measurement properties of device-based physical activity instruments in ambulatory adults with physical disabilities and/or chronic diseases: a scoping review. BMC Sports Sci Med Rehabil 2023; 15:115. [PMID: 37735403 PMCID: PMC10512652 DOI: 10.1186/s13102-023-00717-0] [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: 12/09/2022] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND People with physical disabilities and/or chronic diseases tend to have an inactive lifestyle. Monitoring physical activity levels is important to provide insight on how much and what types of activities people with physical disabilities and/or chronic diseases engage in. This information can be used as input for interventions to promote a physically active lifestyle. Therefore, valid and reliable physical activity measurement instruments are needed. This scoping review aims 1) to provide a critical mapping of the existing literature and 2) directions for future research on measurement properties of device-based instruments assessing physical activity behavior in ambulant adults with physical disabilities and/or chronic diseases. METHODS Four databases (MEDLINE, CINAHL, Web of Science, Embase) were systematically searched from 2015 to April 16th 2023 for articles investigating measurement properties of device-based instruments assessing physical activity in ambulatory adults with physical disabilities and/or chronic diseases. For the majority, screening and selection of eligible studies were done in duplicate. Extracted data were publication data, study data, study population, device, studied measurement properties and study outcome. Data were synthesized per device. RESULTS One hundred three of 21566 Studies were included. 55 Consumer-grade and 23 research-grade devices were studied on measurement properties, using 14 different physical activity outcomes, in 23 different physical disabilities and/or chronic diseases. ActiGraph (n = 28) and Fitbit (n = 39) devices were most frequently studied. Steps (n = 68) was the most common used physical activity outcome. 97 studies determined validity, 11 studies reliability and 6 studies responsiveness. CONCLUSION This scoping review shows a large variability in research on measurement properties of device-based instruments in ambulatory adults with physical disabilities and/or chronic diseases. The variability highlights a need for standardization of and consensus on research in this field. The review provides directions for future research.
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Affiliation(s)
- Pim Brandenbarg
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands.
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands.
| | - Femke Hoekstra
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, V1V 1V7, Canada
| | - Ioulia Barakou
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Bregje L Seves
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Florentina J Hettinga
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, NE1 8ST, UK
| | - Trynke Hoekstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 BT, The Netherlands
| | - Lucas H V van der Woude
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Leonie A Krops
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
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Kamperman RG, Bogaards JA, Evers SW, Walter HAW, de Visser M, de Borgie C, Colen-de Koning JCA, Verhamme C, Maas M, Eftimov F, van Schaik IN, van der Kooi AJ, Raaphorst J. Treatment with add-on IVIg in Myositis Early In the diSease course May be sUperior to Steroids alone for reaching CLinical improvEment (TIME IS MUSCLE): study protocol of a phase-2 double-blind placebo-controlled randomised trial. BMJ Open 2023; 13:e067435. [PMID: 37429682 DOI: 10.1136/bmjopen-2022-067435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION For idiopathic inflammatory myopathies (IIM) ('myositis') standard initial treatment is high-dosed glucocorticoids, which results in relatively slow improvement of muscle strength. Early immunosuppression or modulation by intensive treatment ('hit-early, hit-hard') may induce faster reduction of disease activity and prevent chronic disability due to disease-induced structural muscle damage. Intravenous immunoglobulin (IVIg) in addition to standard glucocorticoid treatment may be promising in this regard as was shown in various studies: add-on IVIg improved symptoms and muscle strength in refractory myositis patients and monotherapy IVIg improved outcomes after 9 weeks, in about half of treatment-naive patients. HYPOTHESIS We hypothesise that early add-on IVIg leads to a greater clinical response after 12 weeks in patients with newly diagnosed myositis, in comparison to prednisone monotherapy. Second, we expect that early treatment with add-on IVIg leads to a faster time to improvement and sustained positive effects on multiple secondary outcomes. METHODS The Time Is Muscle trial is a phase-2 double-blind placebo-controlled randomised trial. Forty-eight patients with IIM will be treated with IVIg or placebo at baseline (within 1 week after diagnosis) and after 4 and 8 weeks, in addition to standard therapy with prednisone. The primary outcome is the Total Improvement Score (TIS) of the myositis response criteria at 12 weeks. At baseline, and after 4, 8, 12, 26 and 52 weeks, relevant secondary outcomes will be assessed, including time to moderate improvement (TIS≥40), mean daily prednisone dosage, physical activity, health-related quality of life, fatigue and MRI muscle imaging parameters. ETHICS AND DISSEMINATION Ethical approval was obtained from the medical ethics committee of the Academic Medical Centre, University of Amsterdam, the Netherlands (2020_180; including a first amendment approval at the 12 April 2023; A2020_180_0001). The results will be distributed through conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER EU Clinical trials register (2020-001710-37).
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Affiliation(s)
- Renske G Kamperman
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes A Bogaards
- Department of Epidemiology and Data Science, Amsterdam UMC - Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanne W Evers
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hannah A W Walter
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marianne de Visser
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Corianne de Borgie
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jantine C A Colen-de Koning
- Department of Clinical Pharmacy, Amsterdam UMC - Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Camiel Verhamme
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam UMC - Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ivo N van Schaik
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Anneke J van der Kooi
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost Raaphorst
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
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Ocagli H, Agarinis R, Azzolina D, Zabotti A, Treppo E, Francavilla A, Bartolotta P, Todino F, Binutti M, Gregori D, Quartuccio L. Physical activity assessment with wearable devices in rheumatic diseases: a systematic review and meta-analysis. Rheumatology (Oxford) 2023; 62:1031-1046. [PMID: 36005834 DOI: 10.1093/rheumatology/keac476] [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: 03/27/2022] [Revised: 08/13/2022] [Accepted: 08/13/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In the management of rheumatic musculoskeletal disorders (RMDs), regular physical activity (PA) is an important recognized non-pharmacological intervention. This systematic review and meta-analysis aims to evaluate how the use of wearable devices (WDs) impacts physical activity in patients with noninflammatory and inflammatory rheumatic diseases. METHODS A comprehensive search of articles was performed in PubMed, Embase, CINAHL and Scopus. A random-effect meta-analysis was carried out on the number of steps and moderate-vigorous physical activity (MVPA). Univariable meta-regression models were computed to assess the possibility that the study characteristics may act as modifiers on the final meta-analysis estimate. RESULTS In the analysis, 51 articles were included, with a total of 7488 participants. Twenty-two studies considered MVPA outcome alone, 16 studies considered the number of steps alone, and 13 studies reported information on both outcomes. The recommended PA threshold was reached for MVPA (36.35, 95% CI 29.39, 43.31) but not for daily steps (-1092.60, -1640.42 to -544.77). Studies on patients with fibromyalgia report a higher number (6290, 5198.65-7381.62) of daily steps compared with other RMDs. Patients affected by chronic inflammatory arthropathies seemed to fare better in terms of daily steps than the other categories. Patients of younger age reported a higher overall level of PA than elderly individuals for both the number of steps and MVPA. CONCLUSION Physical activity can be lower than the recommended threshold in patients with RMDs when objectively measured using WD. WDs could be a useful and affordable instrument for daily monitoring physical activity in RMDs and may support an increase in activity levels. PROSPERO TRIAL REGISTRATION CRD42021227681, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227681.
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Affiliation(s)
- Honoria Ocagli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova
| | - Roberto Agarinis
- Division of Rheumatology, Department of Medicine, University of Udine, ASUFC, Udine
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova.,Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Alen Zabotti
- Division of Rheumatology, Department of Medicine, University of Udine, ASUFC, Udine
| | - Elena Treppo
- Division of Rheumatology, Department of Medicine, University of Udine, ASUFC, Udine
| | - Andrea Francavilla
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova
| | - Patrizia Bartolotta
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova
| | - Federica Todino
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova
| | - Marco Binutti
- Division of Rheumatology, Department of Medicine, University of Udine, ASUFC, Udine
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova
| | - Luca Quartuccio
- Division of Rheumatology, Department of Medicine, University of Udine, ASUFC, Udine
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DiRenzo D, Saygin D, de Groot I, Bingham Iii CO, Lundberg IE, Needham M, Park JK, Regardt M, Sarver C, Song YW, Maxwell L, Beaton D, de Visser M, Christopher-Stine L, Mecoli CA, Alexanderson H. Reliability and validity of PROMIS physical function, pain interference, and fatigue as patient reported outcome measures in adult idiopathic inflammatory myopathies: International study from the OMERACT myositis working group. Semin Arthritis Rheum 2023; 58:152111. [PMID: 36410180 PMCID: PMC10354786 DOI: 10.1016/j.semarthrit.2022.152111] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Pain interference, fatigue, and impaired physical function are common features of idiopathic inflammatory myopathies (IIM). The objective of this study was to evaluate the construct validity and test-retest reliability of the Patient Reported Outcome Information System (PROMIS) Pain Interference 6av1.0, Fatigue 7av1.0, and Physical Function 8bv2.0 instruments. METHODS Patient-Reported Outcome Measures (PROMs) were deployed to adult IIM patients from OMERACT Myositis Working Group (MWG) international clinic sites via two online surveys (2019, 2021). Internal consistency of each PROM was analyzed by Cronbach's α. Construct validity was determined by a priori hypotheses generated by the MWG with >75% agreement for each hypothesis and calculated with Pearson correlations. Test-retest reliability was assessed using intraclass correlation coefficient with PROMIS instruments administered at time zero and 7 days. RESULTS Surveys were sent to 368 participants in total; participants who completed each questionnaire varied (n=65 to 263). For construct validity, 10 out of 13 a priori hypotheses were met supporting construct validity of PROMIS instruments (Pain Interference 3/4, fatigue 4/4, and Physical Function 3/5). Test-retest reliability was strong for all PROMIS instruments. All PROMIS instruments demonstrated excellent internal consistency. None of the measures demonstrated any ceiling or floor effects except for a ceiling effect in the Pain Interference instrument. CONCLUSIONS This study presents test-retest reliability and construct validity evidence supporting PROMIS Pain Interference (6a v1.0), Fatigue (7a v1.0), and Physical Function (8b v2.0) using a large international cohort of patients with IIM. Internal consistency of these instruments was excellent. A ceiling effect was noted in the Pain Interference instrument.
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Affiliation(s)
- Dana DiRenzo
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, USA
| | - Didem Saygin
- Division of Rheumatology, Department of Medicine, University of Chicago, USA
| | | | | | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University, Solna, Stockholm, Sweden
| | - Merrilee Needham
- Dept Neurology, Fiona Stanley Hospital, IIID Murdoch University and University of Notre Dame, Perth, Australia
| | - Jin Kyun Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Malin Regardt
- Occupational Therapist, Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet and Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | | | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University
| | - Lara Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dorcas Beaton
- Institute for Work & Health and Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, the Netherlands
| | | | - Christopher A Mecoli
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, USA.
| | - Helene Alexanderson
- Physiotherapist, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital and Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Leclair V, Tsui H, Hudson M. Pain in autoimmune inflammatory myopathies: a scoping review. RMD Open 2023; 9:rmdopen-2022-002591. [PMID: 36635001 PMCID: PMC9843184 DOI: 10.1136/rmdopen-2022-002591] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/26/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pain is considered a priority for research by adult patients with autoimmune inflammatory myopathy (AIM) and their families. Our aim was to review the literature for studies reporting on pain in adult AIM and to summarise their findings. METHODS A scoping review was conducted searching for studies in PubMed and MEDLINE including more than five adult patients with AIM and assessing pain using a patient-reported outcome measure. Study population characteristics, pain measurement and clinical correlates of pain were extracted using a standardised protocol. RESULTS The search strategy identified 2831 studies with 33 meeting inclusion criteria. Most studies used visual analogue scales (n=14) and/or the Medical Outcomes Study 36-Item Short Form Bodily Pain Scale (n=17). Frequency of pain and/or myalgias ranged from 64% to 100%. Subjects with AIM had significantly more pain than the general population and comparable pain to other chronic rheumatic diseases. Insufficient results were available to identify significant clinical correlates of pain in AIM. CONCLUSION This review suggests that the burden of pain in AIM is considerable. Still, due to the heterogeneity and low quality of the evidence, significant knowledge gaps persist. Studies are needed to characterise pain trajectories of patients with AIM.
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Affiliation(s)
- Valérie Leclair
- Division of Rheumatology, Jewish General Hospital and Lady Davis Institute, McGill University, Montreal, Quebec, Canada
| | - Harmony Tsui
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Marie Hudson
- Division of Rheumatology, Jewish General Hospital and Lady Davis Institute, McGill University, Montreal, Quebec, Canada
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Thurah AD, Marques A, Souza SD, Crowson CS, Myasoedova E. Future challenges in rheumatology – is telemedicine the solution? Ther Adv Musculoskelet Dis 2022; 14:1759720X221081638. [PMID: 35321119 PMCID: PMC8935581 DOI: 10.1177/1759720x221081638] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/26/2022] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has become an unprecedented facilitator of rapid telehealth expansion within rheumatology. Due to demographic shifts and workforce shortages in the future, new models of rheumatology care will be expected to emerge, with a growing footprint of telehealth interventions. Telehealth is already being used to monitor patients with rheumatic diseases and initial studies show good results in terms of safety and disease progression. It is being used as a tool for appointment prioritization and triage, and there is good evidence for using telehealth in rehabilitation, patient education and self-management interventions. Electronic patient-reported outcomes (ePROs) offer a number of long-term benefits and opportunities, and a routine collection of ePROs also facilitates epidemiological research that can inform future healthcare delivery. Telehealth solutions should be developed in close collaboration with all stakeholders, and the option of a telehealth visit must not deprive patients of the possibility to make use of a conventional ‘face-to-face’ visit. Future studies should especially focus on optimal models for rheumatology healthcare delivery to patients living in remote areas who are unable to use or access computer technology, and other patient groups at risk for disparity due to technical inequity and lack of knowledge.
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Affiliation(s)
- Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N 8240, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andrea Marques
- Health Sciences Research Unit: Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal
- Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Savia de Souza
- Centre for Rheumatic Diseases, King’s College London, London, UK
| | - Cynthia S. Crowson
- Department of Qualitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Elena Myasoedova
- Department of Qualitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
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10
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Assessment of Physical Activity and Muscle Function in Adult Inflammatory Myopathies. Curr Rheumatol Rep 2022; 24:54-63. [PMID: 35244882 DOI: 10.1007/s11926-022-01059-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The aim is to summarize the outcome measures used in the assessment and monitoring of muscle function and physical activity in the management idiopathic inflammatory myopathy. RECENT FINDINGS Assessment techniques have progressed and matured over the past decade, and new options are now available to clinicians working in this field. Newer outcome measures, including the Functional Index-3 and wearable motion sensors are reviewed, as well as the current application of more established measures. The available outcome measures for use in clinical practice in idiopathic inflammatory myopathies with regard to muscle function and physical activity have expanded over the past 15 years. There are valid and reliable options for several domains and methods for assessing these factors. In a busy clinical setting, efficiency is important, but there also needs to be considered the choosing of tools that work together to give the fullest picture of the status of the patient.
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11
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Jones GB, Freeman J, Mann A, Khanna A. Physician centricity in the deployment of digital solutions for neurological conditions. Digit Health 2022; 8:20552076221081697. [PMID: 35223078 PMCID: PMC8864254 DOI: 10.1177/20552076221081697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/30/2022] [Indexed: 12/02/2022] Open
Abstract
The widespread deployment of telemedical approaches to managed care during the CoV2
pandemic has provided an opportunity for clinicians to engage in the development and
refinement of this mode of delivery. This also represents a pivotal moment to help effect
a paradigm shift in how new and more sophisticated digital health services are designed
and delivered with the caregiver playing a guiding role. Building on momentum this way can
allow the fuller potential of digital health to be realized by focusing on “end user pull”
which balances the omnipresent “technology push” of the consumer product and medical
device industries. Perhaps nowhere is this more critical than in the care of neurological
illnesses where patient–provider interactions must be managed frequently and rely on a
complex battery of data measures. The emergent role of the physician-entrepreneur can be
envisioned, complimenting established physician-scientist career paths and represents a
timely and opportune moment to refine medical education curricula.
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Affiliation(s)
- Graham B Jones
- Novartis Pharmaceuticals, USA
- Tufts University Medical Center, USA
| | | | | | - Amit Khanna
- Neuroscience Global Drug Development, Novartis Pharma AG, Switzerland
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12
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Validation of two simple patient-centered outcome measures for virtual monitoring of patients with idiopathic inflammatory myositis. Clin Rheumatol 2021; 41:765-772. [PMID: 34791543 PMCID: PMC8598218 DOI: 10.1007/s10067-021-05990-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/23/2021] [Accepted: 11/08/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Telemedicine has changed the landscape of patient care with wider use of patient-centered outcome measures (PCOMs). We evaluated two novel task-based PCOMs namely ten times arm lift (AL) test and two-minute walk distance (2MWD) in idiopathic myositis (IIM). METHODS This was a cross-sectional observational study with the enrolment of adult IIM (ACR/EULAR criteria) patients with active/inactive disease. Active disease was defined as any two of increase in immunosuppression within 3 months, elevated muscle enzymes, physician VAS ≥ 2, worsened cutaneous disease, or fall in MMT8 < 76. Standard myositis core set measures (CSMs) were evaluated and test-retest validity [Cronbach's alfa (CA)], construct validity (Pearson's correlation), and discriminant validity (between active/inactive IIM) were assessed. The results were further validated in a separate tele-rheumatology cohort. RESULTS Among 22 IIM patients (68%-female) of age 30.5(19-62) years, AL and 2MWD showed excellent test-retest reliability (CA-0.987, 0.99). AL exhibited moderate-strong correlation with all CSMs except CK levels and MDI. In contrast, 2MWD values were highly variable without CSM correlation. A higher AL time discriminated active and inactive myositis (16.6 vs 11 s, p = 0.006) with an AUC of 0.882 (p = 0.006). AL > 12.8 s had 94% negative predictive value (NPV) for active muscle disease. In the validation cohort (47 patient visits among 26 patients), AL significantly differentiated between active vs. inactive disease with an NPV of 95%. CONCLUSIONS AL test exhibits pilot evidence of construct and discriminant validity in patients with IIM requiring further evaluation. 2MWD was not a good test for outcome evaluation of IIM patients. Key Points • Novel task-based patient-centered outcome measures were evaluated for remote monitoring of muscle strength in IIM. • Ten times arm lift (AL) test showed strong test-retest reliability as well as provide pilot evidence of construct and discriminant validity in patients with IIM unlike 2-min walk distance. • This provides preliminary evidence to further evaluate the role of AL as patient-centered outcome measure in patients with IIM for virtual clinical trials.
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Saygin D, Rockette-Wagner B, Oddis C, Neiman N, Koontz D, Moghadam-Kia S, Aggarwal R. Consumer-based activity trackers in evaluation of physical activity in myositis patients. Rheumatology (Oxford) 2021; 61:2951-2958. [PMID: 34528065 DOI: 10.1093/rheumatology/keab700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/25/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Inflammatory myopathies are characterized by muscle weakness that limit activities of daily living. Daily step count is an accepted metric of physical activity. Wearable technologies such as Fitbit® enable tracking of daily step counts. We assessed psychometric properties of Fitbit® and compared the accuracy of Fitbit® step counts to ActiGraph®. METHODS This was a pilot, proof of concept, prospective observational study with 4 visits at 0, 1-, 3-, and 6-months in polymyositis (PM), dermatomyositis (DM), necrotizing myopathy (NM) or anti-synthetase syndrome (AS) subjects. Six core set measures [manual muscle testing, physician (MD-GDA), patient (PT-GDA), and extra-muscular disease activity, HAQ-DI and creatine kinase], 3 functional tests [six-minute walk, timed up-and-go, sit-to-stand tests] and SF-36 physical function-10 (PF10) were collected at each visit. Patients wore waist-worn Fitbit® One and ActiGraph® T3X-BT concurrently for 7 days/month for 6-months. RESULTS Twenty-four (10 DM, 8 PM/NM, 6 AS) patients (17 females/7 males; 91% Caucasian) were enrolled. Test-retest reliability of daily steps was strong in 1-month follow-up (ICC 0.89). Daily steps and peak 1-min cadence showed moderate-strong correlations with MD-GDA, PT-GDA, HAQ-DI, SF-36 PF10 and all three functional tests. Fitbit® and ActiGraph® step counts demonstrated good agreement and strong correlation (ICC 0.96). CONCLUSION Fitbit® daily steps and peak 1-min cadence are reliable and valid measures of physical activity in a cohort of myositis patients. This pilot data suggests that Fitbit® has a potential for use in clinical practice and trials to monitor physical activity in myositis patients, but larger studies are needed for further validation.
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Affiliation(s)
- Didem Saygin
- Division of Rheumatology, University of Chicago, Chicago, IL, USA
| | | | - Chester Oddis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nicole Neiman
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Diane Koontz
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Siamak Moghadam-Kia
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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How to manage with telemedicine people with neuromuscular diseases? Neurol Sci 2021; 42:3553-3559. [PMID: 34173087 PMCID: PMC8232560 DOI: 10.1007/s10072-021-05396-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION COVID-19 pandemic radically transformed our daily clinical practice, raising the need not to lose close contact with patients without being able to see them face-to-face. These issues are even more felt and evident in fragile patients, as those affected by neuromuscular disease. An important help came from new digital technologies that allow clinicians to remotely monitor health status and any deterioration of chronically ill patients. METHODS In this mini-review, an initiative of the "Digital Technologies, Web and Social Media Study Group" of the Italian Society of Neurology, we propose to analyze the approach to neuromuscular patients by looking over raising evidence on the main cornerstones of Telemedicine (TM): clinician-patient interaction, remote clinical assessment, remote monitoring, and digital therapeutics. In particular, we explored the strategies developed by researchers and their impact on the physical and emotional status of the patients, with particular focusing on their adherence to the program of virtual monitoring. RESULTS TM plays an important role in each of four stages of approach to neuromuscular disease, having demonstrated validity in keep close clinical patient interaction, clinical assessment, remote monitoring, and telerehabilitation. Nevertheless, there is no remote alternative to electrophysiological testing neither validate tools to assess disability. CONCLUSION The role of TM in neuromuscular care is yet underestimated but is crucial, beyond the pandemic era. Further development of TM is advisable, through making specific apps, remotely controlled by clinicians, and making more engaging clinicians-patients interaction. Last, it is necessary to ensure adequate internet access to everyone.
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