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Benemei S, Boni L, Castaman G. Outcome measures in hemophilia: current and future perspectives. Expert Rev Hematol 2024; 17:329-340. [PMID: 38861342 DOI: 10.1080/17474086.2024.2365929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/05/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Hemophilia can detrimentally affect patients' quality of life and likelihood of survival. In the evolving landscape of therapies, the therapeutic gain of each treatment must be understood to accurately position it in the therapeutic armamentarium. Accordingly, appropriate outcomes must be measured with appropriate tools. AREAS COVERED Our narrative review (PubMed search for 'hemophilia AND outcome' until June 2023), provides a compendium of outcome measures used in hemophilia clinical research. To define each outcome measure's relative value and applicability, several characteristics are critically discussed. EXPERT OPINION Bleeding assessment, first annual/annualized bleeding rate, remains central in evaluating the efficacy and safety of hemophilia treatments. As modern therapies improve clinical outcomes toward zero bleeding events, this endpoint may become less sensitive to detect differences between therapeutic approaches. Technological advancements necessitate the adaptation of outcome measures to address infrequent bleeding events, age-related comorbidities, and laboratory parameters with limited comparability after different treatments. Considerable effort has been dedicated to the development of tools that comprehensively assess coagulation, such as thrombin generation assays. Patient-reported outcome measures are gaining importance although limited by their subjectivity. A definitive set of research outcome measures remains elusive. Outcomes may need to be tailored to different therapeutic interventions.
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Affiliation(s)
| | - Luca Boni
- U.O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
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Mingels S, Granitzer M, Schmid A, Graven-Nielsen T, Dankaerts W. Cross-sectional experimental assessment of pain modulation as part of multidimensional profiling of people with cervicogenic headache: protocol for a feasibility study. BMJ Open 2024; 14:e074743. [PMID: 38890144 PMCID: PMC11191774 DOI: 10.1136/bmjopen-2023-074743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND An endogenous pain modulation profile, reflecting antinociceptive and pronociceptive mechanisms, may help to direct management by targeting the involved pain mechanism. For individuals with cervicogenic headache (CeH), the characteristics of such profiles were never investigated. However, the individual nature of experiencing pain demands profiling within a multidimensional framework including psychosocial lifestyle characteristics. The objective of the current protocol is to assess the pain modulation profile, which includes psychosocial lifestyle characteristics among people with CeH. METHODS AND ANALYSIS A protocol is described to map pain modulation profiles in people with CeH. A cross-sectional non-randomised experimental design will be used to assess feasibility of mapping these profiles. The pain modulation profile is composed based on results on the Depression, Anxiety, Stress Scale, Pittsburgh Sleep Quality Index, Headache Impact Test and on responses to temporal summation of pain (pinprick), conditioned pain modulation and widespread hyperalgesia (mechanical pressure pain threshold and cuff algometry). Primary analyses will report results relating to outcomes on feasibility. Secondary analyses will involve an analysis of proportions (%) of the different psychosocial lifestyle profiles and pain profiles. ETHICS AND DISSEMINATION Ethical approval was granted by the Ethics Committee Research UZ/KU Leuven (Registration number B3222024001434) on 30 May 2024. Results will be published in peer-reviewed journals, at scientific conferences and, through press releases. Protocol V.3. protocol date: 3 June 2024.
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Affiliation(s)
- Sarah Mingels
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Leuven University, Leuven, Belgium
- REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Marita Granitzer
- REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Annina Schmid
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Wim Dankaerts
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Leuven University, Leuven, Belgium
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Filipow N, Bladen M, Raywood E, Robinson E, Chugh D, Douglas H, Thorpe N, O'Connor R, Murray N, Main E. Using reference equations to standardise incremental shuttle walk test performance in children and young people with chronic conditions and facilitate the evaluation of exercise capacity and disease severity. BMJ Open 2024; 14:e075733. [PMID: 38458782 DOI: 10.1136/bmjopen-2023-075733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
AIMS The aim was to evaluate whether standardised exercise performance during the incremental shuttle walk test (ISWT) can be used to assess disease severity in children and young people (CYP) with chronic conditions, through (1) identifying the most appropriate paediatric normative reference equation for the ISWT, (2) assessing how well CYP with haemophilia and cystic fibrosis (CF) perform against the values predicted by the best fit reference equation and (3) evaluating the association between standardised ISWT performance and disease severity. METHODS A cross-sectional analysis was carried out using existing data from two independent studies (2018-2019) at paediatric hospitals in London,UK. CYP with haemophilia (n=35) and CF (n=134) aged 5-18 years were included. Published reference equations for standardising ISWT were evaluated through a comparison of populations, and Bland-Altman analysis was used to assess the level of agreement between distances predicted by each equation. Associations between ISWT and disease severity were assessed with linear regression. RESULTS Three relevant reference equations were identified for the ISWT that standardised performance based on age, sex and body mass index (Vardhan, Lanza, Pinho). A systematic proportional bias of standardised ISWT was observed in all equations, most pronounced with Vardhan and Lanza; the male Pinho equation was identified as most appropriate. On average, CYP with CF and haemophilia performed worse than predicted by the Pihno equation, although the range was wide. Standardised ISWT, and not ISWT distance alone, was significantly associated with forced expiratory volume in 1 s in CYP with CF. Standardised ISWT in CYP with haemophilia was slightly associated with haemophilia joint health score, but this was not significant. CONCLUSIONS ISWT performance may be useful in a clinic to identify those with worsening disease, but only when performance is standardised against a healthy reference population. The development of validated global reference equations is necessary for more robust assessment.
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Affiliation(s)
- Nicole Filipow
- Physiotherapy, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Melanie Bladen
- Physiotherapy, Great Ormond Street Institute of Child Health, University College London, London, UK
- Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Emma Raywood
- Physiotherapy, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Elisabeth Robinson
- Physiotherapy, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Deepti Chugh
- Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Helen Douglas
- Physiotherapy, Great Ormond Street Institute of Child Health, University College London, London, UK
- Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nikki Thorpe
- Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rachel O'Connor
- Paediatric Cystic Fibrosis Centre, Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Nicky Murray
- Paediatric Physiotherapy, Royal Brompton Hospital, London, UK
| | - Eleanor Main
- Physiotherapy, Great Ormond Street Institute of Child Health, University College London, London, UK
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Bladen M, Alderson L, Thorpe N, Cortina-Borja M, Main E. Performance on the iSTEP and 10 m-ISWT in boys with haemophilia. Haemophilia 2023; 29:1343-1350. [PMID: 37572336 DOI: 10.1111/hae.14833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION Boys with haemophilia (BwH) have improved health outcomes. Measures of physical function in haemophilia are not challenging or sensitive enough to reflect physical limitations or guide rehabilitation. To identify meaningful tests, we aimed to: evaluate the performance of BwH on two physical performance measures: iSTEP and 10 m-ISWT; identify factors which predict performance and compare BwH to their unaffected peers. METHODS BwH completed both iSTEP and 10 m-ISWT. Disease severity, age, BMI, HJHS, lower limb muscle torque, time spent in moderate to vigorous physical activity, sedentary time, were included as factors to predict performance. Results were compared to unaffected peers. RESULTS 43 boys median age 10 (10 mild/moderate, 26 severe, 7 inhibitors) were recruited. BwH were less likely to complete the iSTEP and performed less well on the 10 m-ISWT than age matched peers. Ceiling effects were apparent for iSTEP, but not the 10 m-ISWT test. Age was the only significant predictor for performance in the iSTEP, with older boys being more likely to achieve a higher level or complete the test. Greater age, lower BMI, milder disease severity and more time spent in MVPA all predicted better performance on the 10 m-ISWT, with BMI and habitual physical activity a potential rehabilitation focus for underperforming individuals. HJHS and muscle strength did not predict performance on either test. CONCLUSION Despite the space need to conduct the 10 m-ISWT, it appears to be a superior performance measure than the iSTEP in BwH and provides clinically meaningful information, which can be interpreted using age-specific normative reference equations.
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Affiliation(s)
- Melanie Bladen
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Institute of Child Health, University College, London, UK
| | - Lucy Alderson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nicola Thorpe
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Eleanor Main
- Institute of Child Health, University College, London, UK
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Silva JLD, Soares BA, Silva JC, Blum PB, Reimberg MM, Corso SD, Lanza FC. Functional capacity and quality of life in children and adolescents with sickle cell anemia. Pediatr Pulmonol 2023; 58:1100-1105. [PMID: 36593732 DOI: 10.1002/ppul.26300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/16/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the functional and exercise capacity, lung function, quality of life of children and adolescents with sickle cell anemia (SCA HbSS) and to test the reproducibility of functional capacity tests in this population. METHOD Cross-sectional study with volunteers with SCA Hb-SS (SCAG), aged 6-18 years matched in age and gender to the control group (CG) with healthy individuals. Spirometry, 5-repetition sit-to-stand test (5STS-test), modified shuttle test (MST), and Pediatric Quality of Life Questionnaire (PedsQL) were performed. The reproducibility of 5STS-test and MST was evaluated: RESULTS: Forty eight volunteers of SCAG and 48 of CG were evaluated. Lung function of SCAG (FVC: 92 ± 15% pred.; FEV1 /FVC: 84 ± 8% pred.) was worse than the CG (104 ± 15% pred.; FEV1 /FVC: 90 ± 6% pred.) p < 0.05. SCAG had worse functional capacity registered by distance walked: 576 m (515-672 m) and 5STS-test: 8 s (7.4-8.9 s) compared with the CG who showed distance walked: 1010 m (887-1219 m) and 5STS-test: 7 s (7.0-8.1 s), p < 0.001. SCAG had worse quality of life compared to CG, p < 0.05. The reproducibility of MST (ICC 0.99 (0.98-0.99 IC-95%)) and 5STS-test (ICC 0.80 (0.69-0.88) was considered good, p < 0.001. CONCLUSION Children and adolescents with sickle cell anemia presented worse capacity to walk or run, and to perform sit-to-stand test when compared with their control peers. Additionally, they have poorer quality of life. The MST and 5STS-test showed good reproducibility to be applied in pediatric individuals with SCA.
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Affiliation(s)
| | - Bruno A Soares
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Jaksoel C Silva
- University Nove de Julho, UNINOVE, Sao Paulo, Sao Paulo, Brazil
| | - Patrícia B Blum
- Darcy Vargas Children's Hospital, Sao Paulo, Sao Paulo, Brazil
| | | | | | - Fernanda C Lanza
- University Nove de Julho, UNINOVE, Sao Paulo, Sao Paulo, Brazil.,Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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Chugh D, Thorpe N, Alderson L, Main E, Bladen M. Reliability of the submaximal iSTEP performance test in children with haemophilia. Haemophilia 2021; 28:e5-e8. [PMID: 34652869 DOI: 10.1111/hae.14436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Deepti Chugh
- Haemophilia Centre, Great Ormond Street Hospital for Children, London, UK
| | - Nicola Thorpe
- Haemophilia Centre, Great Ormond Street Hospital for Children, London, UK.,Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Lucy Alderson
- Haemophilia Centre, Great Ormond Street Hospital for Children, London, UK
| | - Eleanor Main
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Melanie Bladen
- Haemophilia Centre, Great Ormond Street Hospital for Children, London, UK.,Great Ormond Street Institute of Child Health, University College London, London, UK
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