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Sánchez-Rodríguez E, Roman-Juan J, Castarlenas E, Solé E, Jensen MP, Miró J. The Silhouettes Fatigue Scale: further validation in Spanish-speaking university students and adults with chronic pain. Disabil Rehabil 2024:1-6. [PMID: 38529680 DOI: 10.1080/09638288.2024.2331080] [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: 11/14/2023] [Accepted: 03/11/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE The aim of this study was to evaluate the psychometric properties of the Silhouettes Fatigue Scale (SFS) when used to assess fatigue in undergraduates and middle-aged adults with chronic pain. MATERIALS AND METHODS A total of 426 undergraduates and 207 middle-aged individuals with chronic pain participated in this study. Participants were asked to respond to a survey including the SFS as well as another validated measure of fatigue, questionnaires about pain catastrophizing and pain interference, and questions about pain (i.e., location, duration, and intensity). Convergent, discriminant, criterion and known-groups validity were evaluated. RESULTS Convergent validity was supported by a strong association between the two scales measuring fatigue. Discriminant validity was supported by stronger associations between the two fatigue scales scores compared to those between the SFS and pain catastrophizing scores. Criterion validity was supported by moderate associations between the SFS and measures of pain intensity and pain interference. Finally, known-groups validity was supported by significant differences in the SFS scores between students without chronic pain, students with chronic pain, and middle-aged individuals with chronic pain. CONCLUSIONS The findings support the validity of the SFS scores when used to assess fatigue in undergraduates and middle-aged adults with chronic pain.
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Affiliation(s)
- Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
| | - Josep Roman-Juan
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
| | - Elena Castarlenas
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
| | - Ester Solé
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of WA, Seattle, WA, USA
| | - Jordi Miró
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
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King JP, Chung JR, Donahue JG, Martin ET, Leis AM, Monto AS, Gaglani M, Dunnigan K, Raiyani C, Saydah S, Flannery B, Belongia EA. Post-recovery health domain scores among outpatients by SARS-CoV-2 testing status during the pre-Delta period. BMC Infect Dis 2024; 24:300. [PMID: 38454352 PMCID: PMC10921777 DOI: 10.1186/s12879-024-09108-3] [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: 10/24/2023] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Symptoms of COVID-19 including fatigue and dyspnea, may persist for weeks to months after SARS-CoV-2 infection. This study compared self-reported disability among SARS-CoV-2-positive and negative persons with mild to moderate COVID-19-like illness who presented for outpatient care before widespread COVID-19 vaccination. METHODS Unvaccinated adults with COVID-19-like illness enrolled within 10 days of illness onset at three US Flu Vaccine Effectiveness Network sites were tested for SARS-CoV-2 by molecular assay. Enrollees completed an enrollment questionnaire and two follow-up surveys (7-24 days and 2-7 months after illness onset) online or by phone to assess illness characteristics and health status. The second follow-up survey included questions measuring global health, physical function, fatigue, and dyspnea. Scores in the four domains were compared by participants' SARS-CoV-2 test results in univariate analysis and multivariable Gamma regression. RESULTS During September 22, 2020 - February 13, 2021, 2712 eligible adults were enrolled, 1541 completed the first follow-up survey, and 650 completed the second follow-up survey. SARS-CoV-2-positive participants were more likely to report fever at acute illness but were otherwise comparable to SARS-CoV-2-negative participants. At first follow-up, SARS-CoV-2-positive participants were less likely to have reported fully or mostly recovered from their illness compared to SARS-CoV-2-negative participants. At second follow-up, no differences by SARS-CoV-2 test results were detected in the four domains in the multivariable model. CONCLUSION Self-reported disability was similar among outpatient SARS-CoV-2-positive and -negative adults 2-7 months after illness onset.
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Affiliation(s)
- Jennifer P King
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue ML2, Marshfield, WI, 54449, USA.
| | - Jessie R Chung
- Influenza Division, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop H24-7, Atlanta, GA, 30329, USA.
| | - James G Donahue
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue ML2, Marshfield, WI, 54449, USA
| | - Emily T Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Aleda M Leis
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Arnold S Monto
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, TX, USA
- Texas A&M University College of Medicine, Temple, TX, USA
| | - Kayan Dunnigan
- Baylor Scott & White Research Institute, Temple, TX, USA
| | | | - Sharon Saydah
- Coronavirus and Other Respiratory Viruses Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brendan Flannery
- Influenza Division, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop H24-7, Atlanta, GA, 30329, USA
| | - Edward A Belongia
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue ML2, Marshfield, WI, 54449, USA
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Knoop V, Mathot E, Louter F, Beckwee D, Mikton C, Diaz T, Amuthavalli Thiyagarajan J, Bautmans I. Measurement properties of instruments to measure the fatigue domain of vitality capacity in community-dwelling older people: an umbrella review of systematic reviews and meta-analysis. Age Ageing 2023; 52:iv26-iv43. [PMID: 37902527 PMCID: PMC10615047 DOI: 10.1093/ageing/afad140] [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: 03/01/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Vitality capacity (VC) is a key domain of intrinsic capacity (IC) and is the underlying biophysiological aspect of IC. Energy and metabolism (E&M) is one of the domains of VC. Fatigue is one of the main characteristics of E&M. OBJECTIVE The aims of this umbrella review are (i) to identify the available instruments suitable for measuring fatigue in community-dwelling older adults and (ii) to critically review the measurement properties of the identified instruments. DESIGN Umbrella review. SETTING Healthcare. SUBJECTS Community-dwelling older adults. METHODS PubMed and Web of Knowledge were systematically screened for systematic reviews and meta-analysis reporting on fatigue instruments resulting in 2,263 articles (last search 5 December 2022). The COSMIN checklist was used to appraise psychometric properties and the AMSTAR for assessing methodological quality. Data on fatigue instruments, construct, reference period, assessment method, validated population, reliability, validity, responsiveness and predictive validity on negative health outcomes were extracted. RESULTS 10 systematic reviews and 1 meta-analysis were included in this study. 70 fatigue instruments were identified in the literature and 21 were originally designed for fatigue. The Fatigue Severity Scale (FSS), Pittsburgh Fatigability Scale (PFS) and Visual Analogue scale (VAS-F), Fatigue Impact Scale (FIS) and the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) presented good psychometric properties. CONCLUSIONS The FSS, FIS, FACIT-F, PFS and the VAS-F presented good psychometric properties in various conditions. Therefore, these instruments could be used to quantify trajectories in the domain E&M in the context of VC in community-dwelling older adults.
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Affiliation(s)
- Veerle Knoop
- Gerontology Department, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- SOMT University of Physiotherapy, Amersfoort, The Netherlands
| | - Emelyn Mathot
- Gerontology Department, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Francis Louter
- Gerontology Department, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - David Beckwee
- Gerontology Department, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Christopher Mikton
- Demographic Change and Healthy Aging Unit, Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Theresa Diaz
- Epidemiology, Monitoring and Evaluation Units, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO HQ, Geneva, Switzerland
| | | | - Ivan Bautmans
- Gerontology Department, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- SOMT University of Physiotherapy, Amersfoort, The Netherlands
- Department of Geriatrics, Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium
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Teuwen MMH, Knaapen IRE, Vliet Vlieland TPM, Schoones JW, van den Ende CHM, van Weely SFE, Gademan MGJ. The use of PROMIS measures in clinical studies in patients with inflammatory arthritis: a systematic review. Qual Life Res 2023; 32:2731-2749. [PMID: 37103773 PMCID: PMC10474175 DOI: 10.1007/s11136-023-03422-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Although the use of Patient-Reported Outcomes Measurement Information System (PROMIS) measures is widely advocated, little is known on their use in patients with inflammatory arthritis. We systematically describe the use and outcomes of PROMIS measures in clinical studies involving people with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA). METHODS A systematic review was conducted according to the PRISMA guidelines. Through a systematic search of nine electronic databases, clinical studies including patients with RA or axSpA and reporting the use of PROMIS measure were selected. Study characteristics, details of PROMIS measures and their outcomes, if available, were extracted. RESULTS In total, 29 studies described in 40 articles met the inclusion criteria, of which 25 studies included RA patients, three studies included axSpA patients and one study included both RA and axSpA patients. The use of two general PROMIS measures (PROMIS Global Health, PROMIS-29) and 13 different domain-specific PROMIS measures was reported, of which the PROMIS Pain Interference (n = 17), Physical Function (n = 14), Fatigue (n = 13), and Depression (n = 12) measures were most frequently used. Twenty-one studies reported their results in terms of T-scores. Most T-scores were worse than the general population mean, indicating impairments of health status. Eight studies did not report actual data but rather measurement properties of the PROMIS measures. CONCLUSION There was considerable variety regarding the different PROMIS measures used, with the PROMIS Pain interference, Physical function, Fatigue, and Depression measures being the most frequently used. In order to facilitate the comparisons across studies, more standardization of the selection of PROMIS measures is needed.
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Affiliation(s)
- M M H Teuwen
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center (LUMC), Albinusdreef 2, P.O.Box 9600, 2300 RC, Leiden, The Netherlands.
| | - I R E Knaapen
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center (LUMC), Albinusdreef 2, P.O.Box 9600, 2300 RC, Leiden, The Netherlands
| | - T P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center (LUMC), Albinusdreef 2, P.O.Box 9600, 2300 RC, Leiden, The Netherlands
| | - J W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - C H M van den Ende
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S F E van Weely
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center (LUMC), Albinusdreef 2, P.O.Box 9600, 2300 RC, Leiden, The Netherlands
| | - M G J Gademan
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center (LUMC), Albinusdreef 2, P.O.Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Ong AD, Wilcox KT, Moskowitz JT, Wethington E, Addington EL, Sanni MO, Kim P, Reid MC. Feasibility, Acceptability, and Preliminary Efficacy of a Positive Affect Skills Intervention for Adults With Fibromyalgia. Innov Aging 2023; 7:igad070. [PMID: 38094931 PMCID: PMC10714916 DOI: 10.1093/geroni/igad070] [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: 03/08/2023] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives To examine the feasibility, acceptability, and preliminary efficacy of a positive affect skills intervention for middle-aged and older adults with fibromyalgia syndrome (FMS). Research Design and Methods Ninety-five participants with FMS aged 50 and older (94% female) were randomized to 1 of 2 conditions: (a) Lessons in Affect Regulation to Keep Stress and Pain UndeR control (LARKSPUR; n = 49) or (b) emotion reporting/control (n = 46). LARKSPUR included 5 weeks of skill training that targeted 8 skills to help foster positive affect, including (a) noticing positive events, (b) savoring positive events, (c) identifying personal strengths, (d) behavioral activation to set and work toward attainable goals, (e) mindfulness, (f) positive reappraisal, (g) gratitude, and (h) acts of kindness. Outcome data were collected via online surveys at baseline, postintervention, and 1-month follow-up. Results Completion rates (88%) and satisfaction ratings (10-point scale) were high (LARKSPUR: M = 9.14, standard deviation (SD) = 1.49; control: M = 8.59, SD = 1.97). Improvements were greater in LARKSPUR participants compared with control participants on measures of positive affect (Cohen's d = 0.19 [0.15, 0.24]), negative affect (Cohen's d = -0.07 [-0.11, -0.02]), and pain catastrophizing (Cohen's d = -0.14 [-0.23, -0.05]). Improvements in positive affect (Cohen's d = 0.17 [0.13, 0.22]) and negative affect (Cohen's d = -0.11 [-0.15, -0.06]) were maintained at 1-month follow-up. Dose-response analyses indicated that intervention engagement significantly predicted pre-to-post and post-to-follow-up reductions in pain catastrophizing. Discussion and Implications The current preliminary findings add to existing literature and highlight the specific potential of internet-delivered positive affect skills programs for adults with FMS. Clinical Trial Registration NCT04869345.
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Affiliation(s)
- Anthony D Ong
- Department of Psychology, Cornell University, Ithaca, New York, USA
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York, USA
| | | | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elaine Wethington
- Department of Psychology, Cornell University, Ithaca, New York, USA
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Elizabeth L Addington
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mubarak O Sanni
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Patricia Kim
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - M Cary Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York, USA
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Murphy SL, Zick SM, Harris RE, Smith SN, Sen A, Alexander NB, Caldararo J, Roman P, Firsht E, Belancourt P, Maciasz R, Perzhinsky J, Mitchinson A, Krein SL. Self-administered acupressure for veterans with chronic back pain: Study design and methodology of a type 1 hybrid effectiveness implementation randomized controlled trial. Contemp Clin Trials 2023; 130:107232. [PMID: 37207810 PMCID: PMC11017920 DOI: 10.1016/j.cct.2023.107232] [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: 03/06/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Chronic low back pain is prevalent and disabling in Veterans, but effective pain management is challenging. Clinical practice guidelines emphasize multimodal pain management including evidence-based complementary and integrative health treatments such as acupressure as a first line of care. Unfortunately, the ability to replicate interventions, cost, resources, and limited access are implementation barriers. Self-administered acupressure has shown positive effects on pain and can be practiced anywhere with little to no side effects. METHODS/DESIGN The aims of this Type 1 hybrid effectiveness implementation randomized controlled trial are 1) to determine effectiveness of a self-administered acupressure protocol at improving pain interference and secondary outcomes of fatigue, sleep quality, and disability in 300 Veterans with chronic low back pain, and 2) evaluate implementation barriers and facilitators to scale-up acupressure utilization within Veterans Health Administration (VHA). Participants randomized to the intervention will receive instruction on acupressure application using an app that facilitates daily practice for 6 weeks. During weeks 6 through 10, participants will discontinue acupressure to determine sustainability of effects. Participants randomized to waitlist control will continue their usual care for pain management and receive study materials at the end of the study period. Outcomes will be collected at baseline and at 6- and 10-weeks post baseline. The primary outcome is pain interference, measured by the PROMIS pain interference scale. Using established frameworks and a mixed methods approach, we will evaluate intervention implementation. DISCUSSION If acupressure is effective, we will tailor strategies to support implementation in the VHA based on study findings. TRIAL REGISTRATION NUMBER NCT05423145.
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Affiliation(s)
- Susan L Murphy
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Suzanna M Zick
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, ISA, USA.
| | - Richard E Harris
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Susan Samueli Integrative Health Institute, School of Medicine, University of California at Irvine, Irvine, CA, USA.
| | - Shawna N Smith
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Neil B Alexander
- Department of Internal Medicine, Division of Geriatric Medicine, University of Michigan, Ann Arbor, MI, USA; VA Ann Arbor Healthcare System, Geriatric Research Education Clinical Center, Ann Arbor, MI, USA.
| | - Jennifer Caldararo
- VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA.
| | - Pia Roman
- VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA.
| | - Elizabeth Firsht
- VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA.
| | - Patrick Belancourt
- VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA.
| | - Rachael Maciasz
- VA Ann Arbor Healthcare System, Department of Ambulatory Care, Ann Arbor, MI, USA; Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Juliette Perzhinsky
- VA Ann Arbor Healthcare System, Department of Ambulatory Care, Ann Arbor, MI, USA.
| | - Allison Mitchinson
- VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA.
| | - Sarah L Krein
- VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, MI, USA.
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Dano S, Hussain J, Edwards N, Sun YI, Li M, Howell D, Peipert JD, Novak M, Bartlett SJ, Mucsi I. Assessing Fatigue in Patients Receiving Kidney Replacement Therapy Using PROMIS Computer Adaptive Testing. Am J Kidney Dis 2023; 82:33-42.e1. [PMID: 36906218 DOI: 10.1053/j.ajkd.2022.12.018] [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: 05/21/2022] [Accepted: 12/27/2022] [Indexed: 03/13/2023]
Abstract
RATIONALE & OBJECTIVE Fatigue is a debilitating symptom for many patients receiving kidney replacement therapy (KRT). Patient-reported outcome measures can help clinicians identify and manage fatigue efficiently. We assessed the measurement characteristics of the Patient Reported Outcome Measurement Information System (PROMIS)-Fatigue Computer Adaptive Test (PROMIS-F CAT) in patients receiving KRT using the previously validated Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS 198 adults treated with dialysis or recipients of a kidney transplant in Toronto, Canada. PREDICTORS Demographic data, FACIT-F scores, KRT type. OUTCOME Measurement properties of PROMIS-F CAT T scores. ANALYTICAL APPROACH Reliability and test-retest reliability were assessed using standard errors of measurement and intraclass correlation coefficient (ICC), respectively. Construct validity was assessed using correlation and comparisons across predefined groups expected to have different levels of fatigue. Receiver operating characteristic (ROC) curves were used to assess the discrimination of PROMIS-F CAT, with clinically relevant fatigue defined by a FACIT-F score of≤30. RESULTS Of the 198 participants, 57% were male, the mean±SD age was 57±14 years; 65% had received a kidney transplant. Based on the FACIT-F score, 47 patients (24%) had clinically relevant fatigue. PROMIS-F CAT and FACIT-F were strongly correlated (ρ =-0.80, P<0.001). PROMIS-F CAT had excellent reliability (>0.90 for 98% of sample), and good test-retest reliability (ICC=0.85). The ROC analysis demonstrated outstanding discrimination (area under ROC=0.93 [95%, CI 0.89-0.97]). A PROMIS-F CAT cutoff score of≥59 accurately identified most patients with clinically relevant fatigue (sensitivity=0.83; specificity=0.91). LIMITATIONS A convenience sample of clinically stable patients. FACIT-F items are a part of the PROMIS-F item bank, although there was minimal overlap with only 4 FACIT-F items completed in PROMIS-F CAT. CONCLUSIONS PROMIS-F CAT has robust measurement properties with low question burden to assess fatigue among patients with KRT.
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Affiliation(s)
- Sumaya Dano
- Ajmera Transplant Center and Division of Nephrology, University Health Network, Toronto, Ontario
| | - Junayd Hussain
- Ajmera Transplant Center and Division of Nephrology, University Health Network, Toronto, Ontario; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Nathaniel Edwards
- Ajmera Transplant Center and Division of Nephrology, University Health Network, Toronto, Ontario
| | - Yingji Irie Sun
- Ajmera Transplant Center and Division of Nephrology, University Health Network, Toronto, Ontario
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario
| | - Doris Howell
- Faculty of Nursing, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario
| | - John Devin Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University Chicago, Illinois
| | - Marta Novak
- Centre for Mental Health, University Health Network, Toronto, Ontario
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Center for Health Outcomes Research, Health Center, McGill University, Montreal, Quebec, Canada
| | - Istvan Mucsi
- Ajmera Transplant Center and Division of Nephrology, University Health Network, Toronto, Ontario.
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Bingham CO, Black S, Shiff NJ, Xu S, Langholff W, Curtis JR. Response to Treatment with Intravenous Golimumab or Infliximab in Rheumatoid Arthritis Patients: PROMIS Results from the Real-World Observational Phase 4 AWARE Study. Rheumatol Ther 2023; 10:659-678. [PMID: 36820983 PMCID: PMC10140242 DOI: 10.1007/s40744-023-00533-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/11/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION To assess changes in the Patient-Reported Outcomes Measurement Information System (PROMIS®) outcomes related to social, mental, and physical well-being after approximately 1 year of intravenous (IV) golimumab or infliximab treatment in patients with rheumatoid arthritis (RA) using real-world evidence from AWARE. METHODS AWARE was a prospective, noninterventional, multicenter, observational, U.S.-based phase 4 study of 1270 RA patients who initiated treatment with IV golimumab or infliximab. PROMIS-29 and PROMIS short form (SF) Fatigue 7a and Pain Interference 6b questionnaires were administered at baseline and infusions 2, 5, and 8 (approximately weeks 4, 28, and 52 for IV golimumab and weeks 2, 22, and 46 for infliximab). Mean changes from baseline in all PROMIS-29 domains and respective SFs and response rates for achieving ≥ 3, ≥ 5, or ≥ 10-point improvements were determined. RESULTS Among all patients, baseline mean ± SD PROMIS T-scores were consistent between treatment groups and indicated worse physical function (38.2 ± 6.8 IV golimumab, 38.0 ± 6.9 infliximab), more pain interference (63.0 ± 7.6 IV golimumab, 63.9 ± 7.8 infliximab), and greater fatigue (58.4 ± 9.9 IV golimumab, 59.4 ± 10.0 infliximab) in these patients vs the general U.S. population (T-score = 50). Through the 8th infusion of either treatment, IV golimumab- and infliximab-treated patients achieved meaningful improvements (≥ 3-point improvement in T-scores) in all PROMIS-29 domains and respective SFs, and the proportions of patients with ≥ 3, ≥ 5, or ≥ 10-point improvements in T-scores increased from infusion 2 through infusion 8. CONCLUSIONS RA patients treated with IV golimumab or infliximab achieved comparable improvements across social, mental, and physical well-being PROMIS measures. Additionally, PROMIS detected meaningful clinical changes in patient-reported outcomes in both treatment groups. CLINICALTRIALS GOV REGISTRATION NUMBER NCT02728934.
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Affiliation(s)
- Clifton O Bingham
- Johns Hopkins Division of Rheumatology, Johns Hopkins University, 5200 Eastern Ave, MFL Center Tower, Room 434A, Baltimore, MD, 21224, USA.
| | - Shawn Black
- Department of Immunology, Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Natalie J Shiff
- Department of Immunology, Janssen Scientific Affairs, LLC, Horsham, PA, USA.,Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Stephen Xu
- Department of Biostatistics, Janssen Research & Development, Spring House, PA, USA
| | - Wayne Langholff
- Department of Biostatistics, Janssen Research & Development, Spring House, PA, USA
| | - Jeffrey R Curtis
- Department of Medicine, Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
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Weinhold KR, Light S, Bittoni AM, Zick S, Orchard TS. A remote Whole Food Dietary Intervention to Reduce Fatigue and Improve Diet Quality in Lymphoma Survivors: Results of a Feasibility Pilot Study. Nutr Cancer 2023; 75:937-947. [PMID: 36755357 DOI: 10.1080/01635581.2023.2173259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Long-term, persistent cancer-related fatigue (CRF) is the most common side effect reported by lymphoma survivors. CRF reduces quality of life, and treatments are limited. This pilot study aimed to determine feasibility of recruiting and retaining diffuse large B-cell lymphoma (DLBCL) survivors in a 12-week remote Fatigue Reduction Diet (FRD) intervention and evaluate preliminary efficacy of the intervention. Participants met remotely with a registered dietitian nutritionist for eight individual sessions. FRD goals included consuming specific fruits, vegetables, whole grains, and omega-3 fatty acid rich foods. Acceptability was assessed by session attendance, FRD goal attainment, and exit surveys. Self-reported dietary intake and fatigue were measured using the Healthy Eating Index-2015 and PROMIS Fatigue Short Form, respectively, at baseline and post-intervention. Ten DLBCL survivors enrolled; nine attended all sessions and completed the intervention. Weekly adherence to targeted food intake goals improved significantly throughout the study (all p < 0.05), with participants meeting goals over 4 day per week by week 11. Mean[SD] diet quality improved significantly from baseline (65.9[6.3]) to post-intervention (82.2[5.0], p < 0.001). Mean[SD] fatigue reduced significantly from baseline (50.41[9.18]) to post-intervention (45.79[6.97], p < 0.05). The 12-week remote FRD intervention was feasible, acceptable, and holds promise to improve diet quality and fatigue in DLBCL survivors.
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Affiliation(s)
- Kellie R Weinhold
- Human Sciences Department, The Ohio State University, Columbus, Ohio, USA
| | - Sarah Light
- Human Sciences Department, The Ohio State University, Columbus, Ohio, USA
| | - Anna Maria Bittoni
- Department of Nutrition Services, The Ohio State University Wexner Medical Center and Arthur G. James Cancer hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
| | - Suzanna Zick
- Department of Family Medicine and Nutritional Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Tonya S Orchard
- Human Sciences Department, The Ohio State University, Columbus, Ohio, USA
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10
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Curtis JR, Su Y, Black S, Xu S, Langholff W, Bingham CO, Kafka S, Xie F. Machine Learning Applied to Patient-Reported Outcomes to Classify Physician-Derived Measures of Rheumatoid Arthritis Disease Activity. ACR Open Rheumatol 2022; 4:995-1003. [PMID: 36220128 DOI: 10.1002/acr2.11499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Patient-reported outcome (PRO) data have assumed increasing importance in the care of patients with rheumatoid arthritis (RA), yet physician-derived disease activity measures, such as Clinical Disease Activity Index (CDAI), remain the most accepted metrics to assess disease activity. The possibility that newer longitudinal PRO data might be used as a proxy for the CDAI has not been evaluated. METHODS Using data from a large pragmatic trial, we evaluated patients with RA initiating golimumab intravenous or infliximab. The classification target was low disease activity (LDA) (CDAI ≤10) at the first visit between months 3 and 12. Data were randomly partitioned into training (80%) and test (20%) data sets. Multiple machine learning (ML) methods (eg, random forests, gradient boosting, support vector machines) were used to classify CDAI disease activity category, conduct feature selection, and assess feature importance. Model performance evaluated cross-validated error, comparing different ML approaches using both training and test data. RESULTS A total of 494 patients were analyzed, and 36.4% achieved LDA. The most important classification features included several Patient-Reported Outcomes Measurement Information System measures (social participation, pain interference, pain intensity, and physical function), patient global, and baseline CDAI. Among all ML methods, random forests performed best. Overall model accuracy and positive predictive values for all ML methods were approximately 80%. CONCLUSION ML methods coupled with longitudinal PRO data appear useful and can achieve reasonable accuracy in classifying LDA among patients starting a new biologic. This approach has promise for real-world evidence generation in the common circumstance when physician-derived disease activity data are not available yet PRO measures are.
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Affiliation(s)
| | - Yujie Su
- University of Alabama at Birmingham
| | - Shawn Black
- Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Stephen Xu
- Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Wayne Langholff
- Janssen Research & Development, LLC, Spring House, Pennsylvania
| | | | - Shelly Kafka
- Janssen Research & Development, LLC, Spring House, Pennsylvania
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van Kalsbeek RJ, Korevaar JC, Rijken M, Haupt R, Muraca M, Kepák T, Kepakova K, Blondeel A, Boes S, Frederiksen LE, Essiaf S, Winther JF, Hermens RPMG, Kienesberger A, Loonen JJ, Michel G, Mulder RL, O'Brien KB, van der Pal HJH, Pluijm SMF, Roser K, Skinner R, Renard M, Uyttebroeck A, Follin C, Hjorth L, Kremer LCM. Evaluating the feasibility, effectiveness and costs of implementing person-centred follow-up care for childhood cancer survivors in four European countries: the PanCareFollowUp Care prospective cohort study protocol. BMJ Open 2022; 12:e063134. [PMID: 36396317 PMCID: PMC9677022 DOI: 10.1136/bmjopen-2022-063134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Long-term survival after childhood cancer often comes at the expense of late, adverse health conditions. However, survivorship care is frequently not available for adult survivors in Europe. The PanCareFollowUp Consortium therefore developed the PanCareFollowUp Care Intervention, an innovative person-centred survivorship care model based on experiences in the Netherlands. This paper describes the protocol of the prospective cohort study (Care Study) to evaluate the feasibility and the health economic, clinical and patient-reported outcomes of implementing PanCareFollowUp Care as usual care in four European countries. METHODS AND ANALYSIS In this prospective, longitudinal cohort study with at least 6 months of follow-up, 800 childhood cancer survivors will receive the PanCareFollowUp Care Intervention across four study sites in Belgium, Czech Republic, Italy and Sweden, representing different healthcare systems. The PanCareFollowUp Care Intervention will be evaluated according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Clinical and research data are collected through questionnaires, a clinic visit for multiple medical assessments and a follow-up call. The primary outcome is empowerment, assessed with the Health Education Impact Questionnaire. A central data centre will perform quality checks, data cleaning and data validation, and provide support in data analysis. Multilevel models will be used for repeated outcome measures, with subgroup analysis, for example, by study site, attained age, sex or diagnosis. ETHICS AND DISSEMINATION This study will be conducted in accordance with the guidelines of Good Clinical Practice and the Declaration of Helsinki. The study protocol has been reviewed and approved by all relevant ethics committees. The evidence and insights gained by this study will be summarised in a Replication Manual, also including the tools required to implement the PanCareFollowUp Care Intervention in other countries. This Replication Manual will become freely available through PanCare and will be disseminated through policy and press releases. TRIAL REGISTRATION NUMBER Netherlands Trial Register (NL8918; https://www.trialregister.nl/trial/8918).
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Affiliation(s)
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Mieke Rijken
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Health and Social Care Management, University of Eastern Finland-Kuopio Campus, Kuopio, Finland
| | - Riccardo Haupt
- DOPO Clinic, Department of Hematology/Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Monica Muraca
- DOPO Clinic, Department of Hematology/Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Tomáš Kepák
- International Clinical Research Centre (FNUSA-ICRC) at St Anne's University Hospital, Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - Katerina Kepakova
- International Clinical Research Centre (FNUSA-ICRC) at St Anne's University Hospital, Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - Anne Blondeel
- European Society for Pediatric Oncology (SIOP Europe), Brussels, Belgium
| | - Stefan Boes
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Line E Frederiksen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Samira Essiaf
- European Society for Pediatric Oncology (SIOP Europe), Brussels, Belgium
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine and Faculty of Health, Aarhus Universitet, Aarhus, Denmark
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboudumc, Nijmegen, The Netherlands
| | | | | | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Renée L Mulder
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Helena J H van der Pal
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- PanCare, Bussum, The Netherlands
| | - Saskia M F Pluijm
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Roderick Skinner
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
- Royal Victoria Infirmary, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Marleen Renard
- Department of Paediatric Haematology and Oncology, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Paediatric Haematology and Oncology, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Cecilia Follin
- Department of Clinical Sciences Lund, Oncology, Lund University, Skane University Hospital, Lund, Sweden
| | - Lars Hjorth
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skane University Hospital, Lund, Sweden
| | - Leontien C M Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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12
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Kozłowska KA, Formanowicz D, Bączyk G. The Link between the Demographic and Clinical Factors and Fatigue Symptoms among Rheumatoid Arthritis Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14681. [PMID: 36429400 PMCID: PMC9690362 DOI: 10.3390/ijerph192214681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 06/16/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic systemic disease of connective tissue with periods of exacerbation and remission. Fatigue is excessive strain throughout the body that is disproportionate or unrelated to an activity or lifestyle. Fatigue is an integral part of RA in most patients. The study aimed to assess the level of fatigue in RA patients and establish the relationship between fatigue and demographic and clinical factors. The study group consisted of 128 RA patients according to European League Against Rheumatism (EULAR) criteria. The Functional Assessment of Chronic Illness Therapy-Fatigue and -Medical Outcomes Study Short Form 36 (SF-36) vitality scores were used to assess the severity of fatigue symptoms. The analyzed variables were gender, age, disease duration, education, marital status, place of residence, work and residence status, pharmacological treatment, pain, morning stiffness, hemoglobin, C-reactive protein (CRP), rheumatoid factor (RF), compression soreness, Richie Articular Index, and DAS28 disease activity. The examined patients experience chronic fatigue-the mean value on the FACIT-F scale was 24.1 ± 9.1 points and on the SF-36 Vitality score was 14.2 ± 1.8 points. There is a relationship between the level of fatigue and pain, long-lasting morning stiffness, active disease, increased soreness of joints, and low hemoglobin values. When analyzing the symptom of fatigue, each patient should be approached individually, using the existing questionnaires or asking key questions to recognize the situation. The presence of fatigue symptoms should be considered during therapy and patient care by searching for and eliminating additional, intensifying stimuli and increasing its level.
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Affiliation(s)
| | - Dorota Formanowicz
- Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Grażyna Bączyk
- Department of Nursing Practices, Poznan University of Medical Sciences, 61-701 Poznan, Poland
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13
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Solomon DH, Dalal AK, Landman AB, Santacroce L, Altwies H, Stratton J, Rudin RS. Development and Testing of an Electronic Health
Record‐Integrated Patient‐Reported
Outcome Application and Intervention to Improve Efficiency of Rheumatoid Arthritis Care. ACR Open Rheumatol 2022; 4:964-973. [PMID: 36099161 PMCID: PMC9661861 DOI: 10.1002/acr2.11498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Many patients with rheumatoid arthritis (RA) have difficulty finding clinicians to treat them because of workforce shortages. We developed an app to address this problem by improving care efficiency. The app collects patient‐reported outcomes (PROs) and can be used to inform visit timing, potentially reducing the volume of low‐value visits. We describe the development process, intervention design, and planned study for testing the app. Methods We employed user‐centered design, interviewing patients and clinicians, to develop the app. To improve visit efficiency, symptom tracking logic alerts clinicians to PRO trends: worsening PROs generate alerts suggesting an earlier visit, and stable or improving PROs generate notifications that scheduled visits could be delayed. An interrupted time‐series analysis with a nonrandomized control population will allow assessment of the impact of the app on visit frequency. Results Patient interviews identified several of the following needs for effective app and intervention design: the importance of a simple user interface facilitating rapid answering of PROs, the availability of condensed summary information with links to more in‐depth answers to common questions regarding RA, and the need for clinicians to discuss the PRO data during visits with patients. Clinician interviews identified the following user needs: PRO data must be easy to view and use during the clinical workflow, and there should be reduced interval visits when PROs are trending worse. Some clinicians believed visits could be delayed for patients with stable PROs, whereas others raised concerns. Conclusion PRO apps may improve care efficiency in rheumatology. Formal evaluation of an integrated PRO RA app is forthcoming.
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14
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A comparison of the measurement properties of the PROMIS Fatigue (MS) 8a against legacy fatigue questionnaires. Mult Scler Relat Disord 2022; 66:104048. [PMID: 35905689 DOI: 10.1016/j.msard.2022.104048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/11/2022] [Accepted: 07/08/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Amidst the growing number of patient-reported outcome (PRO) measures of fatigue being used in multiple sclerosis (MS) clinical trials and clinics, evidence-based consensus on the most appropriate and generalizable measures across different settings would be beneficial for clinical research and patient care. The objective of this research was to compare the validity and responsiveness of scores from the PROMIS Fatigue (MS) 8a with those of the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS), across US and UK MS populations. METHODS Two observational studies were performed in MS populations as part of a PRO measure development project, including a cross-sectional study in two tertiary US MS centers (n = 340) and a 96-week longitudinal study in the UK MS Register cohort (n = 352). In post-hoc analyses, we examined relative validity, based on ability to discriminate across patient groups with different fatigue levels or functional status at baseline (i.e., ANOVA-F PROX ÷ ANOVA-F PROMIS (MS) 8a), and relative responsiveness, based on baseline-to-Week-52 score change (effect sizes) across fatigue or functional status response groups . RESULTS Mean ± standard deviation (SD) age was 44.6 ± 11.3/50.0 ± 9.7; and 72.9%/77.3% were female (US/UK samples). The mean PROMIS Fatigue (MS) 8a T-score ± SD at baseline was 57.7 ± 10.5/58.9 ± 9.3 (US/UK samples). Compared with the PROMIS Fatigue (MS) 8a, relative validity (anchor: Global Health Score [GHS] fatigue global question) was 85% for MFIS symptom score, 48% for MFIS total score, and 44% for the FSS. Relative to the FSS, PROMIS Fatigue (MS) 8a scores were more sensitive to worsening (effect size = -0.43 versus -0.18) as well as improvement (effect size = 0.5 versus 0.2) in fatigue (≥1-point increase/decrease in GHS fatigue global question) over 52 weeks of follow-up. A similar pattern of score changes was observed based on a second anchor. CONCLUSION The PROMIS Fatigue (MS) 8a scores showed higher responsiveness to fatigue changes than those of the FSS. The PROMIS measure also had higher precision in differentiating levels of fatigue compared to the FSS, the MFIS physical, and MFIS total scores. These differences have practical implications for the application of these questionnaires in both clinical practice and research settings (e.g., sample size estimation in clinical trials).
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15
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Iaquinta FS, Grembiale RD, Mauro D, Pantano I, Naty S, Cosco C, Iacono D, Gaggiano E, Ruggiero A, Ciccia F, Doldo P, Spagnuolo R. Fatigue and Associated Factors in an Immune-Mediated Inflammatory Disease Population: A Cross-Sectional Study. J Clin Med 2022; 11:2455. [PMID: 35566580 PMCID: PMC9099976 DOI: 10.3390/jcm11092455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
Abstract
Fatigue is a main symptom of chronic diseases, including immune-mediated inflammatory diseases (IMIDs), such as inflammatory bowel disease (IBD) and inflammatory arthritis (IA); however, the pathophysiological mechanisms are not completely understood. The aim of this study was to assess the prevalence of fatigue and the associated factors in an IMIDs population. A control group, IBD, and IA patients, were enrolled. The PROMIS® fatigue questionnaire was used to evaluate the symptoms. Information on demographics, anthropometrics, disease characteristics, and medications was collected for each participant. A total of 471 subjects (137 with IBD, 103 with IA, and 206 controls) were enrolled. IBD and IA patients reported greater fatigue than controls (p < 0.001, each). In univariate regression, patients with anxiety and depression were more likely to report fatigue (p = 1.40 × 10−9 and p = 3.80 × 10−11, respectively). Males, holding a high school diploma, and being employed were inversely correlated to the domain (p = 1.3 × 10−5; p = 0.003 and p = 0.005, respectively). The use of steroids and disease activity determined increased fatigue (p = 0.014 and p = 0.019; respectively). In the multivariate analysis, anxiety and depression remained associated (p = 0.002 and p = 1.3 × 10−5, respectively). IMIDs patients present increased fatigue compared with healthy subjects. Anxiety and depression are the main associated factors, suggesting a psychological component of the symptom; thus, a holistic management should be established.
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Affiliation(s)
| | - Rosa Daniela Grembiale
- Department of Health Sciences, Magna Græcia University of Catanzaro, 88100 Catanzaro, Italy; (R.D.G.); (S.N.)
| | - Daniele Mauro
- Department of Precision Medicine, L. Vanvitelli University of Campania, 80131 Naples, Italy; (D.M.); (I.P.); (D.I.); (E.G.); (A.R.); (F.C.)
| | - Ilenia Pantano
- Department of Precision Medicine, L. Vanvitelli University of Campania, 80131 Naples, Italy; (D.M.); (I.P.); (D.I.); (E.G.); (A.R.); (F.C.)
| | - Saverio Naty
- Department of Health Sciences, Magna Græcia University of Catanzaro, 88100 Catanzaro, Italy; (R.D.G.); (S.N.)
| | - Cristina Cosco
- Department of Clinical and Experimental Medicine, Magna Græcia University of Catanzaro, 88100 Catanzaro, Italy; (C.C.); (P.D.); (R.S.)
| | - Daniela Iacono
- Department of Precision Medicine, L. Vanvitelli University of Campania, 80131 Naples, Italy; (D.M.); (I.P.); (D.I.); (E.G.); (A.R.); (F.C.)
| | - Emanuela Gaggiano
- Department of Precision Medicine, L. Vanvitelli University of Campania, 80131 Naples, Italy; (D.M.); (I.P.); (D.I.); (E.G.); (A.R.); (F.C.)
| | - Annarita Ruggiero
- Department of Precision Medicine, L. Vanvitelli University of Campania, 80131 Naples, Italy; (D.M.); (I.P.); (D.I.); (E.G.); (A.R.); (F.C.)
| | - Francesco Ciccia
- Department of Precision Medicine, L. Vanvitelli University of Campania, 80131 Naples, Italy; (D.M.); (I.P.); (D.I.); (E.G.); (A.R.); (F.C.)
| | - Patrizia Doldo
- Department of Clinical and Experimental Medicine, Magna Græcia University of Catanzaro, 88100 Catanzaro, Italy; (C.C.); (P.D.); (R.S.)
| | - Rocco Spagnuolo
- Department of Clinical and Experimental Medicine, Magna Græcia University of Catanzaro, 88100 Catanzaro, Italy; (C.C.); (P.D.); (R.S.)
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16
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Drenkard C, Easley K, Bao G, Dunlop-Thomas C, Lim SS, Brady T. Cross-sectional study of the effects of self-efficacy on fatigue and pain interference in black women with systemic lupus erythematosus: the role of depression, age and education. Lupus Sci Med 2022; 9:9/1/e000566. [PMID: 35149578 PMCID: PMC8845307 DOI: 10.1136/lupus-2021-000566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
Abstract
Objective While fatigue and pain are pervasive symptoms in SLE, self-efficacy can mitigate their intensity and impact on patients’ daily activity. We examined the relationships of these domains and their interactions with demographics and depression in black women with SLE. Methods This is a cross-sectional analysis of data collected among 699 black women with SLE. We used validated, self-reported measures of fatigue, pain interference, symptom self-efficacy, treatment self-efficacy and depression. Linear regression analyses were conducted to examine the relationships between each outcome (fatigue and pain interference) and each predictor (symptom self-efficacy and treatment self-efficacy), and the interaction of demographics and depression. Results We found inverse associations between fatigue and each of symptom self-efficacy (slope −0.556, p<0.001) and treatment self-efficacy (slope −0.282, p<0.001), as well as between pain interference and each of symptom self-efficacy (slope −0.394, p<0.001) and treatment self-efficacy (slope −0.152, p<0.001). After adjusting for confounders, symptom self-efficacy remained significantly associated with each outcome (adjusted slope −0.241 (p<0.001) and −0.103 (p=0.008) for fatigue and pain, respectively). The amount of decrease in fatigue and pain interference differed by depression severity (p<0.05 for the interaction of symptom self-efficacy and depression). The difference in fatigue by depression widened as symptom self-efficacy increased; the adjusted fatigue scores for moderate/severe depression compared with no depression were 6.8 and 8.7 points higher at mean and high symptom self-efficacy, respectively (p<0.001). Age and education significantly changed the relationship between outcomes and self-efficacy. Conclusions Symptom self-efficacy and treatment self-efficacy were inversely related to fatigue and pain interference in black women with SLE. Depression disproportionately increased the intensity of these outcomes. While older women with low symptom self-efficacy reported disproportionately higher pain interference, those with higher education and mean or high levels of symptom self-efficacy reported lower pain interference. These findings may help predict who might benefit most from self-efficacy-enhancing interventions.
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Affiliation(s)
- Cristina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA .,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Gaobin Bao
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charmayne Dunlop-Thomas
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Teresa Brady
- Clarity Consulting and Communications, Atlanta, Georgia, USA
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17
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Kuijlaars IAR, Teela L, van Vulpen LFD, Timmer MA, Coppens M, Gouw SC, Peters M, Kruip MJHA, Cnossen MH, Muis JJ, van Hoorn ES, Haverman L, Fischer K. Generic PROMIS item banks in adults with hemophilia for patient-reported outcome assessment: Feasibility, measurement properties, and relevance. Res Pract Thromb Haemost 2021; 5:e12621. [PMID: 34849449 PMCID: PMC8606028 DOI: 10.1002/rth2.12621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/02/2021] [Accepted: 10/13/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Legacy hemophilia-specific questionnaires are considered too long, show floor-/ceiling effects, and/or include irrelevant questions. Patient Reported Outcomes Measurement Information System (PROMIS) item banks, including Computer Adaptive Tests (CATs) and short forms, were designed for more efficient outcome assessment. OBJECTIVES Evaluate the feasibility, measurement properties, and relevance of seven PROMIS CATs and two short forms in patients with hemophilia. PATIENTS/METHODS In this cross-sectional study, Dutch adults with hemophilia completed nine PROMIS item banks electronically. Feasibility was assessed by number of items and floor/ceiling effects. Reliability was determined as the proportion of reliable scores (standard error ≤3.2). Construct validity was assessed by comparison with legacy instruments and expected differences between subgroups. Relevance of item banks was determined by proportions of limited scores. RESULTS Overall, 142 of 373 invited patients (mean age, 47 [range, 18-79], 49% severe hemophilia, 46% receiving prophylaxis) responded. Per CAT item bank, mean number of items answered varied from 5 (range, 3-12) to 9 (range, 5-12), with floor effects in pain interference (26% lowest scores) and depression (18% lowest scores). Construct validity and reliability were good for physical function, pain interference, satisfaction with social roles and activities, and fatigue. The CAT physical function showed the most limited scores (38%). The self-efficacy short forms showed ceiling effects (22%-28%) and no relation with the legacy instruments. CONCLUSIONS The PROMIS CATs physical function, pain interference, satisfaction with social roles and activities, and fatigue are feasible, reliable, and valid alternatives to legacy instruments for patients with hemophilia, with few items and low floor-/ceiling effects.
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Affiliation(s)
- Isolde A. R. Kuijlaars
- Van CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Lorynn Teela
- Amsterdam University Medical CentersEmma Children’s HospitalChild and Adolescent Psychiatry & Psychosocial CareAmsterdam Reproduction and DevelopmentAmsterdam Public HealthUniversity of AmsterdamAmsterdamThe Netherlands
| | - Lize F. D. van Vulpen
- Van CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Merel A. Timmer
- Van CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Michiel Coppens
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Samantha C. Gouw
- Emma Children’s HospitalAmsterdam University Medical CentersPediatric HematologyUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Marjolein Peters
- Emma Children’s HospitalAmsterdam University Medical CentersPediatric HematologyUniversity of AmsterdamAmsterdamThe Netherlands
| | - Marieke J. H. A. Kruip
- Erasmus MCDepartment of HematologyErasmus University Medical Center RotterdamRotterdamThe Netherlands
| | - Marjon H. Cnossen
- Erasmus MCDepartment of Pediatric HematologySophia Children’s HospitalErasmus University Medical Center RotterdamRotterdamThe Netherlands
| | - Jelmer J. Muis
- Amsterdam University Medical CentersEmma Children’s HospitalChild and Adolescent Psychiatry & Psychosocial CareAmsterdam Reproduction and DevelopmentAmsterdam Public HealthUniversity of AmsterdamAmsterdamThe Netherlands
- Emma Children’s HospitalAmsterdam University Medical CentersPediatric HematologyUniversity of AmsterdamAmsterdamThe Netherlands
| | - Evelien S. van Hoorn
- Erasmus MCDepartment of Public HealthErasmus University Medical Center RotterdamRotterdamThe Netherlands
| | - Lotte Haverman
- Amsterdam University Medical CentersEmma Children’s HospitalChild and Adolescent Psychiatry & Psychosocial CareAmsterdam Reproduction and DevelopmentAmsterdam Public HealthUniversity of AmsterdamAmsterdamThe Netherlands
| | - Kathelijn Fischer
- Van CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
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18
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Young HJ, Mehta T, Herman C, Baidwan NK, Lai B, Rimmer JH. The Effects of a Movement-to-Music (M2M) Intervention on Physical and Psychosocial Outcomes in People Poststroke: A Randomized Controlled Trial. Arch Rehabil Res Clin Transl 2021; 3:100160. [PMID: 34977542 PMCID: PMC8683867 DOI: 10.1016/j.arrct.2021.100160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the effects of a 12-week movement-to-music (M2M) intervention on physical and psychosocial outcomes in people poststroke. DESIGN Two-arm randomized controlled trial. SETTING A community-based fitness facility. PARTICIPANTS Participants (N=47) with stroke between 18 and 65 years old were randomized to M2M (n=23) or waitlist control (n=24). INTERVENTIONS Participants in M2M completed 3 60-minute exercise sessions per week for 12 weeks. Controls received biweekly educational newsletters via mail. MAIN OUTCOME MEASURES Primary outcomes included Six-Minute Walk Test (6MWT, in meters), Five Times Sit-to-Stand Test (FTSST, in seconds) and Timed Up and Go (TUG, in seconds). Secondary outcomes were self-reported measures using Patient-Reported Outcomes Measurement Information System Fatigue and Pain Interference Short Form 8a. Outcomes were collected at baseline and postintervention. Analyses involved descriptive statistics and adjusted linear mixed models. RESULTS Mixed models adjusted for the respective baseline values and demographic variables showed that M2M participants had longer 6MWT distance (least square mean difference [LSM], 14.5; 95% confidence interval [CI], -12.9 to 42.0), more FTSST time (LSM, 2.0; 95% CI, -4.5 to 8.5), and less fatigue (LSM, -3.0; 95% CI, -7.2 to 1.2) compared with controls postintervention. When controlling for baseline TUG and demographic variables, there was a larger increase in 6MWT distance (LSM, 37.9; 95% CI, -22.7 to 98.6), lower FTSST time (LSM, -6.1; 95% CI, -18.5 to 6.2), and decrease in fatigue (LSM, -6.5; 95% CI, -13.1 to 0.2) in the M2M group compared with controls. Moderate effect sizes were observed for improving 6MWT (d=0.6), FTSST (d=-0.6), and fatigue (d=-0.6). There was no group difference in change in TUG time and pain interference, with trivial effect sizes (d=-0.1). CONCLUSION M2M may be a valuable exercise form for adults with stroke. Future studies are needed to determine optimal exercise doses for improving health and function in this population.
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Key Words
- 6MWT, Six-Minute Walk Test
- AEs, adverse events
- BMI, body mass index
- CI, confidence interval
- Dance
- Exercise
- FTSST, Five Times Sit to Stand Test
- ICC, intraclass correlation coefficient
- LSM, least square means
- M2M, movement-to-music
- MCID, minimally clinically important difference
- PROMIS, Patient-Reported Outcomes Measurement Information System
- Physical performance
- Quality of life
- RPE, Rating of Perceived Exertion
- Rehabilitation
- Stroke
- TUG, Timed Up and Go
- WC, waitlist control
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Affiliation(s)
- Hui-Ju Young
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Tapan Mehta
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Cassandra Herman
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Navneet Kaur Baidwan
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Byron Lai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Division of Pediatric and Rehabilitation Medicine, School of University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - James H. Rimmer
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
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19
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Patient-Reported Nausea and Fatigue Related to Methotrexate: A Prospective, Self-Controlled Study in the ArthritisPower ® Registry. Rheumatol Ther 2021; 9:207-221. [PMID: 34843092 PMCID: PMC8628141 DOI: 10.1007/s40744-021-00398-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The magnitude and frequency of temporally related methotrexate (MTX)-associated side effects in rheumatoid arthritis (RA) or psoriatic arthritis (PsA) patients are difficult to quantify using traditional research methods. As proof of concept designed in part to implement digital data collection for remote patient monitoring, we conducted a study implementing self-controlled case series analytic methods to understand MTX-related symptoms in RA or PsA. Methods In study phase 1, adults with RA or PsA from the ArthritisPower® Registry (past or current oral MTX users) participated in a cross-sectional survey. In phase 2, current MTX users participated in a longitudinal study and completed the Patient-Reported Outcomes Measurement Information System (PROMIS®) 1-day nausea/vomiting and fatigue measure. Within-person change in PROMIS scores between risk (6–36 h post-dose) and control (96–144 h post-dose) windows were compared using mixed models. Results The baseline survey was completed by 671 participants (mean age: 54 years, 88% female, 92% white, 79% with RA). Among current MTX users (353/671 [53%]), most reported MTX-associated side effects (216/353 [61%]), most frequently fatigue (161/353 [46%]). Among phase 2 participants with (n = 39) and without (n = 84) baseline nausea, mean increase in PROMIS nausea was 5.1 units (P < 0.0001) and 0.7 units (P = 0.135), respectively; among those with (n = 51) and without (n = 72) baseline fatigue, mean increase in PROMIS fatigue was 3.9 units (P = 0.0003) and 0.4 units (P = 0.554), respectively. Conclusions Digital remote patient monitoring presents an opportunity to detect and address medication tolerability in real time. Using a novel study design to control for between-person confounding, the magnitude of nausea and fatigue experienced by participants with RA and PsA temporally related to weekly MTX use was substantial. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00398-6.
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20
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Miró J, Jensen MP, Ramírez-Maestre C, Esteve R, López-Martínez AE, de la Vega R. The Silhouettes Fatigue Scale: a validity study with individuals with physical disabilities and chronic pain. Disabil Rehabil 2021; 44:6408-6413. [PMID: 34403273 DOI: 10.1080/09638288.2021.1964621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Fatigue is known to interfere with function in individuals with physical disabilities. In order to monitor changes in fatigue over time and evaluate the efficacy of treatments, psychometrically sound measures of fatigue are needed. The aim of this work was to evaluate the validity of the Silhouettes Fatigue Scale with English instructions (SFS-EN) in a sample of adults with physical disabilities living in the USA. METHODS Individuals with medical conditions associated with physical disabilities responded to an online survey that included the SFS-EN as well as another validated measure of fatigue (PROMIS short form-4a Fatigue Scale), and measures of pain intensity and pain catastrophizing. RESULTS 523 individuals participated (mean age = 59.1 years; SD = 11.4). Most participants were Caucasian (89%), women (59%) and unemployed (71%). Results showed strong positive correlations between both measures of fatigue, supporting the convergent validity of the SFS-EN. In addition, the magnitude of this association was significantly greater than the association between the scores of the SFS-EN and the measures of pain intensity and pain catastrophizing, supporting the former's discriminant validity. CONCLUSIONS The findings extend previous results supporting the SFS as a brief, easy to administer and understand, and valid measure of fatigue.IMPLICATIONS FOR REHABILITATIONFatigue is common in adults with physical disabilities and chronic pain.The Silhouettes Fatigue Scale (SFS) is a new single-item measure of general fatigue.Findings show that the SFS with English instructions (SFS-EN) is an easy to understand measure.Results support the convergent and discriminant validity of the SFS-EN score in adults with physical disabilities and chronic pain.
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Affiliation(s)
- Jordi Miró
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Carretera de Valls, Tarragona, Spain.,Institut d'Investigació Sanitària Pere Virgili, Avda. de la Universitat, Reus, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Carmen Ramírez-Maestre
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Rosa Esteve
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Alicia E López-Martínez
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Rocío de la Vega
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
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21
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Fatigue in Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Comparison of Mechanisms, Measures and Management. J Clin Med 2021; 10:jcm10163566. [PMID: 34441861 PMCID: PMC8396818 DOI: 10.3390/jcm10163566] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022] Open
Abstract
Fatigue is a common constitutional feature of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). While the two diseases share a common mechanism of autoimmunity, they differ in their clinical manifestations and treatment. Fatigue is one of the most commonly reported symptoms in both groups, associated with pain, depression and anxiety, and affecting function, work and quality of life. Fatigue is not easy to assess or conceptualise. It can be linked to disease activity, although it is not always, and is challenging to treat. Several measures have been trialled in RA and SLE; however, none have been adopted into mainstream practice. Despite being a common symptom, fatigue remains poorly managed in both RA and SLE—more so in the latter, where there have been relatively fewer studies. Additionally, comorbidities contribute to fatigue, further complicating its management. Pain, depression and anxiety also need to be addressed, not as separate entities, but together with fatigue in a holistic manner. Here, we describe the similarities and differences between fatigue in patients with RA and SLE, discuss concepts and practices applicable to both conditions and identify areas for further research. Through this review, we aim to highlight the importance of the holistic management of fatigue in SLE.
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22
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Lee YC, Lu F, Colls J, Luo D, Wang P, Dunlop DD, Muhammad LN, Song J, Michaud K, Solomon DH. Outcomes of a Mobile App to Monitor Patient-Reported Outcomes in Rheumatoid Arthritis: A Randomized Controlled Trial. Arthritis Rheumatol 2021; 73:1421-1429. [PMID: 33559338 PMCID: PMC8330418 DOI: 10.1002/art.41686] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/04/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine the effects of a smartphone application (app) to monitor longitudinal electronic patient-reported outcomes (ePROs) on patient satisfaction and disease activity in patients with rheumatoid arthritis (RA). METHODS We conducted a 6-month randomized controlled trial of care coordination along with an app (intervention) versus care coordination alone (control) in 191 RA patients. Participants in the intervention group were prompted to provide information daily using ePROs. In both the intervention and control groups, a care coordinator contacted participants at 6 and 18 weeks to assess for flares. The main outcome measures were the global satisfaction score from the Treatment Satisfaction Questionnaire for Medication (TSQM), the score from the Perceived Efficacy in Patient-Physician Interactions (PEPPI) Questionnaire, and the Clinical Disease Activity Index (CDAI) score. RESULTS Groups were similar at baseline. The median TSQM score at 6 months was 83.3 in both groups, and the median PEPPI score at 6 months was 50 in both groups. The median CDAI score at 6 months was 8 in the intervention group versus 10 in the control group. No statistically significant group differences in the medians of TSQM, PEPPI, or CDAI scores at 6 months were detected. Of the 67 intervention participants who completed the exit survey, 90% rated their likelihood of recommending the app as ≥7 of 10. Of the 11 physicians who completed the exit survey, 73% agreed/strongly agreed that they wanted to continue offering the app to patients. CONCLUSION A mobile app designed to collect ePRO data on RA symptoms did not significantly improve patient satisfaction or disease activity compared to care coordination alone. However, both patients and physicians reported positive experiences with the app.
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Affiliation(s)
- Yvonne C. Lee
- Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Fengxin Lu
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Joshua Colls
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Dee Luo
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Penny Wang
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Dorothy D. Dunlop
- Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lutfiyya N. Muhammad
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jing Song
- Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kaleb Michaud
- Division of Rheumatology and Immunology, University of Nebraska, Omaha, NE, USA, & FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | - Daniel H. Solomon
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, USA
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23
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Kamudoni P, Johns J, Cook KF, Salem R, Salek S, Raab J, Middleton R, Henke C, Repovic P, Alschuler K, von Geldern G, Wundes A, Amtmann D. Standardizing fatigue measurement in multiple sclerosis: the validity, responsiveness and score interpretation of the PROMIS SF v1.0 - Fatigue (MS) 8a. Mult Scler Relat Disord 2021; 54:103117. [PMID: 34256350 DOI: 10.1016/j.msard.2021.103117] [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: 04/13/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Fatigue is one of the most common and the single most disabling symptom of multiple sclerosis (MS). However, there is a lack of consensus on the most appropriate fatigue measures in clinical practice and research, based upon rigorously validated, generalizable, and publicly available instruments. The objective of this research was to generate additional evidence regarding the validity and applicability of the PROMIS SF v1.0 - Fatigue (MS) 8a, including content validity, reliability, construct validity and responsiveness, as well as to assess minimal important difference (MID) estimates and a score interpretation tool to aide meaningful individual level score interpretation. METHODS A mixed-methods, sequential design was followed. Cognitive debriefing (CD) interviews (n=29) were performed with MS patients, to assess the relevance and comprehensiveness of the PROMIS Fatigue (MS) 8a scores. To evaluate the psychometric properties of the PROMIS Fatigue (MS) 8a, two observational studies were conducted: a cross-sectional study at two US MS centers (n=296), and a 96-week longitudinal study in a UK MS Register cohort (n=384). Main outcomes and measures were estimates of known-groups validity, convergence validity, reliability, and responsiveness, a guide for interpreting PROMIS Fatigue (MS) 8a T-scores, and anchor-based MID estimates. RESULTS The CD interviews confirmed the comprehensiveness and relevance of the PROMIS Fatigue (MS) 8a in assessing MS fatigue. Cronbach's alpha (>0.9) and intra-class correlation coefficient (≥0.9) for test-retest scores at 5-7 days follow-up, supported strong internal consistency and test-retest reliability. Hypothesized differences were found across patient groups in patient reported fatigue and related concepts (analysis of variance [ANOVA], P <0.001). PROMIS Fatigue (MS) 8a scores were sensitive to bi-directional changes in fatigue (GHS fatigue global question) and physical health (PROMIS GHS GPH), over a 52-week follow-up. Score changes of 3.4-4 points are proposed as MID criteria for minimal improvement or worsening in fatigue. CONCLUSION This research extends the evidence supporting the content validity and the robust psychometric performance of the PROMIS Fatigue (MS) 8a across US and UK MS populations. Importantly, data supporting the measure's integration in clinical practice and research, including meaningful score interpretation, are now available.
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Affiliation(s)
- Paul Kamudoni
- Global Evidence & Value Development, R&D, Merck Healthcare KGaA, Darmstadt, Germany.
| | | | | | - Rana Salem
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
| | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
| | - Jana Raab
- Global Evidence & Value Development, R&D, Merck Healthcare KGaA, Darmstadt, Germany.
| | - Rod Middleton
- UK MS Register, Swansea University Medical School, Swansea, UK.
| | - Christian Henke
- Global Evidence & Value Development, R&D, Merck Healthcare KGaA, Darmstadt, Germany.
| | | | - Kevin Alschuler
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; Department of Neurology, University of Washington, Seattle, WA, USA.
| | | | - Annette Wundes
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; Department of Neurology, University of Washington, Seattle, WA, USA.
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
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24
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Colls J, Lee YC, Xu C, Corrigan C, Lu F, Marquez-Grap G, Murray M, Suh DH, Solomon DH. Patient adherence with a smartphone app for patient-reported outcomes in rheumatoid arthritis. Rheumatology (Oxford) 2021; 60:108-112. [PMID: 32572490 DOI: 10.1093/rheumatology/keaa202] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/23/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Electronic patient-reported outcomes (ePROs) transmitted digitally allow patients to communicate with their clinicians and track the activity of chronic diseases, such as RA. Several ePRO smartphone apps have been developed in rheumatology, yet few data have been reported regarding patient adherence. We developed a PRO app for RA and assessed adherence over 6 months. METHODS We developed an app to deliver daily assessments to participants (RA App v.1.0). The app was tested as part of a randomized controlled trial examining potential clinical benefits. The current analyses focus on the adherence to the ePRO app for patients randomized to receive the app. We recruited RA patients from an academic rheumatology practice in the USA. Patients randomized to receive the app received daily notifications regarding ePROs. We examined adherence to the PRO questionnaires over the 6-month study and examined factors related to adherence. RESULTS Seventy-eight patients received the app and have data included in these analyses: 63 (80.7%) were female, mean age was 55.2 years, 71% had attended college or beyond, and the mean Clinical Disease Activity Index at baseline was 9.7 (low disease activity). Median adherence to the daily questions was 79% (interquartile range 48-90%). Significant predictors of increased adherence were age ≥65 (P = 0.03) and low baseline Clinical Disease Activity Index (P = 0.02). CONCLUSION We developed and tested an ePRO app for RA over a 6-month study. Adherence to the app was strong. There was correlation between older age and better disease control and increased adherence. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov/, NCT02822521.
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Affiliation(s)
- Josh Colls
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA
| | - Yvonne C Lee
- Division of Rheumatology, Northwestern University Medical Center, Chicago, IL, USA
| | - Chang Xu
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA
| | | | - Fengxin Lu
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA
| | | | - Meredith Murray
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA
| | - Dong H Suh
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA
| | - Daniel H Solomon
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA
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25
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Pope JE. Management of Fatigue in Rheumatoid Arthritis. RMD Open 2021; 6:rmdopen-2019-001084. [PMID: 32385141 PMCID: PMC7299512 DOI: 10.1136/rmdopen-2019-001084] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/04/2020] [Accepted: 04/09/2020] [Indexed: 12/31/2022] Open
Abstract
Fatigue in rheumatoid arthritis is highly prevalent. It is correlated only weakly with disease activity but more so with pain, mood, personality features, poor sleep, obesity and comorbidities. Fatigue can be measured by many standardised questionnaires and more easily with a Visual Analogue Scale or numeric rating scale. Most patients with RA have some fatigue, and at least one in six have severe fatigue. Chronic pain and depressed mood are also common in RA patients with significant fatigue. It affects function and quality of life and is worse on average in women. Evidence-based treatment for fatigue includes treatment of underlying disease activity (with on average modest improvement of fatigue), exercise programmes and supervised self-management programmes with cognitive-behavioural therapy, mindfulness and reinforcement (such as reminders). The specific programmes for exercise and behavioural interventions are not standardised. Some medications cause fatigue such as methotrexate. More research is needed to understand fatigue and how to treat this common complex symptom in RA that can be the worst symptom for some patients.
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Affiliation(s)
- Janet E Pope
- Medicine, Division Rheumatology, Western University, Ontario, Canada
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26
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Bingham CO, Butanis AL, Orbai AM, Jones M, Ruffing V, Lyddiatt A, Schrandt MS, Bykerk VP, Cook KF, Bartlett SJ. Patients and clinicians define symptom levels and meaningful change for PROMIS pain interference and fatigue in RA using bookmarking. Rheumatology (Oxford) 2021; 60:4306-4314. [PMID: 33471127 DOI: 10.1093/rheumatology/keab014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/30/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Using patient-reported outcomes to inform clinical decision-making depends on knowing how to interpret scores. Patient-Reported Outcome Measurement Information System® (PROMIS®) instruments are increasingly used in rheumatology research and care, but there is little information available to guide interpretation of scores. We sought to identify thresholds and meaningful change for PROMIS Pain Interference and Fatigue scores from the perspective of RA patients and clinicians. METHODS We developed patient vignettes using the PROMIS item banks representing a continuum of Pain Interference and Fatigue levels. During a series of face-to-face 'bookmarking' sessions, patients and clinicians identified thresholds for mild, moderate and severe levels of symptoms and identified change deemed meaningful for making treatment decisions. RESULTS In general, patients selected higher cut points to demarcate thresholds than clinicians. Patients and clinicians generally identified changes of 5-10 points as representing meaningful change. The thresholds and meaningful change scores of patients were grounded in their lived experiences having RA, approach to self-management, and the impacts on function, roles and social participation. CONCLUSION Results offer new information about how both patients and clinicians view RA symptoms and functional impacts. Results suggest that patients and providers may use different strategies to define and interpret RA symptoms, and select different thresholds when describing symptoms as mild, moderate or severe. The magnitude of symptom change selected by patients and clinicians as being clinically meaningful in interpreting treatment efficacy and loss of response may be greater than levels determined by external anchor and statistical methods.
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Affiliation(s)
- Clifton O Bingham
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alessandra L Butanis
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ana Maria Orbai
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michelle Jones
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Victoria Ruffing
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anne Lyddiatt
- Patient Partners in Arthritis, Ingersoll, ON, Canada
| | | | | | - Karon F Cook
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Susan J Bartlett
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Divisions of Clinical Epidemiology and Rheumatology, Department of Medicine, McGill University, CORE Offices
- Research Institute - McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montreal, QC, Canada
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27
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Elera-Fitzcarrald C, Rocha J, Burgos PI, Ugarte-Gil MF, Petri M, Alarcón GS. Measures of Fatigue in Patients With Rheumatic Diseases: A Critical Review. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:369-409. [PMID: 33091265 DOI: 10.1002/acr.24246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
Affiliation(s)
| | - Judith Rocha
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula I Burgos
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuel F Ugarte-Gil
- Hospital Guillermo Almenara Irigoyen, and Universidad Científica del Sur, Lima, Peru
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Graciela S Alarcón
- University of Alabama at Birmingham, and Universidad Peruana Cayetano Heredia, Lima, Peru
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28
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Bartlett SJ, Gutierrez AK, Andersen KM, Bykerk VP, Curtis JR, Haque UJ, Orbai AM, Jones MR, Bingham CO. Identifying Minimal and Meaningful Change in PROMIS ® for Rheumatoid Arthritis: Use of Multiple Methods and Perspectives. Arthritis Care Res (Hoboken) 2020; 74:588-597. [PMID: 33166066 PMCID: PMC10360361 DOI: 10.1002/acr.24501] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/22/2020] [Accepted: 11/03/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is chronic, painful, disabling condition resulting in significant impairments in physical, emotional, and social health. We used different methods and perspectives to evaluate the responsiveness of PROMIS® short forms (SFs) and identify minimal and meaningful score changes. METHODS Adults with RA enrolled in a multi-site prospective observational cohort completed PROMIS Physical Function, Pain Interference, Fatigue, Participation in Social Roles/Activities SFs, PROMIS-29, and pain, patient global, and rated change in specific symptoms and RA (a little vs. lot better or worse) at the second visit. Physicians recorded joint counts, MD Global Assessment, and change in RA at visit 2. We compared mean score differences for minimal and meaningful improvement/worsening using patient and MD change ratings and distribution-based methods, and visually inspected empirical cumulative distribution function curves by change categories. RESULTS The 348 adults were mostly (81%) female with longstanding RA. Using patient ratings, generally 1-3 point differences were observed for minimal change and 3-7 points for meaningful change. Larger differences were observed with patient vs. physician ratings and for symptom-specific vs. RA change. Mean differences were similar among SF versions. Prespecified hypotheses about change in PROMIS Physical Function, Pain Interference, Fatigue and Participation and legacy scales were supported. CONCLUSIONS PROMIS SFs and the PROMIS-29 Profile are responsive to change and generally distinguish between minimal and meaningful improvement and worsening in key RA domains. These data add to a growing body of evidence demonstrating robust psychometric properties of PROMIS and supporting use in RA care, research, and decision-making.
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Affiliation(s)
- Susan J Bartlett
- Divisions of Clinical Epidemiology and Rheumatology, McGill University, CORE Centre, 5252 de Maisonneuve #3D.57, Montreal, QC, Canada, H4A 3S5.,RI-MUHC, Centre for Outcomes Research and Evaluation and MUHC Center for Outcomes Research, 5252 de Maisonneuve #3D.57, Montreal, QC, Canada, H4A 3S5.,Division of Rheumatology, Johns Hopkins University, MFL Center Tower, 5200 Eastern Avenue, Suite 4100, Baltimore, MD, 21224, USA
| | - Anna Kristina Gutierrez
- Division of Rheumatology, Johns Hopkins University, MFL Center Tower, 5200 Eastern Avenue, Suite 4100, Baltimore, MD, 21224, USA
| | - Kathleen M Andersen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street #W6021, Baltimore, MD, 21205, USA.,Center for Drug Safety and Effectiveness, Johns Hopkins University, 615 North Wolfe Street #W6035, Baltimore, MD, 21205, United States
| | - Vivian P Bykerk
- Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, 525 East 71st St, 7th floor, New York, NY, USA, 10021
| | - Jeffrey R Curtis
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL, United States
| | - Uzma J Haque
- Division of Rheumatology, Johns Hopkins University, MFL Center Tower, 5200 Eastern Avenue, Suite 4100, Baltimore, MD, 21224, USA
| | - Ana-Maria Orbai
- Division of Rheumatology, Johns Hopkins University, MFL Center Tower, 5200 Eastern Avenue, Suite 4100, Baltimore, MD, 21224, USA
| | - Michelle R Jones
- Division of Rheumatology, Johns Hopkins University, MFL Center Tower, 5200 Eastern Avenue, Suite 4100, Baltimore, MD, 21224, USA
| | - Clifton O Bingham
- Division of Rheumatology, Johns Hopkins University, MFL Center Tower, 5200 Eastern Avenue, Suite 4100, Baltimore, MD, 21224, USA
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Phelps C, Bellon S, Hinkey M, Nash A, Boyd J, Cook CE, Garcia AN. Measurement properties of Patient-Reported Outcome Measures used to assess the sleep quality in adults with high prevalence chronic pain conditions: a systematic review. Sleep Med 2020; 74:315-331. [DOI: 10.1016/j.sleep.2020.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
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Esfandiary T, Park JK, Alexanderson H, Regardt M, Needham M, de Groot I, Sarver C, Lundberg IE, de Visser M, Song YW, DiRenzo D, Bingham CO, Christopher-Stine L, Mecoli CA. Assessing the content validity of patient-reported outcome measures in adult myositis: A report from the OMERACT myositis working group. Semin Arthritis Rheum 2020; 50:943-948. [PMID: 32906029 DOI: 10.1016/j.semarthrit.2020.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/23/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the content validity of several patient-reported outcome measures (PROMs) in patients with idiopathic inflammatory myopathies (IIM). METHODS Seven individual PROM instruments were selected by the Outcome Measures in Rheumatology (OMERACT) Myositis Working Group relating to the following domains: pain, fatigue, physical function and physical activity. Twenty patients from the Johns Hopkins Myositis Center were selected for one-on-one face-to-face or phone interviews for cognitive interviewing of individual PROMs to assess comprehension and content validity. Additionally, patients were asked if they thought muscle symptoms, an area originally identified in qualitative studies, were encapsulated by the other four domains. RESULTS The majority of patients (>70%) felt that each of the instruments was clear, easy to read and understand, and could be used for assessment of its domain. Two-thirds (66%) of patients felt that 'muscle symptoms' were captured by the other domains. CONCLUSIONS We provided evidence to support adequate content validity for several PROMs. Further research is needed to determine whether 'muscle symptoms' warrant a separate domain.
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Affiliation(s)
- Tina Esfandiary
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jin Kyun Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Helene Alexanderson
- Physiotherapist, Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine Solna, Rheumatology Unit, Karolinska Institutet, and Medical Unit Occupational Therapy and Physical therapy, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - 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, Solna, Stockholm, Sweden
| | - Merrilee Needham
- Dept Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University, Australia
| | | | | | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska University, Hospital, Karolinska Institutet, Solna, Stockholm, Sweden; Center for Global health, University of Ottawa, Ottawa, ON, Canada
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - 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, Seoul, South Korea
| | - Dana DiRenzo
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore 21224, MD, USA
| | - Clifton O Bingham
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore 21224, MD, USA
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore 21224, MD, USA
| | - Christopher A Mecoli
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore 21224, MD, USA.
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Bingham CO, Bartlett SJ, Kannowski C, Sun L, DeLozier AM, Cella D. Conversion of Functional Assessment of Chronic Illness Therapy-Fatigue to Patient-Reported Outcomes Measurement Information System Fatigue Scores in Two Phase III Baricitinib Rheumatoid Arthritis Trials. Arthritis Care Res (Hoboken) 2020; 73:481-488. [PMID: 31961494 DOI: 10.1002/acr.24144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) is validated for measuring fatigue in rheumatoid arthritis (RA). However, 10 of 13 FACIT-F items are identified as relevant to patients with RA. The Patient-Reported Outcomes Measurement Information System (PROMIS) uses an item response theory-calibrated T score metric. The PROMIS Fatigue item bank includes the FACIT-F items, enabling score conversion. The performance of converted PROMIS Fatigue scores has not been evaluated in RA populations or clinical trials. Our objective was to assess the performance of converted PROMIS Fatigue scores in 2 RA clinical trials of baricitinib. METHODS Crosswalk tables and pattern-scoring methods converted FACIT-F scores to PROMIS Fatigue for both the 13-item FACIT-F and the 10-item RA-optimized FACIT-F instrument, in 2 RA clinical trials evaluating baricitinib, RA-BEAM, and RA-BEACON. RA-BEAM patients had an inadequate response to methotrexate. RA-BEACON patients had an inadequate response or intolerance to ≥1 tumor necrosis factor inhibitor. Baricitinib was compared to all treatment arms via analysis of covariance on PROMIS Fatigue score conversions. RESULTS Baseline FACIT-F-derived PROMIS Fatigue scores reflected severe fatigue across treatment groups and were similar using different scoring methods. At week 24 in both studies, baricitinib was associated with clinically meaningful improvements in PROMIS Fatigue scores. PROMIS Fatigue scores were consistent for conversion methods and for the 13-item or 10-item FACIT-F. CONCLUSION All 4 conversion methods showed differentiation of active treatment compared with placebo from week 12, supporting the use of the PROMIS Fatigue and converting the 10-item FACIT-F to assess fatigue and demonstrate treatment benefit in RA clinical trials on a standardized metric.
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Affiliation(s)
| | - Susan J Bartlett
- Johns Hopkins University, Baltimore, Maryland, and McGill University and McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Luna Sun
- Eli Lilly and Company, Indianapolis, Indiana
| | | | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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