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Establishing Test-Retest Reliability and Reliable Change for the King-Devick Test in High School Athletes. Clin J Sport Med 2021; 31:e235-e239. [PMID: 31842057 DOI: 10.1097/jsm.0000000000000772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 05/31/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To establish test-retest reliability in nonconcussed high school athletes and compare absolute change, reliable change indices (RCIs), and minimal detectable change (MDC) methods for classifying impairment after sport-related concussion. DESIGN Prospective, repeated measures. SETTING High schools from the Midwest and Central regions of the United States. PARTICIPANTS A convenience sample of 772 nonconcussed high school athletes (n = 546 men) completed preseason K-D testing. In addition, 69 athletes completed a second postseason K-D test, and 54 athletes sustained a concussion and completed postconcussion K-D tests. INTERVENTION K-D test. MAIN OUTCOME MEASURES Data for age, sex, and concussion history were determined using preseason K-D test outcomes. Test-retest reliability, RCIs, and MDCs were calculated using postseason K-D tests (M = 98.9, SD = 9.1 days). Postinjury K-D assessments within 5 days of injury (M = 1.5, SD = 1.5 days) were used to classify impairment on K-D using absolute change, RCI, and MDC methods. RESULTS Significant effects for age (P < 0.001) and history of concussion (P = 0.001) were supported on baseline K-D time, with no sex differences (P = 0.21). Preseason to postseason reliability for K-D times was 0.60 (intraclass correlation coefficient, 95% CI, 0.43-0.73), although 38% of athletes exhibited slower postseason K-D times compared with baseline. Impairment on K-D exhibited for 72% of the concussed sample using absolute change, 48% using MDC, and 44% using RCI methods. CONCLUSIONS K-D exhibited moderate test-retest reliability across 1 season. Absolute change yielded the highest sensitivity for preinjury to postinjury impairment on the K-D compared with RCI and MDC methods.
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2
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Ernst N, Schatz P, Trbovich AM, Emami K, Eagle SR, Mucha A, Collins MW, Kontos AP. Utility of 1 Measurement Versus Multiple Measurements of Near Point of Convergence After Concussion. J Athl Train 2021; 55:850-855. [PMID: 32577736 DOI: 10.4085/1062-6050-431-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Increased near point of convergence (NPC) distance is a common finding after concussion and is associated with physical symptoms and worsened neurocognitive performance. Vestibular/Ocular Motor Screening measures NPC distance across 3 trials and uses the average measurement to inform clinical care. However, whether 3 trials are necessary, are consistent, or add clinical utility is unknown. OBJECTIVE To investigate the consistency across 3 trials of NPC and establish the classification accuracy (ie, clinical utility) of 1 or 2 trials compared with the standardized average of 3 trials. DESIGN Retrospective cohort study. SETTING Sports medicine clinic and research laboratory. PATIENTS OR OTHER PARTICIPANTS Consecutively enrolled patients aged 10 to 22 years with diagnosed concussions (74% sport related; n = 380). MAIN OUTCOME MEASURE(S) The previously reported clinical cutoff value of ≥5 cm across 3 trials was used. Pearson correlation and intraclass correlation coefficients were used to evaluate agreement between trials and average scores. Reliable change indices (RCIs) using 95% confidence intervals were also calculated. RESULTS The Pearson correlation (r = .98) and intraclass correlation (0.98) coefficients revealed excellent agreement between the first measurement and average NPC distance across 3 measurements. The RCI across all trials was 2 cm. When the first NPC measurement was ≤3 cm or ≥7 cm, agreement existed within the RCI between the first measurement and the average of 3 measurements in 99.6% of cases. When we averaged the first and second measurements, 379/380 (99.7%) participants had the same classification (ie, <5 cm = normal, ≥5 cm = abnormal) as the average NPC distance across 3 measurements. CONCLUSIONS Our findings suggest limited utility of multiple or average NPC distance measurements when the initial NPC distance is outside of RCI clinical cutoffs (ie, ≤3 cm or ≥7 cm). Given the high consistency between the first measurement and average NPC distance across 3 trials, only 1 measurement of NPC distance is warranted unless the first measurement is between 3 and 7 cm.
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Affiliation(s)
- Nathan Ernst
- Department of Orthopaedic Surgery, University of Pittsburgh, PA.,UPMC Sports Medicine Concussion Program, University of Pittsburgh, PA
| | | | - Alicia M Trbovich
- Department of Orthopaedic Surgery, University of Pittsburgh, PA.,UPMC Sports Medicine Concussion Program, University of Pittsburgh, PA
| | - Kouros Emami
- Department of Orthopaedic Surgery, University of Pittsburgh, PA.,UPMC Sports Medicine Concussion Program, University of Pittsburgh, PA
| | - Shawn R Eagle
- Department of Orthopaedic Surgery, University of Pittsburgh, PA
| | - Anne Mucha
- UPMC Center for Rehab Services, University of Pittsburgh, PA
| | - Michael W Collins
- Department of Orthopaedic Surgery, University of Pittsburgh, PA.,UPMC Sports Medicine Concussion Program, University of Pittsburgh, PA
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, PA.,UPMC Sports Medicine Concussion Program, University of Pittsburgh, PA
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3
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Mason SJ, Davidson BS, Lehto M, Ledreux A, Granholm AC, Gorgens KA. A Cohort Study of the Temporal Stability of ImPACT Scores Among NCAA Division I Collegiate Athletes: Clinical Implications of Test-Retest Reliability for Enhancing Student Athlete Safety. Arch Clin Neuropsychol 2020; 35:1131–1144. [PMID: 32853329 DOI: 10.1093/arclin/acaa047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE In this study we examined the temporal stability of the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) within NCAA Division I athletes across various timepoints using an exhaustive series of statistical models. METHODS Within a cohort design, 48 athletes completed repeated baseline ImPACT assessments at various timepoints. Intraclass correlation coefficients (ICC) were calculated using a two-way mixed effects model with absolute agreement. RESULTS Four ImPACT composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, and Reaction Time) demonstrated moderate reliability (ICC = 0.51-0.66) across the span of a typical Division I athlete's career, which is below previous reliability recommendations (0.90) for measures used in individual decision-making. No evidence of fixed bias was detected within Verbal Memory, Visual Motor Speed, or Reaction Time composite scores, and minimal detectable change values exceeded the limits of agreement. CONCLUSIONS The demonstrated temporal stability of the ImPACT falls below the published recommendations, and as such, fails to provide robust support for the NCAA's recommendation to obtain a single preparticipation cognitive baseline for use in sports-related concussion management throughout an athlete's career. Clinical interpretation guidelines are provided for clinicians who utilize baseline ImPACT scores for later performance comparisons.
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Affiliation(s)
- Sara J Mason
- Graduate School of Professional Psychology, University of Denver, Denver 80208, CO, USA
| | - Bradley S Davidson
- Mechanical and Materials Engineering, University of Denver, Denver 80208, CO, USA
| | - Marybeth Lehto
- Graduate School of Professional Psychology, University of Denver, Denver 80208, CO, USA
| | - Aurélie Ledreux
- Knoebel Institute for Healthy Aging, University of Denver, Denver 80208, CO, USA
| | | | - Kim A Gorgens
- Graduate School of Professional Psychology, University of Denver, Denver 80208, CO, USA
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4
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Gavilán-Carrera B, Vargas-Hitos JA, Morillas-de-Laguno P, Rosales-Castillo A, Sola-Rodríguez S, Callejas-Rubio JL, Sabio JM, Soriano-Maldonado A. Effects of 12-week aerobic exercise on patient-reported outcomes in women with systemic lupus erythematosus. Disabil Rehabil 2020; 44:1863-1871. [PMID: 32878503 DOI: 10.1080/09638288.2020.1808904] [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] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the effects of aerobic exercise on patient-reported outcomes (PROs) in women with systemic lupus erythematosus (SLE), and whether changes in cardiorespiratory fitness (CRF) mediate the changes in PROs. METHODS A total of 58 women with SLE were assigned to either an exercise group (EG; n = 26) or a control group (CG; n = 32) in this non-randomized clinical trial. The EG comprised 12 weeks of aerobic exercise (2 sessions/week) between 40%-75% of the individual's heart rate reserve. At baseline, and at week 12, CRF (Bruce test) and PROs were assessed including psychological stress (Perceived Stress Scale), sleep quality (Pittsburg Sleep Quality Index), fatigue (Multidimensional Fatigue Inventory), depressive symptoms (Beck Depression Inventory), and quality of life (36-item Short-Form Health Survey). RESULTS In comparison to the CG, the EG showed a significant reduction in general fatigue (mean difference (MD) -2.86 units; 95%CI -5.70 to -0.01; p = 0.049), physical fatigue (MD -4.33 units; 95%CI -7.02 to -1.65; p = 0.002) and a non-significant reduction of reduced motivation (MD - 1.29 units; 95%CI -2.60 to 0.03; p = 0.055). There were no significant between-group differences in the changes in psychological stress, sleep quality, depressive symptoms, quality of life, or other fatigue dimensions (all p > 0.05). Changes in CRF mediated the effects of the exercise intervention on general fatigue by 53.8%. CONCLUSION The results suggest that 12 weeks of progressive aerobic exercise might improve relevant dimensions of fatigue in women with SLE, despite the absence of effects on other PROs. Improvements in CRF seem to mediate the effect of exercise on general fatigue.Implications for rehabilitationAerobic exercise could be safely introduced in rehabilitation programs for inactive patients with SLE with mild disease activity.Including physical activity recommendations as part of rehabilitation could improve relevant aspects of fatigue in women with SLE.When rehabilitation aims at reducing fatigue, cardiorespiratory fitness improvements derived from physical activity might enhance benefits.
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Affiliation(s)
- Blanca Gavilán-Carrera
- PA-HELP "Physical Activity for Health Promotion" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Pablo Morillas-de-Laguno
- Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Antonio Rosales-Castillo
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Sergio Sola-Rodríguez
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
| | - José Luis Callejas-Rubio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "San Cecilio" University Hospital, Granada, Spain
| | - José Mario Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
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5
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Elbin R, Fazio-Sumrok V, Anderson MN, D'Amico NR, Said A, Grossel A, Schatz P, Lipinski D, Womble M. Evaluating the suitability of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized neurocognitive battery for short-term, serial assessment of neurocognitive functioning. J Clin Neurosci 2019; 62:138-141. [DOI: 10.1016/j.jocn.2018.11.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/12/2018] [Indexed: 11/28/2022]
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6
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McGlasson S, Wiseman S, Wardlaw J, Dhaun N, Hunt DPJ. Neurological Disease in Lupus: Toward a Personalized Medicine Approach. Front Immunol 2018; 9:1146. [PMID: 29928273 PMCID: PMC5997834 DOI: 10.3389/fimmu.2018.01146] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/07/2018] [Indexed: 12/11/2022] Open
Abstract
The brain and nervous system are important targets for immune-mediated damage in systemic lupus erythematosus (SLE), resulting in a complex spectrum of neurological syndromes. Defining nervous system disease in lupus poses significant challenges. Among the difficulties to be addressed are a diversity of clinical manifestations and a lack of understanding of their mechanistic basis. However, despite these challenges, progress has been made in the identification of pathways which contribute to neurological disease in SLE. Understanding the molecular pathogenesis of neurological disease in lupus will inform both classification and approaches to clinical trials.
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Affiliation(s)
- Sarah McGlasson
- MRC Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom
- The UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- The Anne Rowling Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Stewart Wiseman
- The UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna Wardlaw
- The UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Neeraj Dhaun
- Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - David P. J. Hunt
- MRC Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom
- The UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- The Anne Rowling Clinic, University of Edinburgh, Edinburgh, United Kingdom
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7
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Assessment of the Hospital Anxiety and Depression Scale (HADS) performance for the diagnosis of anxiety in patients with systemic lupus erythematosus. Rheumatol Int 2017; 37:1999-2004. [DOI: 10.1007/s00296-017-3819-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
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8
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Macêdo EA, Appenzeller S, Costallat LTL. Depression in systemic lupus erythematosus: gender differences in the performance of the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS). Lupus 2017; 27:179-189. [PMID: 28587586 DOI: 10.1177/0961203317713142] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prevalence of depressive symptoms in patients with systemic lupus erythematosus (SLE) varies widely between different cohorts (17-75%), primarily due to factors such as the heterogeneity of the samples and the instruments used to detect depressive symptoms. Most of these instruments are self-administered questionnaires that have different characteristics and approaches to depressive symptoms. This study aimed to evaluate gender differences in the performance of three questionnaires used to assess depressive symptoms in patients with SLE: the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS). This study included 54 male and 54 female SLE patients. Depressive symptoms were assessed using BDI (cutoffs 13 and 15), CES-D and HADS. The gold standard method used was the diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Regarding the performance of the BDI questionnaire, no significant differences in sensitivity or specificity were found between the genders. The specificity of the CES-D questionnaire was significantly greater for the male group (83% vs. 62.5%, p = 0.0309), and its sensitivity was non-significantly higher for the female group (92.9% for women and 71.4% for men; p = 0.2474). Regarding the performance of the HADS, we found similar sensitivities between the genders (71.4%) but a higher specificity among the men (95.7% in men and 82.5% in women, p = 0.0741). In conclusion, our results suggest the presence of gender differences in the performance of the questionnaires in SLE patients. The BDI had the most similar performances between the male and female groups. In contrast, the CES-D and HADS-D showed considerable variation in performances between men and women with SLE.
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Affiliation(s)
- E A Macêdo
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
| | - S Appenzeller
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
| | - L T L Costallat
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
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9
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Macêdo EA, Appenzeller S, Costallat LTL. Gender differences in systemic lupus erythematosus concerning anxiety, depression and quality of life. Lupus 2016; 25:1315-27. [DOI: 10.1177/0961203316638934] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 02/22/2016] [Indexed: 12/12/2022]
Abstract
Several studies have demonstrated a high prevalence of depression and anxiety in patients with systemic lupus erythematosus (SLE); however, few data address gender differences regarding these manifestations. This study aimed to investigate gender differences in the prevalence of depressive and anxiety symptoms, and their effect on the quality of life (QOL) of male and female SLE patients. This study included 54 male SLE patients, 54 female SLE patients, 54 male controls and 54 female controls. Depressive symptoms were assessed using the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Hospital Anxiety and Depression Scale (HADS); the anxiety symptoms were examined using HADS. We used the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to assess QOL. Depressive symptoms were found in 22.2% of BDI respondents, 24.1% of CES-D respondents and 13% of HADS-D respondents who were male SLE patients; while in the female SLE patient group, they were found in 38.9% of BDI respondents ( p = 0.063), 51.9% of CES-D respondents ( p = 0.653) and 31.5% of HADS-D respondents ( p = 0.003). Anxiety symptoms were found in 16.7% of the male SLE patients and 38.9% of the female SLE patients ( p = 0.024). Lower scores on the SF-36 (for QOL) were found in both male and female SLE patients with depression and anxiety symptoms. In conclusion, we observed significant gender differences regarding the prevalence of depressive and anxiety symptoms in patients with SLE, with significantly higher values in the female group. The presence of these symptoms appears to have a negative effect on the QOL of patients of both genders.
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Affiliation(s)
- E A Macêdo
- Department of Medicine, State University of Campinas, Campinas, Brazil
| | - S Appenzeller
- Department of Medicine, State University of Campinas, Campinas, Brazil
| | - L T L Costallat
- Department of Medicine, State University of Campinas, Campinas, Brazil
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10
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Brunner HI, Bishnoi A, Barron AC, Houk LJ, Ware A, Farhey Y, Mongey AB, Strife CF, Graham TB, Passo MH. Disease outcomes and ovarian function of childhood-onset systemic lupus erythematosus. Lupus 2016; 15:198-206. [PMID: 16686258 DOI: 10.1191/0961203306lu2291oa] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The objective of this study was to determine the medical outcomes including the ovarian function childhood-onset SLE (cSLE). The medical records of all patients diagnosed with cSLE in the Greater Cincinnati area between 1981 and 2002 were reviewed. Patient interviews were performed to obtain additional information on current medication regimens, disease activity [SLE Disease Activity Index (SLEDAI-2k)], and damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)]. The occurence of premature ovarian failure (POF) and reduction of the ovarian reserve was assessed by timed gonadotropin levels. There were 77 patients (F: M = 70: 7, 53% Caucasian, 45% African-American and 2% Asian) with a mean age at diagnosis of 14.6 years. Nine patients died (88.3% survival) during the mean follow-up of 7.1 years (standard deviation [SD] 5.6) and 88% of the patients continued to have active disease (SLEDAI-2k mean/SD: 6.6/6.7), with 42% of them having disease damage (SDI mean/SD: 1.62/2.1); Non-Caucasian patients had higher disease activity (mean SLEDAI-2k: 10 versus 3.4; P < 0.0001) and more disease damage (mean SDI: 2.1 versus 1.2; P < 0.02) than Caucasian patients. Cyclophosphamide was given to 47% of the patients during the course of their disease and associated with the presence of significantly reduced ovarian reserve (RR = 2.8; 95% CI: 1.7-4.8; P = 0.026). Patient mortality and disease damage with cSLE continue to be high. Although overt POF with cyclophosphamide exposure is rare, it is a risk factor for significantly decreased ovarian reserve cSLE.
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Affiliation(s)
- H I Brunner
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, William Rowe Division of Rheumatology, OH 45229, USA.
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11
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Bogdanovic G, Stojanovich L, Djokovic A, Stanisavljevic N. Physical Activity Program Is Helpful for Improving Quality of Life in Patients with Systemic Lupus Erythematosus. TOHOKU J EXP MED 2015; 237:193-9. [DOI: 10.1620/tjem.237.193] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Aleksandra Djokovic
- University Medical Centre “Bezanijska Kosa”
- Univeristy of Belgrade, School of Medicine
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12
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Schatz P, Robertshaw S. Comparing post-concussive neurocognitive test data to normative data presents risks for under-classifying "above average" athletes. Arch Clin Neuropsychol 2014; 29:625-32. [PMID: 25178629 DOI: 10.1093/arclin/acu041] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We compared classification accuracy of post-concussion test data against baseline and normative data, accounting for baseline level of performance. Athletes (N = 250) completed baseline and post-concussion ImPACT assessments, within 7 days of concussion (verified by sports medicine professionals and self-reported symptoms). Athletes were classified as "below average," "average," or "above average" at baseline. Change from baseline was calculated using reliable change indices (RCIs) and regression-based measures (RBz), and comparison to normative data was achieved using z-scores. Normative comparisons identified fewer symptomatic, concussed athletes than RCIs and RBz. Both RCIs and RBz consistently identified "impairment" at 1 and 1.5 SD, regardless of baseline level, whereas normative comparisons identified 46-48% fewer athletes performing "above average" at baseline using a cut-off of 1 SD and 36-38% fewer using a cut-off of 1.5 SD. The use of normative comparisons may differentially classify concussed, symptomatic athletes who are outside the "average" range at baseline.
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Affiliation(s)
- Philip Schatz
- Department of Psychology, Saint Joseph's University, Philadelphia, PA, USA
| | - Stacey Robertshaw
- Department of Psychology, Saint Joseph's University, Philadelphia, PA, USA
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13
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Nakayama Y, Covassin T, Schatz P, Nogle S, Kovan J. Examination of the Test-Retest Reliability of a Computerized Neurocognitive Test Battery. Am J Sports Med 2014; 42:2000-5. [PMID: 24907286 DOI: 10.1177/0363546514535901] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Test-retest reliability is a critical issue in the utility of computer-based neurocognitive assessment paradigms employing baseline and postconcussion tests. Researchers have reported low test-retest reliability for the Immediate Post Concussion Assessment and Cognitive Testing (ImPACT) across an interval of 45 and 50 days. PURPOSE To re-examine the test-retest reliability of the ImPACT between baseline, 45 days, and 50 days. STUDY DESIGN Descriptive laboratory study. METHODS Eighty-five physically active college students (51 male, 34 female) volunteered for this study. Participants completed the ImPACT as well as a 15-item memory test at baseline, 45 days, and 50 days. Intraclass correlation coefficients (ICCs) were calculated for ImPACT composite scores, and change scores were calculated using reliable change indices (RCIs) and regression-based methods (RBMs) at 80% and 95% confidence intervals (CIs). RESULTS The respective ICCs for baseline to day 45, day 45 to day 50, baseline to day 50, and overall were as follows: verbal memory (0.76, 0.69, 0.65, and 0.78), visual memory (0.72, 0.66, 0.60, and 0.74), visual motor (processing) speed (0.87, 0.88, 0.85, and 0.91), and reaction time (0.67, 0.81, 0.71, and 0.80). All ICCs exceeded the threshold value of 0.60 for acceptable test-retest reliability. All cases fell well within the 80% CI for both the RCI and RBM, while 1% to 5% of cases fell outside the 95% CI for the RCI and 1% for the RBM. CONCLUSION Results suggest that the ImPACT is a reliable neurocognitive test battery at 45 and 50 days after the baseline assessment. The current findings agree with those of other reliability studies that have reported acceptable ICCs across 30-day to 1-year testing intervals, and they support the utility of the ImPACT for the multidisciplinary approach to concussion management. CLINICAL RELEVANCE This study suggests that the computerized neurocognitive test battery, ImPACT, is a reliable test for postconcussion serial assessments. However, when managing concussed athletes, the ImPACT should not be used as a stand-alone measure.
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Affiliation(s)
- Yusuke Nakayama
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Philip Schatz
- Department of Psychology, Saint Joseph's University, Philadelphia, Pennsylvania, USA
| | - Sally Nogle
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Jeff Kovan
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
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14
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Williams EM, Penfield M, Kamen D, Oates JC. An Intervention to Reduce Psychosocial and Biological Indicators of Stress in African American Lupus Patients: The Balancing Lupus Experiences with Stress Strategies Study. ACTA ACUST UNITED AC 2014; 4:22-31. [PMID: 24999444 DOI: 10.4236/ojpm.2014.41005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Very little is known about the impact of psychosocial stress on African American lupus patients. Due to the exposure of African Americans to a unique trajectory of stressors throughout life, it may be critical to understand the relationship between psychosocial stress and underlying biological mechanisms that influence disease activity and pathology in this high risk group. METHODS The Balancing Lupus Experiences with Stress Strategies (BLESS) study piloted the validated "Better Choices, Better Health" Chronic Disease Self-Management Program (CDSMP) in 30 African-American lupus patients participating in the SLE Clinic Database Project at the Medical University of South Carolina (MUSC). Measures of psychosocial and biological indicators of stress were collected in all of the patients in each of the study conditions before and after intervention activities, as well as four months post-intervention, to assess the effectiveness of the program in reducing perceived and biological indicators of stress. RESULTS Participation in the workshops had large effects upon depression (d=1.63 and d = 1.68), social/role activities limitations (d =1.15), health distress (d =1.13 and d = 0.78), fatigue (d =1.03), pain (d =0.96), and lupus self-efficacy (d =0.85). Neither the differences in cortisol or DHEA levels pre- and post-intervention were found to be significantly different between intervention participants and controls. CONCLUSION The intervention workshops acted to reduce perceived stress and improve quality of life. Our findings imply that comparable, if not more significant gains in relevant health indicators are possible in African American patients when provided the opportunity to participate in CDSMP's.
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Affiliation(s)
- Edith M Williams
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 208, Columbia, SC 29210
| | - Megan Penfield
- Institutional Assessment and Compliance, University of South Carolina, 1710 College Street, Suite 205, Columbia, SC 29208
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, Charleston, SC 29425
| | - James C Oates
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, Charleston, SC 29425; Medical Service, Ralph H. Johnson VA Medical Center, Charleston, SC
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Correlates of sleep abnormalities in systemic lupus: a cross-sectional survey in an urban, academic center. J Clin Rheumatol 2013; 19:7-13. [PMID: 23319017 DOI: 10.1097/rhu.0b013e31827cd20d] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a complex autoimmune disease that is associated with poor health-related quality-of-life outcomes. OBJECTIVES The objectives of this study were to identify correlates of the domains of the Medical Outcomes Study (MOS) Sleep Scale in SLE and to determine the factors most associated with overall sleep quality. METHODS Sleep in 118 SLE patients was assessed using the self-administered MOS Sleep Scale. Bivariate correlations were determined between each of 6 MOS Sleep subscale scores and each sociodemographic, clinical, or psychological predictor variable. Serial hierarchical multiple regression analyses were computed to identify the variables associated with the individual sleep domains and the overall Sleep Problems Index. RESULTS The MOS Sleep Scale scores of patients with SLE were poorer than the US general population. Depression moderately correlated with 5 (all P < 0.01) and anxiety with 4 subscale scores (all P < 0.05). The SLE Disease Activity Index did not significantly correlate with any of the subscale scores. Results of a multivariate regression model showed that sleep adequacy and sleep disturbance were independently associated with depression (β = -0.84; 95% confidence interval [CI], -1.37 to -0.32; and β = 0.80; 95% CI, 0.15-1.45; respectively). Daytime somnolence was significantly associated with daily prednisone dosage (β = 0.54; 95% CI, 0.29-0.80) and anxiety trait (β = 0.81; 95% CI, 0.41-1.21). Snoring independently correlated with anxiety (β = 1.64; 95% CI, 0.80-2.29). When demographic, clinical, and psychological variables were simultaneously regressed on the Sleep Problems Index, pain trended toward association with overall sleep problems (β = 0.17; 95% CI, -0.02 to 0.36). CONCLUSIONS Patients with SLE have greater sleep problems relative to the general population. Psychosocial factors, particularly depression and anxiety, are important determinants that are significantly associated with sleep abnormalities in SLE.
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Schatz P, Ferris CS. One-Month Test-Retest Reliability of the ImPACT Test Battery. Arch Clin Neuropsychol 2013; 28:499-504. [DOI: 10.1093/arclin/act034] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Delgadillo J. Depression and anxiety symptoms: measuring reliable change in alcohol and drug users. ADVANCES IN DUAL DIAGNOSIS 2012. [DOI: 10.1108/17570971211253685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Schatz P, Kontos A, Elbin R. Response to Mayers and Redick: “Clinical utility of ImPACT assessment for postconcussion return-to-play counseling: Psychometric issues”. J Clin Exp Neuropsychol 2012; 34:428-34; discussion 435-442. [DOI: 10.1080/13803395.2012.667789] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Philip Schatz
- Department of Psychology, Saint Joseph's University, Philadelphia, PA 19131, USA.
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Elbin RJ, Schatz P, Covassin T. One-year test-retest reliability of the online version of ImPACT in high school athletes. Am J Sports Med 2011; 39:2319-24. [PMID: 21841066 DOI: 10.1177/0363546511417173] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) neurocognitive testing battery is a popular assessment tool used for concussion management. The stability of the baseline neurocognitive assessment is important for accurate comparisons between postconcussion and baseline neurocognitive performance. Psychometric properties of the recently released online version of ImPACT have yet to be established; therefore, research evaluating the reliability of this measure is warranted. PURPOSE The authors investigated the 1-year test-retest reliability of the ImPACT online version in a sample of high school athletes. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 369 varsity high school athletes completed 2 mandatory preseason baseline cognitive assessments approximately 1 year apart as required by their respective athletics program. No diagnosed concussion occurred between assessments. RESULTS Intraclass correlation coefficients (ICCs) for ImPACT online indicated that motor processing speed (.85) was the most stable composite score, followed by reaction time (.76), visual memory (.70), and verbal memory (.62). Unbiased estimates of reliability were consistent with ICCs: motor processing speed (.85), reaction time (.76), visual memory (.71), and verbal memory (.62). CONCLUSION The online ImPACT baseline is a stable measure of neurocognitive performance across a 1-year time period for high school athletes. These reliability data for online ImPACT are higher than the 2-year ICCs previously reported from the desktop version. CLINICAL RELEVANCE It is recommended that the ImPACT baseline assessment (both desktop and online) continue to be updated every 2 years. The online version of ImPACT appears to be a stable measure of neurocognitive performance over a 1-year period, and systematic evaluation of its stability over a 2-year period is warranted.
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Affiliation(s)
- R J Elbin
- Department of Kinesiology, Leisure and Sport Science, East Tennessee State University, Johnson City, TN 37614, USA.
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The relationship between alexithymia and psychological factors in systemic lupus erythematosus. Compr Psychiatry 2011; 52:754-62. [PMID: 21193176 DOI: 10.1016/j.comppsych.2010.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 11/04/2010] [Accepted: 11/14/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Alexithymia has been described as an important dimension in several medical diseases. Systemic lupus erythematosus (SLE) is a chronic condition characterized by unpredictable clinical manifestations. Our aim is to reveal which factors (psychological factors and quality of life dimensions) are associated with alexithymia in SLE patients. METHODS Fifty-three sequential SLE patients (ACR criteria) and 41 asthma patients were studied by means of validated scales for alexithymia (Toronto Alexithymia Scale), psychopathology (Brief Symptom Inventory, Hospital Anxiety and Depression Scale), personality dimensions (NEO-FFI), and quality of life (Short Form-36 Health Survey). Systemic lupus erythematosus patient's clinical and laboratorial evaluation was performed by indicators of activity (Systemic Lupus Erythematosus Disease Activity Index) of accumulated damage (Systemic Lupus International Collaborating Clinics/ACR Damage Index), length of disease, and therapy. RESULTS An association between alexithymia and psychopathological symptoms, and personality and quality of life dimensions was found. By means of multiple regression analysis, openness and depression were the 2 predictors for alexithymia in SLE patients. We found a high prevalence rate of alexithymia in SLE patients; however, when controlling for depression symptoms (Hospital Anxiety and Depression Scale-Depression, <7), we found a lower percentage of alexithymic traits than that of the total sample of SLE. CONCLUSION Alexithymia was associated with psychological distress and with quality of life impairment. Understanding the role of psychological factors in SLE patients may contribute to a more comprehensive perspective of the disease, its impact on patient's daily routine, and how patients adapt emotionally to a chronic disease.
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Quality-of-life measurements versus disease activity in systemic lupus erythematosus. Curr Rheumatol Rep 2010; 12:250-8. [PMID: 20586000 DOI: 10.1007/s11926-010-0114-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic disease affecting the physical, social, and psychological well-being of patients. Different instruments have been developed to measure health-related quality of life, some of which are SLE-specific. Contributors to poor quality of life in patients with SLE include fatigue, fibromyalgia, depression, and cognitive dysfunction. Health-related quality of life is not strongly associated with disease activity or organ damage. The Medical Outcomes Survey Short Form 36 is the most common instrument used to measure quality of life in SLE.
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Kellner ES, Lee PY, Li Y, Switanek J, Zhuang H, Segal MS, Sobel ES, Satoh M, Reeves WH. Endogenous type-I interferon activity is not associated with depression or fatigue in systemic lupus erythematosus. J Neuroimmunol 2010; 223:13-9. [PMID: 20416954 PMCID: PMC3580233 DOI: 10.1016/j.jneuroim.2010.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/25/2010] [Accepted: 03/26/2010] [Indexed: 11/27/2022]
Abstract
Patients with systemic lupus erythematosus (SLE) often suffer from depression and fatigue in addition to the physical manifestations of the autoimmune disease. Elevated production of type-I interferons (IFN-I) has been found in lupus patients and IFN-I can precipitate a variety of neuropsychiatric side effects. This study was conducted to evaluate the relationship between dysregulated IFN-I production and the presence of depression or fatigue in lupus patients. Through cross-sectional and longitudinal analysis we found no significant correlation between abnormal IFN-I levels (as measured by peripheral blood expression of IFN-I-stimulated genes) and neuropsychiatric manifestations. Elevation of endogenous serum IFN-I levels is unlikely to account for the depression and fatigue associated with SLE.
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Affiliation(s)
- Erinn S. Kellner
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
| | - Pui Y. Lee
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL 32610
| | - Yi Li
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
| | - Juliana Switanek
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
| | - Haoyang Zhuang
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
| | - Mark S. Segal
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL 32610
| | - Eric S. Sobel
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610
| | - Minoru Satoh
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610
| | - Westley H. Reeves
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610
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Abstract
BACKGROUND Computer-based assessment programs are commonly used to document baseline cognitive performance for comparison with postconcussion testing. There are currently no guidelines for how often baseline assessments should be updated, and no data documenting the test-retest stability of baseline measures over relevant time periods. PURPOSE To establish long-term test-retest reliability of baseline assessments using ImPACT, and to compare various statistical methods for establishing test-retest reliability. STUDY DESIGN Case series; Level of evidence, 4. METHODS Participants were 95 collegiate varsity athletes completing baseline cognitive testing at 2 time periods, approximately 2 years apart. No participant sustained a concussion between assessments. All athletes completed the ImPACT test battery; dependent measures were the composite scores and total symptom scale score. RESULTS Intraclass correlation coefficient estimates for visual memory (.65), processing speed (.74), and reaction time (.68) composite scores reflected stability over the 2-year period, with greater variability in verbal memory (.46) and symptom scale (.43) scores. Using reliable change indices and regression-based methods, only a small percentage of participants' scores showed "reliable" or "significant" change on the composite scores (0%-6%), or symptom scale scores (5%-10%). CONCLUSION The current results suggest that college athletes' cognitive performance at baseline remains considerably stable over a 2-year period. These data help establish the effects of longer, clinically pragmatic testing intervals on test-retest reliability. CLINICAL IMPLICATIONS The current results suggest that stretching the time between baseline assessments from 1 to 2 years may have little effect on the clinical management of concussions in collegiate athletes. These results should not be generalized to collegiate football players, who were not included in this sample. Youth athletes (high school and younger) should continue to receive annually updated baseline assessments until prospective study of the stability of baseline assessments for this younger age group can be completed.
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Affiliation(s)
- Philip Schatz
- Department of Psychology, Saint Joseph's University, 222 Post Hall, 5600 City Avenue, Philadelphia, PA 19131, USA.
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Barbosa F, Mota C, Alves M, Alcântara C, Rossiñol B, Patrício P, Barbosa A, Ferreira C. Alexithymia in Systemic Lupus Erythematosus Patients. Ann N Y Acad Sci 2009; 1173:227-34. [DOI: 10.1111/j.1749-6632.2009.04640.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dussán KB, Magder L, Brodsky RA, Jones RJ, Petri M. High dose cyclophosphamide performs better than monthly dose cyclophosphamide in quality of life measures. Lupus 2008; 17:1079-85. [PMID: 19029275 DOI: 10.1177/0961203308093828] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In spite of current therapies, the overall health status of patients with SLE is poor. High-dose cyclophosphamide (50 mg/kg for 4 days) with or without stem-cell rescue has been introduced as a new therapy for severe SLE, including renal and central nervous system (CNS)-SLE. Long-term durable responses have been found to be 40%. A randomised clinical trial was completed comparing high-dose cyclophosphamide with monthly intravenous cyclophosphamide (750 mg/m squared bovine serum albumin) in patients with SLE who need cyclophosphamide for the first time. The primary outcome of the trial was complete clinical response. In this report, we compare the treatment groups with respect to quality of life. The patients in this study had a mean age of 35.3 +/- 10.1 years, were of Caucasian (35%), African-American (51%), Hispanic (8%) and Asian (6%) people, and 88% were women. The organ leading to treatment was renal lupus in 29%, CNS-lupus in 45% and other organs in 26%. Quality of life was measured at each visit using the Medical Outcome Study Short-Form 36 (SF-36). At 6 months, the patients in the high-dose cyclophosphamide trial arm had significantly greater improvement than patients in the monthly intravenous cyclophosphamide arm (P = 0.026; P = 0.0082, respectively) in the categories of general health and social functioning. At 18 months, the improvement in the role-physical score was significantly greater in the high-dose cyclophosphamide trial arm than in the monthly-dose cyclophosphamide arm (P = 0.025). At the end of the two and a half-year study, there were no significant differences between the groups with respect to changes in SF-36. By pooling the groups, at 30 months, there was a statistically significant (P < 0.05) improvement over baseline in 6 of the 8 SF-36 domains. This study shows earlier improvement in SF-36 measures at 6 months in the high-dose cyclophosphamide group but equal improvement in both arms at two and one and a half years. Eventual improvements in quality-of-life with both cyclophosphamide regimens are clinically meaningful to both patients and treating physicians.
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Affiliation(s)
- K B Dussán
- Michigan State College of Human Medicine, East Lansing, Michigan, USA
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Lederman LF, Lindner H, Greenwood KM, Philip EJ. Depression and pain in night time and daytime functioning of individuals with lupus. Psychol Health 2008; 23:537-50. [DOI: 10.1080/08870440701724849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ramírez Parrondo R. Depresión, primera manifestación de lupus eritematoso sistémico. Semergen 2007. [DOI: 10.1016/s1138-3593(07)73936-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Monaghan SM, Sharpe L, Denton F, Levy J, Schrieber L, Sensky T. Relationship between appearance and psychological distress in rheumatic diseases. ACTA ACUST UNITED AC 2007; 57:303-9. [PMID: 17330287 DOI: 10.1002/art.22553] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the relationship between physical appearance concerns and psychological distress in patients with rheumatic diseases. METHODS A total of 60 patients with systemic lupus erythematosus (SLE), 44 with chronic rheumatoid arthritis (RA), and 53 with recent-onset RA were evaluated for levels of appearance concern and a range of illness-specific measures to determine how these demographic and clinical variables were related to the dependent variable psychological distress. RESULTS Using hierarchical multiple regression analyses, we found that both appearance concerns and levels of disability were predictive of depression in patients with RA. In the SLE sample, physical disability was predictive of depression when appearance concerns were not included in the analysis. However, disability did not predict depression when appearance concerns were entered into the analysis. This indicates that appearance concerns mediated the relationship between disability and depression in SLE. There was no association between appearance concerns and anxiety in either sample. CONCLUSION The results suggest that appearance concerns are strongly related to depression in patients with rheumatic diseases and should be routinely assessed.
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Kozora E, Ellison MC, West S. Depression, fatigue, and pain in systemic lupus erythematosus (SLE): relationship to the American College of Rheumatology SLE neuropsychological battery. ACTA ACUST UNITED AC 2006; 55:628-35. [PMID: 16874786 DOI: 10.1002/art.22101] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the frequency and reliability of depression, fatigue, and pain self-report measures in patients with systemic lupus erythematosus (SLE) and healthy controls, and to examine the relationship between a cognitive impairment index (CII) derived from the American College of Rheumatology neuropsychology research battery of tests for SLE (ACR-SLE battery) and measures of depression, pain, fatigue, and perceived cognitive dysfunction. METHODS Thirty-one patients with SLE with a history of overt neuropsychiatric symptoms (neuropsychiatric SLE [NPSLE]), 22 patients with SLE without overt neuropsychiatric symptoms (non-NPSLE), and 25 healthy controls completed the following measures at baseline and 1-month followup: ACR-SLE battery, perceived cognitive difficulties, depression, fatigue, and pain. RESULTS Patients with SLE (both NPSLE and non-NPSLE) showed higher symptoms of depression, higher levels of fatigue, greater pain, and more perceived cognitive problems. All measures except the Center for Epidemiologic Studies Depression scale (CES-D) demonstrated adequate reliability across the SLE groups at retest. Only patients with NPSLE had significant correlations between CII and depression, fatigue, and pain. Neither the non-NPSLE patients nor the controls had significant relationships with the CII and these behavioral measures. CONCLUSION Patients with SLE report higher levels of cognitive difficulties, depression, pain, and fatigue compared with controls. Reliability for all measures, except the CES-D, was established in the SLE group. Overall, results suggest that cognitive dysfunction, pain, fatigue, and depression in patients with NPSLE may represent global changes in the central nervous system that require ongoing evaluation and treatment.
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Affiliation(s)
- Elizabeth Kozora
- National Jewish Medical and Research Center, University of Colorado Health Sciences Center, Denver, CO 80206, USA.
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Martens MP, Vandyke M, Parker JC, Smarr KL, Hewett JE, Hewett JE, Walker SE. Analyzing reliability of change in depression among persons with rheumatoid arthritis. ACTA ACUST UNITED AC 2005; 53:973-8. [PMID: 16342109 DOI: 10.1002/art.21578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine several methods of determining reliability of change constructs in depressive symptoms in patients with rheumatoid arthritis (RA) and to demonstrate the strengths, weaknesses, and uses of each method. METHODS Data were analyzed from a cohort of 54 persons with RA who participated in a combined behavioral/pharmacologic intervention of 15 months duration. These longitudinal data were used to examine 3 methodologies for assessing the reliability of change for various measures of depression. The specific methodologies involved the calculations of reliable change, sensitivity to change, and reliability of the change score. RESULTS The analyses demonstrated differences in reliability of change performance across the various depression measures, which suggest that no single measure of depression for persons with RA should be considered superior in all contexts. CONCLUSION The findings highlight the value of utilizing reliability of change constructs when examining changes in depressive symptoms over time.
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Affiliation(s)
- Matthew P Martens
- Harry S. Truman Memorial Veterans' Hospital, and the University of Missouri School of Medicine, Columbia, Missouri 65201, USA
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Carvalho MRPD, Sato EI, Tebexreni AS, Heidecher RTC, Schenkman S, Neto TLB. Effects of supervised cardiovascular training program on exercise tolerance, aerobic capacity, and quality of life in patients with systemic lupus erythematosus. ACTA ACUST UNITED AC 2005; 53:838-44. [PMID: 16342102 DOI: 10.1002/art.21605] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine if supervised cardiovascular training improves exercise tolerance, aerobic capacity, depression, functional capacity, and quality of life in patients with systemic lupus erythematosus (SLE). METHODS Sixty women with SLE (ages 18-55 years) were evaluated using Short Form 36, visual analog scale for pain, scale for fatigue, Beck Depression Inventory, and Health Assessment Questionnaire (HAQ), and participated in a training protocol of incremental load on a treadmill with computed gas metabolic analysis. Maximum oxygen consumption (VO(2max)) and anaerobic threshold VO(2) were calculated with a SensorMedics Vmax29C analyzer (Sensor Medics, Yorba Linda, CA), and heart rate was measured by electrocardiogram. Patients were divided into 2 groups: a training group (41 patients) that participated in the supervised cardiovascular training program and a control group (19 patients) that did not participate in the program. All variables were analyzed at baseline and after 12 weeks for both groups. The training program occurred in the morning for 60 minutes, 3 times a week for 12 weeks. Statistical analysis included Wilcoxon's rank sum test, Mann-Whitney U test, chi-square test, and Fisher's exact test. P values <0.05 were considered to be statistically significant. RESULTS The 2 groups were homogeneous and comparable at baseline. The training group showed a significant improvement of aerobic capacity measured by anaerobic threshold VO(2) (14.67 +/- 3.03 versus 17.08 +/- 3.35 ml/kg/minute, P < 0.001). Comparison of the training group and control group after 12 weeks showed a significant difference relating to VO(2max) (24.31 +/- 4.61 versus 21.21 +/- 3.88 ml/kg/minute, P = 0.01) and anaerobic threshold VO(2) (17.08 +/- 3.35 versus 13.66 +/- 2.82 ml/kg/minute, P < 0.0001). After cardiovascular training, we found a significant improvement of Beck inventory score (8.37 +/- 12.79 versus 2.90 +/- 3.00, P < 0.001) and HAQ score (0.14 +/- 0.21 versus 0.06 +/- 0.19, P < 0.01) in the training group. CONCLUSION This study showed significant improvement in exercise tolerance, aerobic capacity, quality of life, and depression after a supervised cardiovascular training program in patients with SLE.
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