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Sun X, Zhou X, Zhuang J, Qiu S, Liu Z, Li Q, Zhang Y, Li Y, Du D, Sun J. Relationship between serum cartilage turnover biomarkers and haemophilic arthropathy severity in adult patients with severe haemophilia A in China. Haemophilia 2023; 29:362-364. [PMID: 36418153 DOI: 10.1111/hae.14695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Xueyan Sun
- Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Haematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinmu Zhuang
- Shenzhen Hospital, Southern Medical University, Guangzhou, China
| | - Shiqiu Qiu
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhuqin Liu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiang Li
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaru Zhang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yingjia Li
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dong Du
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Sun
- Nanfang Hospital, Southern Medical University, Guangzhou, China
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St-Louis J, Abad A, Funk S, Tilak M, Classey S, Zourikian N, McLaughlin P, Lobet S, Hernandez G, Akins S, Wells AJ, Manco-Johnson M, John J, Austin S, Chowdhary P, Hermans C, Nugent D, Bakeer N, Mangles S, Hilliard P, Blanchette VS, Feldman BM. The Hemophilia Joint Health Score version 2.1 Validation in Adult Patients Study: A multicenter international study. Res Pract Thromb Haemost 2022; 6:e12690. [PMID: 35356667 PMCID: PMC8956786 DOI: 10.1002/rth2.12690] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background The Hemophilia Joint Health Score (HJHS) was developed and validated to detect arthropathy in children. Additional evidence is required to show validity in adults. We studied the convergent and discriminant construct validity of the HJHS version 2.1(HJHSv2.1) in adults with hemophilia. A secondary aim was to define age‐related normative adult HJHSv2.1 reference values. Methods We studied 192 adults with hemophilia, and 120 healthy adults in four age‐matched groups—18 to 29, 30 to 40, 41 to 50, and >50 years—at nine centers. Trained physiotherapists scored the HJHS and World Federation of Hemophilia (WFH) joint score. Health history, the Functional Independence Scale of Hemophilia (FISH), Hemophilia Activities List (HAL), and Short‐Form McGill Pain Questionnaire (SF‐MPQ) were also collected. Results The median age was 35.0 years. Of participants with hemophilia, 68% had severe, 14% moderate, and 18% mild disease. The HJHS correlated strongly with WFH score (Spearman’s rho [rs] = .95, P < .001). Moderate correlations were seen between the FISH (rs = .50, P < .001) and SF‐MPQ Present Pain Intensity (rs = .50, P < .001), while a modest correlation was found with the HAL (rs = −.37, P < .001). The HJHS significantly differentiated between age groups (Kruskal‐Wallis T = 35.02, P < .001) and disease severity in participants with hemophilia. The HJHS had high internal reliability (Cronbach’s α = .88). We identified duration of swelling as a redundant item in the HJHS. Conclusions The HJHS shows evidence of strong convergent and discriminant construct validity to detect arthropathy in adults with hemophilia and is well suited for use in this population.
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Affiliation(s)
- Jean St-Louis
- Department of Hematology CHU Sainte-Justine and Hôpital Maisonneuve-Rosemont Montréal Québec Canada.,Department of Medicine Université de Montréal Montréal Québec Canada
| | - Audrey Abad
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto Ontario Canada
| | - Sharon Funk
- Hemophilia and Thrombosis Center University of Colorado Denver Colorado USA
| | - Merlyn Tilak
- Department of Physical Medicine & Rehabilitation Christian Medical College Vellore India
| | - Stephen Classey
- Haemostasis and Thrombosis Centre St Thomas' Hospital London UK
| | - Nichan Zourikian
- Pediatric/Adult Comprehensive Hemostasis Center CHU Sainte-Justine Montréal Québec Canada
| | - Paul McLaughlin
- Katharine Dormandy Haemophilia and Thrombosis Centre The Royal Free Hospital London UK
| | - Sébastien Lobet
- Haemostasis and Thrombosis Unit Division of Haematology Cliniques Universitaires Saint-Luc Brussels Belgium
| | - Grace Hernandez
- The Center for Inherited Blood Disorders (CIBD) Orange County California USA
| | - Stacie Akins
- Indiana Hemophilia & Thrombosis Center Indianapolis Indiana USA
| | - Anna J Wells
- Haemophilia, Haemostasis & Thrombosis Centre Hampshire Hospitals NHS Foundation Trust Basingstoke UK
| | | | - Judy John
- Department of Physical Medicine & Rehabilitation Christian Medical College Vellore India
| | - Steve Austin
- Haemostasis and Thrombosis Centre St Thomas' Hospital London UK
| | - Pratima Chowdhary
- Katharine Dormandy Haemophilia and Thrombosis Centre The Royal Free Hospital London UK
| | - Cedric Hermans
- Haemostasis and Thrombosis Unit Division of Haematology Cliniques Universitaires Saint-Luc Brussels Belgium
| | - Diane Nugent
- The Center for Inherited Blood Disorders (CIBD) Orange County California USA
| | - Nihal Bakeer
- Indiana Hemophilia & Thrombosis Center Indianapolis Indiana USA
| | - Sarah Mangles
- Haemophilia, Haemostasis & Thrombosis Centre Hampshire Hospitals NHS Foundation Trust Basingstoke UK
| | - Pamela Hilliard
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto Ontario Canada
| | - Victor S Blanchette
- Division of Hematology/Oncology The Hospital for Sick Children Toronto Ontario Canada.,Department of Pediatrics Faculty of Medicine University of Toronto Toronto Ontario Canada
| | - Brian M Feldman
- Division of Rheumatology The Hospital for Sick Children Toronto Ontario Canada.,Department of Pediatrics Faculty of Medicine Institute of Health Policy, Management and Evaluation The Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
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van Balen EC, Haverman L, Hassan S, Taal EM, Smit C, Driessens MH, Beckers EAM, Coppens M, Eikenboom J, Hooimeijer HL, Leebeek FWG, van Vulpen LFD, Schols SEM, Terwee CB, Rosendaal FR, van der Bom JG, Gouw SC. Validation of PROMIS Profile-29 in adults with hemophilia in the Netherlands. J Thromb Haemost 2021; 19:2687-2701. [PMID: 34245088 PMCID: PMC8596807 DOI: 10.1111/jth.15454] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS) Profile-29 questionnaire is widely used worldwide, but it has not yet been validated in the Netherlands, nor in persons with hemophilia. OBJECTIVE To validate the Dutch-Flemish version of the PROMIS-29 Profile v2.01 in adults with hemophilia. METHODS Dutch males with hemophilia (all severities) completed questionnaires that contained sociodemographic and clinical characteristics, the PROMIS-29, RAND-36, and the Hemophilia Activities List (HAL). Structural validity of each subscale was assessed with confirmatory factor analysis (CFA). Internal consistency was calculated for each subscale with sufficient model fit in CFA. Construct validity was assessed by testing hypotheses about (1) correlations of each PROMIS-29 subscale with corresponding scales of RAND-36 and domains of HAL, and (2) mean differences in T-scores between subgroups with different hemophilia severities, self-reported joint impairment, and HIV infection status. We considered ≥75% of data in accordance with the hypotheses evidence for construct validity. RESULTS In total, 770 persons with hemophilia participated in this cross-sectional study. CFA revealed sufficient structural validity for five subscales: Physical Function, Depression, Sleep Disturbance, Ability to Participate in Social Roles and Activities, and Pain Interference. Internal consistency was high and Cronbach's alpha ranged from 0.79 for Sleep Disturbance to 0.96 for Pain Interference. Differences between clinical subgroups were in the expected direction. Construct validity was confirmed for Physical Function, Anxiety, Depression, Fatigue, Sleep Disturbance, and Pain Intensity. CONCLUSION This study revealed sufficient evidence for structural validity, internal consistency, and construct validity for most PROMIS Profile-29 subscales among people with hemophilia in the Netherlands.
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Affiliation(s)
- Erna C. van Balen
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Lotte Haverman
- Child and Adolescent Psychiatry & Psychosocial CareAmsterdam Reproduction and DevelopmentAmsterdam Public HealthEmma Children’s HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Shermarke Hassan
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Elisabeth M. Taal
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Cees Smit
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Erik A. M. Beckers
- Department of HematologyMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Michiel Coppens
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jeroen Eikenboom
- Department of Internal MedicineDivision of Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - Hélène L. Hooimeijer
- Department of PaediatricsUniversity Medical Center GroningenGroningenThe Netherlands
| | | | - Lize F. D. van Vulpen
- Department of Benign HematologyVan CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Saskia E. M. Schols
- Department of HematologyRadboud University Medical CenterNijmegenthe Netherlands
- Hemophilia Treatment Center Nijmegen‐Eindhoven‐MaastrichtNijmegenThe Netherlands
| | - Caroline B. Terwee
- Department of Epidemiology and Data ScienceAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamThe Netherlands
| | - Frits R. Rosendaal
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Johanna G. van der Bom
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Center for Clinical Transfusion ResearchSanquin Research/LUMCLeidenThe Netherlands
| | - Samantha C. Gouw
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Pediatric HematologyEmma Children’s HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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Witkop M, Santaella M, Nichols CD, Lambing AY, Baumann K, Curtis RG, Humphrey C, Humphries TJ, Newman J, Fritz R, Mauer K, Thibodeaux CB, Wheat E, Buckner T. Understanding the Pain Management Landscape within the US Bleeding Disorder Community: A Multi-Center Survey. PAIN MEDICINE 2021; 23:269-279. [PMID: 34185087 PMCID: PMC8807078 DOI: 10.1093/pm/pnab196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives Pain is a known complication in persons with hemophilia (PWH) as a result of muscle and joint bleeding. Little is known regarding national Hemophilia Treatment Center (HTC) practice patterns related to pain management. The aim of this study was to: 1) Describe pain management practice patterns of HTC providers, 2) Identify gaps and areas of alignment with the CDC pain guidelines, and 3) Address educational opportunities for pain management. This survey is the first extensive description of multidisciplinary practice patterns of pain management for PWH. Methods This descriptive study involved physicians, nurse practitioners, nurses, physical therapists, and social workers from federally funded Hemophilia Treatment Centers (HTC) eligible to complete an online survey exploring pain management practice patterns within the CDC pain guidelines. Results Results of this survey shed light on areas of strength and cohesiveness between HTC providers, including the following: dedication to effective pain management, utilization of non-pharmacological pain options, trial of non-opioid medications first before opioids, maintaining follow-up with patients after opioid prescription initiation, recognizing and utilizing clinically important findings before prescribing opioids, and counseling their patients regarding potential risk factors. Conclusions There remain opportunities to incorporate into clinical practice consistent use of tools such as formal screening questionnaires, opioid use agreements, written measurable goals, ongoing prescription monitoring, and written plans for discontinuation of opioid therapy. These results provide opportunities for improvement in education of HTC team members thus optimizing pain management in persons with bleeding disorders.
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Affiliation(s)
| | | | | | | | - Kimberly Baumann
- University of Minnesota Health-Center for Bleeding and Clotting Disorders
| | | | | | | | | | | | | | | | - Emily Wheat
- University of Colorado Anshultz Medical Campus
| | - Tyler Buckner
- University of Colorado School of Medicine, Hemophilia and Thrombosis Center
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Zhao Y, Hu Y, Jin J, Zhao X, Wang X, Wu R, Wu D, Yang R, Yang F, Hu Q, Wang J, Fang H, Engl W. Phase 4 Safety and Efficacy Study of Antihemophilic Factor (Recombinant) in Previously Treated Chinese Patients With Severe/Moderately Severe Hemophilia A. Clin Appl Thromb Hemost 2021; 27:1076029621989811. [PMID: 33587652 PMCID: PMC7890741 DOI: 10.1177/1076029621989811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Antihemophilic factor (recombinant) (rAHF; ADVATE®; Baxalta US Inc., a Takeda company, Lexington, MA, USA) is indicated for the treatment and prevention of bleeding in patients with hemophilia A. We aimed to assess the safety and efficacy of standard prophylaxis versus on-demand treatment with rAHF in previously treated Chinese patients with severe/moderately severe hemophilia A. This open-label, sequential, interventional, postapproval study (NCT02170402) conducted in China included patients of any age with hemophilia A with factor VIII (FVIII) level ≤2%. Patients received 6 months’ on-demand rAHF then 6 months’ rAHF prophylaxis (20-40 IU/kg every 48 ± 6 hours). The primary objective was percentage reduction in annualized bleeding rate (ABR) in the per-protocol analysis set (PPAS); secondary objectives included ABR by bleeding subtype, hemostatic efficacy, immunogenicity, and safety. Of 72 patients who received ≥1 rAHF dose, 61 were included in the PPAS. Total ABR was lower during prophylaxis (mean 2.5, 95% CI 1.5-3.7; median 0) versus on-demand treatment (mean 58.3, 95% CI 52.5-64.7; median 53.9), representing a 95.9% risk reduction. Similar findings in favor of prophylaxis were observed for all types of bleeding event by cause and location. rAHF hemostatic efficacy was rated as “excellent”/“good” in 96.1% of treated bleeding events. Transient FVIII inhibitors (0.6-1.7 BU) in 4 patients resolved before study end; no unexpected safety issues were observed. rAHF prophylaxis in this study of previously treated Chinese patients with severe/moderately severe hemophilia A resulted in a clear reduction in bleeding events versus rAHF on-demand treatment, with no change in safety profile.
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Affiliation(s)
| | - Yu Hu
- Union Hospital, 66375Tongji Medical College of Huazhong, Wuhan, China
| | - Jie Jin
- The First Affiliated Hospital of College of Medicine, 12377Zhejiang University, Hangzhou, China
| | - Xielan Zhao
- 159374Xiangya Hospital, Central South University, Changsha, China
| | - Xuefeng Wang
- 162762Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Runhui Wu
- 117984Beijing Children's Hospital, Capital University of Medical Sciences, Beijing, China
| | - Depei Wu
- 74566The First Affiliated Hospital of Soochow University, Soochow, China
| | - Renchi Yang
- Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin, China
| | - Feng'e Yang
- 117890Fujian Medical University Union Hospital, Fuzhou, China
| | - Qun Hu
- 66375Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Juan Wang
- Cangzhou Central Hospital, Cangzhou, China
| | - Hai Fang
- Shire BioScience (Shanghai) Co., Ltd., a Takeda Company, Shanghai, China
| | - Werner Engl
- Baxalta Innovations GmbH, a Takeda Company, Vienna, Austria
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6
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Wang M, Recht M, Iyer NN, Cooper DL, Soucie JM. Hemophilia without prophylaxis: Assessment of joint range of motion and factor activity. Res Pract Thromb Haemost 2020; 4:1035-1045. [PMID: 32864554 PMCID: PMC7443428 DOI: 10.1002/rth2.12347] [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: 09/24/2019] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recurrent joint bleeding in hemophilia results in arthropathy and functional impairment. The relationship of arthropathy development and factor activity (FA) has not been reported in patients with FA levels <15%-20%. METHODS During the Centers for Disease Control and Prevention Universal Data Collection, joint range-of-motion (ROM) measurements were taken at each comprehensive visit. Data were extracted from male patients with hemophilia (PWH) age ≥2 years with baseline factor activity levels ≤40%, excluding those prescribed prophylaxis, and used to calculate a proportion of normal ROM (PN-ROM) measure. Data were analyzed using regression models. RESULTS There were 6703 eligible PWH with 30 102 visits. PN-ROM declined with increasing age, and was associated with hemophilia severity, race/ethnicity, obesity, and viral illnesses. PWH ≥30 years old with fFA ≤2% and those ≥50 years old with FA ≤5% had mean PN-ROM values >10% less than controls; those ≥40 years old with FA <1% had values >20% less than controls. In the multivariable analysis, subjects with <1% FA had a 0.43% greater decrease (-0.49 to -0.37, 95% confidence interval) in PN-ROM each year relative to those with 16%-40% factor activity. A less pronounced effect was seen with 1%-5% or 6%-9% FA. CONCLUSION The effect of FA on ROM loss is far greater than that of any of the other characteristics, especially with FA <10%. This emphasizes the need to maintain a high index of suspicion for arthropathy in individuals with moderate and low-mild hemophilia.
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Affiliation(s)
- Michael Wang
- Hemophilia and Thrombosis CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Michael Recht
- The Hemophilia Center at Oregon Health & Science UniversityPortlandOregonUSA
| | - Neeraj N. Iyer
- Novo Nordisk Inc.Clinical, Medical, and Regulatory AffairsPlainsboroNew JerseyUSA
| | - David L. Cooper
- Novo Nordisk Inc.Clinical, Medical, and Regulatory AffairsPlainsboroNew JerseyUSA
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Buckner TW, Sidonio R, Witkop M, Guelcher C, Cutter S, Iyer NN, Cooper DL. Correlations between patient-reported outcomes and self-reported characteristics in adults with hemophilia B and caregivers of children with hemophilia B: analysis of the B-HERO-S study. PATIENT-RELATED OUTCOME MEASURES 2019; 10:299-314. [PMID: 31572035 PMCID: PMC6755243 DOI: 10.2147/prom.s219166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/19/2019] [Indexed: 02/05/2023]
Abstract
Purpose Pain, anxiety, depression, and other aspects of health-related quality of life (HRQoL) are important issues for people with hemophilia and caregivers of children with hemophilia. Patient-reported outcome (PRO) instruments may be used to assess aspects of HRQoL; however, the use of PROs in clinical management of patients with hemophilia is limited and inconsistent. The Bridging Hemophilia B Experiences, Results and Opportunities Into Solutions (B-HERO-S) study evaluated the impact of hemophilia B on HRQoL and other psychosocial aspects in affected adults and caregivers of children with hemophilia B. This post hoc analysis assessed correlations between PRO scores and psychosocial questions commonly asked in comprehensive care settings among B-HERO-S respondents. Patients and methods B-HERO-S consisted of two online surveys, one administered to adults with hemophilia B (n=299) and one administered to caregivers of children with hemophilia B (n=150). The adult survey included EQ-5D-5L with visual analog scale, BPI, HAL, and PHQ-9. The caregiver survey included PHQ-9 and GAD-7. Questions related to demographics, hemophilia treatment, and psychosocial questions asked in comprehensive care visits were also included in the surveys. A post hoc analysis was performed to assess correlations between responses to selected psychosocial questions with PRO scores. Results For adults with hemophilia B, greater pain severity and pain interference scores were associated with work-related problems, functional limitations, and relationship, psychological, and treatment issues. Significant correlations were also noted between some of these psychosocial outcomes and depressive symptoms. For caregivers, greater depression and anxiety were associated with employment issues, their child’s functional, relationship, and psychological issues, having had difficulty or concerns with treatment/factor availability or affordability, and having less frequent HTC visits. Conclusion High correlations were observed between PRO scores measuring pain, depression, and anxiety and questions commonly used in the comprehensive care setting to assess the psychosocial impact of hemophilia.
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Affiliation(s)
- Tyler W Buckner
- Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert Sidonio
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Christine Guelcher
- Hemostasis and Thrombosis Program, Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC, USA
| | - Susan Cutter
- Penn Comprehensive Hemophilia and Thrombosis Center, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Mahlangu J, Oldenburg J, Callaghan MU, Shima M, Mancuso ME, Trask P, Recht M, Garcia C, Yang R, Lehle M, Macharia H, Asikanius E, Levy GG, Kruse‐Jarres R, von Mackensen S. Health-related quality of life and health status in persons with haemophilia A with inhibitors: A prospective, multicentre, non-interventional study (NIS). Haemophilia 2019; 25:382-391. [PMID: 31016855 PMCID: PMC6850115 DOI: 10.1111/hae.13731] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/15/2019] [Accepted: 02/19/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Real-world data (RWD) on health-related outcomes in persons with haemophilia A (PwHA) provide insights into patient needs and can guide clinical study design. A global, prospective, non-interventional study (NIS; NCT02476942) collected detailed RWD on bleeding outcomes, health-related quality of life (HRQoL) and health status in PwHA treated per local routine clinical practice. AIM To report HRQoL and health status in the adult/adolescent PwHA with inhibitors cohort in the NIS. METHODS This cohort enrolled PwHA aged ≥12 years with high-titre factor VIII inhibitor history. Participants remained on their usual treatment (no protocol-specified interventions). Health-related outcomes: Haemophilia Quality of Life Questionnaire for Adults (Haem-A-QoL), Haemophilia-specific Quality of Life Questionnaire for Children Short Form (Haemo-QoL SF), EuroQol 5-Dimensions 5-Levels (EQ-5D-5L) index utility score (IUS) and visual analogue scale (EQ-VAS). RESULTS One hundred three participants were enrolled on episodic (n = 75) or prophylactic treatment (n = 28); median (range) age, 31 (12-75) years; median (range) observation time, 26 (4-70) weeks. Haem-A-QoL scores indicated impairments in HRQoL aspects; comparable between episodic/prophylactic regimens and relatively consistent over time. Haemo-QoL SF scores with both regimens varied over time, and appeared poorer with episodic than prophylactic treatment. IUS and EQ-VAS were comparable between regimens, stable over time and lower on bleeding days. Mean proportions of missed work and school days were 16% and 23%, respectively; mean (standard deviation) number of days hospitalized was 3.2 (8.8) (comparable between groups). CONCLUSIONS These RWD demonstrate that PwHA with inhibitors have impaired HRQoL, despite standard treatment, and that more effective treatment options are needed.
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Affiliation(s)
- Johnny Mahlangu
- Haemophilia Comprehensive Care Centre, Faculty of Health SciencesUniversity of the Witwatersrand and NHLSJohannesburgSouth Africa
| | - Johannes Oldenburg
- Department of Experimental Haematology and Transfusion MedicineUniversity Clinic BonnBonnGermany
| | | | - Midori Shima
- Department of PediatricsNara Medical UniversityKashihara, NaraJapan
| | | | - Peter Trask
- Genentech, Inc.South San FranciscoCalifornia
| | | | | | - Renchi Yang
- Institute of Hematology and Blood Diseases HospitalChinese Academy of Medical SciencesTianjinChina
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9
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Buckner TW, Sidonio R, Guelcher C, Kessler CM, Witkop M, Clark D, Owens W, Fridman M, Iyer NN, Cooper DL. Reliability and validity of patient-reported outcome instruments in US adults with hemophilia B and caregivers in the B-HERO-S study. Eur J Haematol 2018; 101:781-790. [PMID: 30179272 DOI: 10.1111/ejh.13168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the reliability and validity of six patient-reported outcomes (PRO) instruments for evaluating health-related quality of life in adults with mild-severe hemophilia B and caregivers of children with hemophilia B, including affected women/girls. METHODS Adults with hemophilia B and caregivers completed separate online surveys containing several PRO instruments, which were administered to adult participants only (EQ-5D-5L, Brief Pain Inventory v2 Short Form, Hemophilia Activities List, and International Physical Activities Questionnaire), both adults and caregivers (Patient Health Questionnaire [PHQ-9]), or caregivers only (Generalized Anxiety Disorder 7-Item [GAD-7] scale). Construct validity and item-total correlation were assessed using Pearson product-moment correlation, internal consistency was assessed using Cronbach's alpha coefficient, and known-group validity was assessed by comparisons to self-reported characteristics based on the Kruskal-Wallis test. RESULTS Patient-reported outcomes instruments generally showed satisfactory reliability for adults (n = 299) and caregivers (n = 150). In adults, PRO instruments generally showed high construct validity. Most PRO instruments showed expected significant differences among known groups for adults and caregivers. PHQ-9 and GAD-7 did not show significant differences among caregiver age groups. CONCLUSIONS Patient-reported outcomes instruments administered in B-HERO-S demonstrated reliability and validity in the broader population of adults with hemophilia B and caregivers when including all severities and genders.
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Affiliation(s)
| | | | | | - Craig M Kessler
- Georgetown University Hospital, Washington, District of Columbia
| | | | - David Clark
- The Coalition for Hemophilia B, New York, New York
| | - Wendy Owens
- Hemophilia Federation of America, Washington, District of Columbia
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10
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孙 雪, 庄 金, 周 璇, 李 惠, 柳 竹, 孙 竞. [Efficacy of short-term full-dose prophylaxis in adult Chinese patients with severe hemophilia A]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:1222-1227. [PMID: 30377129 PMCID: PMC6744067 DOI: 10.3969/j.issn.1673-4254.2018.10.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the efficacy of short-term full-dose prophylaxis in adult Chinese patients with severe hemophilia A. METHODS Thirteen adult Chinese patients with severe hemophilia A receiving on-demand or low-dose prophylaxis underwent ultrasound examination of the target joints and evaluation of Hemophilia Joint Health Score (HJHS). The data of annual bleeding episodes in the period of on-demand or low-dose prophylaxis were collected retrospectively from the patients, and the changes in bleeding and joint condition (ultrasound findings of the target joints and HJHS) were observed during short-term full-dose prophylaxis. The activity intensity of the patients was assessed using the IPAQ questionnaire, and the 72 h FⅧ trough activity was measured during full-dose prophylaxis. RESULTS The median age of the 13 patients was 26.0 (20.5-29.0) years. For full-dose prophylaxis, the patients received a median therapeutic dose of 31.0 (29.1-33.0) IU/kg, administered for 3 times per week; the median 72 h FⅧ trough activity of patients was 1.7% (1.3-3.4%). During the follow-up period for 3 months, the annual bleeding rates (ABR) and annual joint bleeding rates (AJBR) decreased significantly in all the patients (P=0.001 and 0.001, respectively), but zero bleeding was achieved in only 4 patients (30.8%) and zero joint bleeding in 7 patients (53.8%); 9 patients (69.2%) still experienced breakthrough bleeding. The damage severity of target joints assessed by ultrasound and HJHS in 6 patients (46.2%)was worse than before and no obvious progression of target joints damage was found in 7 patients (53.8%). Compared with the patients without progression, the patients with worsened joint damage had poorer baseline joint condition, higher bleeding frequencies before and during the follow-up, a higher intensity of physical activity, and a lower baseline FⅧ activity. CONCLUSIONS At present, although short-term full-dose prophylaxis can significantly reduce the bleeding and partially prevent the progression of joint damage, it is not yet possible to achieve the goal of zero bleeding for all adult patients with severe hemophilia A in China, nor can it completely prevent further joint damage. For adult patients with different clinical bleeding phenotypes, joint conditions and physical activity intensity, individualized therapy involving additional evaluation methods should be implemented, and physiotherapy and surgical intervention can be considered when necessary.
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Affiliation(s)
- 雪岩 孙
- />南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - 金木 庄
- />南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - 璇 周
- />南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - 惠萍 李
- />南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - 竹琴 柳
- />南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - 竞 孙
- />南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
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Batt K, Boggio L, Neff A, Buckner TW, Wang M, Quon D, Witkop M, Recht M, Kessler C, Iyer NN, Cooper DL. Patient-reported outcomes and joint status across subgroups of US adults with hemophilia with varying characteristics: Results from the Pain, Functional Impairment, and Quality of Life (P-FiQ) study. Eur J Haematol 2018; 100 Suppl 1:14-24. [PMID: 29498783 DOI: 10.1111/ejh.13028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Pain and functional impairment associated with joint disease are major problems for people with hemophilia, and impact on health-related quality of life (HRQoL) may vary across groups defined by demographic and treatment-related characteristics. OBJECTIVE To evaluate differences in overall HRQoL, pain, function, and joint status between P-FiQ study subgroups. METHODS Adult males with hemophilia and a history of joint pain/bleeding completed a pain history and the patient-reported outcome instruments EQ-5D-5L, Brief Pain Inventory v2 Short Form (BPI), International Physical Activity Questionnaire (IPAQ), and Hemophilia Activities List (HAL); optionally, joint status was assessed (Hemophilia Joint Health Score v2.1 [HJHS]). Scores were analyzed between subgroups across sets of participant characteristics. RESULTS A total of 381 adult males with hemophilia were enrolled, with median age of 34 years. Worse scores on EQ-5D-5L index, BPI pain severity/interference, HAL overall score, and HJHS were generally associated with being college educated, unemployment, self-reporting both acute and chronic pain, and self-reporting anxiety/depression. CONCLUSIONS Measures of joint status and HRQoL were consistently lower in participants who had higher educational levels, were unemployed, self-reported having both acute and chronic pain, and self-reported having anxiety/depression. A greater understanding of the association of these factors with disease outcomes may improve individualized patient management.
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Affiliation(s)
| | - Lisa Boggio
- Rush University Medical Center, Chicago, IL, USA
| | - Anne Neff
- Cleveland Clinic, Cleveland, OH, USA
| | | | - Michael Wang
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Doris Quon
- Orthopaedic Hemophilia Treatment Center, Orthopaedic Institute for Children, Los Angeles, CA, USA
| | | | - Michael Recht
- Oregon Health & Science University, Portland, OR, USA
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Buckner TW, Witkop M, Guelcher C, Sidonio R, Kessler CM, Clark DB, Owens W, Frick N, Iyer NN, Cooper DL. Impact of hemophilia B on quality of life in affected men, women, and caregivers-Assessment of patient-reported outcomes in the B-HERO-S study. Eur J Haematol 2018; 100:592-602. [DOI: 10.1111/ejh.13055] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 01/19/2023]
Affiliation(s)
| | | | | | - Robert Sidonio
- Emory University and Children's Healthcare of Atlanta; Atlanta GA USA
| | | | | | - Wendy Owens
- Hemophilia Federation of America; Washington DC USA
| | - Neil Frick
- National Hemophilia Foundation; New York NY USA
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Buckner TW, Batt K, Cooper DL, Kempton CL. What can we learn from using formal patient-reported outcome instruments to assess pain, functional impairment, anxiety, and depression in US adults with hemophilia? Eur J Haematol 2018; 100 Suppl 1:3-4. [PMID: 29498785 DOI: 10.1111/ejh.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 11/27/2022]
Abstract
People with hemophilia frequently suffer from arthropathy that leads to pain and functional impairment, ultimately resulting in reduced quality of life. The impact of pain and functional impairment on the lives of people with hemophilia was explored in the Pain, Functional Impairment, and Quality of Life (P-FiQ) study. Various patient-reported outcome (PRO) instruments were employed to assess the effect of pain and functional impairment on multiple aspects of health in people with hemophilia. The results presented in this supplement include detailed observations from PRO instruments regarding pain, functional impairment, anxiety, and depression, an analysis of the differences in health-related quality of life across subgroups of patients defined by demographic and treatment-related characteristics, and results of a modeling analysis to identify patient factors which influence perceptions of pain and functional impairment, independent of joint status. These data provide insights into how the results from PRO assessments may be used to evaluate outcomes for people with hemophilia in the clinical and research settings.
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Kempton CL, Buckner TW, Fridman M, Iyer NN, Cooper DL. Factors associated with pain severity, pain interference, and perception of functional abilities independent of joint status in US adults with hemophilia: Multivariable analysis of the Pain, Functional Impairment, and Quality of Life (P-FiQ) study. Eur J Haematol 2018; 100 Suppl 1:25-33. [DOI: 10.1111/ejh.13025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 01/31/2023]
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Kempton CL, Recht M, Neff A, Wang M, Buckner TW, Soni A, Quon D, Witkop M, Boggio L, Gut RZ, Cooper DL. Impact of pain and functional impairment in US adults with haemophilia: Patient-reported outcomes and musculoskeletal evaluation in the pain, functional impairment and quality of life (P-FiQ) study. Haemophilia 2017; 24:261-270. [DOI: 10.1111/hae.13377] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2017] [Indexed: 01/19/2023]
Affiliation(s)
| | - M. Recht
- Oregon Health & Science University; Portland OR USA
| | - A. Neff
- Cleveland Clinic; Cleveland OH USA
| | - M. Wang
- University of Colorado School of Medicine; Aurora CO USA
| | - T. W. Buckner
- University of Colorado School of Medicine; Aurora CO USA
| | - A. Soni
- Center for Inherited Blood Disorders; CHOC Children's Hospital/UC Irvine; Orange CA USA
| | - D. Quon
- Orthopaedic Hemophilia Treatment Center; Orthopaedic Institute for Children; Los Angeles CA USA
| | - M. Witkop
- Munson Medical Center; Traverse City MI USA
| | - L. Boggio
- Rush University Medical Center; Chicago IL USA
| | - R. Z. Gut
- Novo Nordisk Inc.; Plainsboro NJ USA
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Wang M, Batt K, Kessler C, Neff A, Iyer NN, Cooper DL, Kempton CL. Internal consistency and item-total correlation of patient-reported outcome instruments and hemophilia joint health score v2.1 in US adult people with hemophilia: results from the Pain, Functional Impairment, and Quality of life (P-FiQ) study. Patient Prefer Adherence 2017; 11:1831-1839. [PMID: 29123383 PMCID: PMC5661843 DOI: 10.2147/ppa.s141391] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The Pain, Functional Impairment, and Quality of Life study was an observational, cross-sectional assessment of the impact of pain on functional impairment and quality of life in adult people with hemophilia (PWH) of any severity in the USA who experience joint pain and/or bleeding. OBJECTIVE To assess internal consistency (IC) and item-total correlation (ITC) of assessment tools used in the Pain, Functional Impairment, and Quality of Life study. METHODS Participants completed 5 patient-reported outcome instruments (EQ-5D-5L with visual analog scale, Brief Pain Inventory v2 Short Form [BPI], International Physical Activity Questionnaire [IPAQ], Short Form 36 Health Survey v2 [SF-36v2], and Hemophilia Activities List [HAL]) and underwent an optional physiotherapist-administered musculoskeletal exam (Hemophilia Joint Health Score v2.1) during routine visits. Reliability assessment included IC and ITC of each instrument. RESULTS A total of 381 adult PWH (median age, 34 years) were enrolled. Participants were predominantly white/non-Hispanic (69.2%); 75% had congenital hemophilia A, and 70.5% had severe hemophilia. A total of 310 subjects reported bleeding within the past 6 months (mean [SD] number of bleeds, 7.1 [13.00]). IC was generally high across the instruments employed (Cronbach's alpha 0.79-0.98) with the exception of HAL use of transportation (0.58) and IPAQ total physical activity (0.51). ITC was high (Pearson's product-moment correlation coefficient >0.20) for all items except the "vigorous intensity activities" item of IPAQ, which was applicable to less than one-third of participants. The ITCs were generally highest in domains/scores that measured the functional consequences of hemophilic arthropathy on mobility and pain. CONCLUSION The demonstrated reliability (IC/ITC) of the patient-reported outcome instruments and Hemophilia Joint Health Score v2.1 support a role for these instruments in evaluating adult PWH in US clinical and research settings.
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Affiliation(s)
- Michael Wang
- Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora, CO
| | - Katharine Batt
- Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Craig Kessler
- Department of Medicine and Pathology, Division of Hematology/Oncology, Georgetown University Hospital, Washington, DC
| | - Anne Neff
- Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Neeraj N Iyer
- Novo Nordisk Inc., Clinical, Medical, and Regulatory Affairs, Plainsboro, NJ
| | - David L Cooper
- Novo Nordisk Inc., Clinical, Medical, and Regulatory Affairs, Plainsboro, NJ
| | - Christine L Kempton
- Departments of Pediatrics and Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Buckner TW, Wang M, Cooper DL, Iyer NN, Kempton CL. Known-group validity of patient-reported outcome instruments and hemophilia joint health score v2.1 in US adults with hemophilia: results from the Pain, Functional Impairment, and Quality of life (P-FiQ) study. Patient Prefer Adherence 2017; 11:1745-1753. [PMID: 29066870 PMCID: PMC5644599 DOI: 10.2147/ppa.s141392] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The Pain, Functional Impairment, and Quality of Life (P-FiQ) study was an observational, cross-sectional assessment of the impact of pain on functional impairment and quality of life in adults with hemophilia in the United States who experience joint pain or bleeding. OBJECTIVE To describe known-groups validity of assessment tools used in the P-FiQ study. PATIENTS AND METHODS Participants completed 5 patient-reported outcome (PRO) instruments (5-level EuroQoL 5-dimensional questionnaire [EQ-5D-5L] with visual analog scale [VAS], Brief Pain Inventory v2 Short Form [BPI], International Physical Activity Questionnaire [IPAQ], Short-Form Health Survey [SF-36v2], and Hemophilia Activities List [HAL]) and underwent a musculoskeletal examination (Hemophilia Joint Health Score [HJHS]) during a routine clinical visit. RESULTS P-FiQ enrolled 381 adults with hemophilia (median age, 34 years). Participants were predominantly white/non-Hispanic (69.2%), 75% had congenital hemophilia A, and 70.5% had severe hemophilia. Most (n=310) reported bleeding within the past 6 months (mean [SD] number of bleeds, 7.1 [13.00]). All instruments discriminated between relevant known (site- or self-reported) participant groups. Domains related to pain on EQ-5D-5L, BPI, and SF-36v2 discriminated self-reported pain (acute/chronic/both; P<0.05), domains related to functional impairment on IPAQ, SF-36v2, and HAL discriminated self-reported functional impairment (restricted/unrestricted; P<0.05), and domains related to mental health on the EQ-5D-5L and SF-36v2 discriminated self-reported anxiety/depression (yes/no; P<0.01). HJHS ankle and global gait domains and global score discriminated self-reported arthritis/bone/joint problems, percentage of lifetime on prophylaxis, current treatment regimen, and hemophilia severity (P<0.01); knee and elbow domains discriminated all of these (P<0.01) except for current treatment regimen. CONCLUSION All assessment tools demonstrated known-group validity and may have practical applicability in evaluating adults with hemophilia in clinical and research settings in the United States.
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Affiliation(s)
- Tyler W Buckner
- Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora, CO
| | - Michael Wang
- Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora, CO
| | - David L Cooper
- Novo Nordisk Inc., Clinical, Medical, and Regulatory Affairs, Plainsboro, NJ
| | - Neeraj N Iyer
- Novo Nordisk Inc., Clinical, Medical, and Regulatory Affairs, Plainsboro, NJ
| | - Christine L Kempton
- Departments of Pediatrics and Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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