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Howell TA, Matza LS, Stone JH, Gelinas D, Stone MN, Rao VTS, Phillips GA. Qualitative interviews to support development of a patient-reported companion measure to the Glucocorticoid Toxicity Index. J Neurol Sci 2024; 458:122907. [PMID: 38309251 DOI: 10.1016/j.jns.2024.122907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Glucocorticoids (GCs) are associated with multiple toxicities that have substantial impact on patients. We conducted qualitative interviews with patients to identify the toxicities that are most relevant from their perspective, with the goal of creating a patient-reported companion measure to the Glucocorticoid Toxicity Index (GTI), a clinician-facing instrument. METHODS Thirty-one patients with recent or current GC use participated in concept elicitation interviews. Participants received GC treatment for myasthenia gravis, chronic inflammatory demyelinating polyradiculoneuropathy, vasculitis, or systemic lupus erythematosus. Transcripts were coded following a thematic analysis approach. RESULTS Participants reported more than 100 toxicities they believed to be associated with their GC medications. Common toxicities included weight gain (87%), increased appetite (84%), insomnia/sleep problems (77%), cognitive impairment/brain fog (71%), easy bruising (68%), anxiety (65%), irritability/short temper (65%), and osteoporosis (39%). These toxicities often centered on self-esteem, neuropsychiatric effects, skin toxicities, and musculoskeletal function. They can be categorized into domains such emphasizing neuropsychiatric, metabolic/endocrine, musculoskeletal, and dermatological effects, highlighting aspects of GC toxicity that patients are uniquely positioned to appreciate and report. CONCLUSION Our results confirm that the toxicities associated with GCs are pervasive and diverse, with substantial impact on patients' lives. These data will be used to inform the development of a patient-reported outcome measure assessing GC toxicity. This patient-reported instrument will be designed to complement the clinician-reported GTI, facilitating a more detailed understanding of the nuances of change in GC toxicity.
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Affiliation(s)
| | - Louis S Matza
- Patient-Centered Research, Evidera, Bethesda, MD, USA
| | - John H Stone
- Division of Rheumatology, Allergy, and Immunology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
| | - Deborah Gelinas
- Health Economics and Outcomes Research, Argenx, Boston, MA, USA
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Saccà F, Barnett C, Vu T, Peric S, Phillips GA, Zhao S, Qi CZ, Gelinas D, Chiroli S, Verschuuren JJGM. Efgartigimod improved health-related quality of life in generalized myasthenia gravis: results from a randomized, double-blind, placebo-controlled, phase 3 study (ADAPT). J Neurol 2023; 270:2096-2105. [PMID: 36598575 PMCID: PMC10025199 DOI: 10.1007/s00415-022-11517-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/26/2022] [Accepted: 12/03/2022] [Indexed: 01/05/2023]
Abstract
There are substantial disease and health-related quality-of-life (HRQoL) burdens for many patients with myasthenia gravis (MG), especially for those whose disease symptoms are not well controlled. HRQoL measures such as the Myasthenia Gravis Quality of Life 15-item revised (MG-QOL15r) and EuroQoL 5-Dimensions 5-Levels (EQ-5D-5L) are vital for evaluating the clinical benefit of therapeutic interventions in patients with MG, as they assess the burden of disease and the effectiveness of treatment, as perceived by patients. The phase 3 ADAPT study (NCT03669588) demonstrated that efgartigimod-a novel neonatal Fc receptor inhibitor-was well tolerated and that acetylcholine receptor antibody-positive (AChR-Ab+) participants who received efgartigimod had statistically significant improvements in MG-specific clinical scale scores. The ancillary data reported here, which cover an additional treatment cycle, show that these participants had similar significant improvements in HRQoL measures, the MG-QOL15r and EQ-5D-5L utility and visual analog scales, and that these improvements were maintained in the second treatment cycle. Positive effects on HRQoL were rapid, seen as early as the first week of treatment in both treatment cycles, and maintained for up to 4 weeks in the follow-up-only portion of treatment cycles. The pattern of improvements in HRQoL paralleled changes in immunoglobulin G level, and correlational analyses show that improvements were consistent across HRQoL measures and with clinical efficacy measures in the ADAPT study. The substantial and durable improvements in HRQoL end points in this study demonstrate the broader benefit of treatment with efgartigimod beyond relief of immediate signs and symptoms of gMG.
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Affiliation(s)
| | - Carolina Barnett
- Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital/UHN, Toronto, ON, Canada
| | - Tuan Vu
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Stojan Peric
- University of Belgrade-Faculty of Medicine, University Clinical Center of Serbia-Neurology Clinic, Belgrade, Serbia
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Muppidi S, Silvestri NJ, Tan R, Riggs K, Leighton T, Phillips GA. Utilization of MG-ADL in myasthenia gravis clinical research and care. Muscle Nerve 2022; 65:630-639. [PMID: 34989427 PMCID: PMC9302997 DOI: 10.1002/mus.27476] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
Abstract
The Myasthenia Gravis Activities of Living (MG‐ADL) scale is an 8‐item patient‐reported scale that measures myasthenia gravis (MG) symptoms and functional status. The objective of the current review is to summarize the psychometric properties of the MG‐ADL and published evidence of MG‐ADL use. A targeted literature review for published studies of the MG‐ADL was conducted using a database and gray literature search. A total of 48 publications and 35 clinical trials were included. Studies indicated that the MG‐ADL is a reliable and valid measure that has been used as an outcome in clinical trials and observational studies to measure MG symptoms and response to treatment. While most often used as a secondary endpoint in clinical trials, its use as a primary endpoint has increased in recent years. The most common MG‐ADL endpoint is change in MG‐ADL score from baseline, although there has been an increase in the analysis of a responder threshold using the MG‐ADL. A new concept of minimal symptom expression (MSE) has emerged more recently. Duration of treatment effect is another important construct that is being increasingly evaluated using the MG‐ADL. The use of the MG‐ADL as a primary endpoint in clinical trials and in responder threshold analyses to indicate treatment improvement has increased in recent years. MSE using the MG‐ADL shows promise in helping to determine success of treatment and may be the aspirational goal of MG treatment for the future once validated, particularly given the evolving treatment landscape in MG.
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Affiliation(s)
- Srikanth Muppidi
- Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Nicholas J Silvestri
- Department of Neurology, State University of New York, Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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Matza LS, Phillips GA, Howell TA, Ciffone N, Ahmad Z. Estimating health state utilities associated with a rare disease: familial chylomicronemia syndrome (FCS). J Med Econ 2020; 23:978-984. [PMID: 32479143 DOI: 10.1080/13696998.2020.1776719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: Familial chylomicronemia syndrome (FCS) is a rare genetic disorder with no currently approved therapies. Treatments are in development, and cost-utility analyses will be needed to examine their value. These models will require health state utilities representing FCS. Therefore, the purpose of this study was to estimate utilities for FCS and an associated episode of acute pancreatitis (AP).Methods: Because it is not feasible to gather a large enough sample of patients with this extremely rare condition to complete standardized preference-based measures, vignette-based methods were used to estimate utilities. In time trade-off interviews, general population participants in the UK and Canada valued health state vignettes drafted based on literature review, clinician input, and interviews with patients. Four health states described variations of FCS. A fifth health state, describing AP, was added to one of the other health states to evaluate its impact on utility.Results: A total of 308 participants provided utility data (208 UK; 100 Canada). Mean utilities for FCS health states ranged from 0.46 to 0.83, with higher triglycerides, more severe symptoms, and a history of AP associated with lower utility values. The disutility (i.e. utility decrease) of AP ranged from -0.17 to -0.25, with variations depending on the health state to which it was added. Utility means were similar in the UK and Canada.Conclusions: The vignette-based approach is useful for estimating utilities of a rare disease. The health state utilities derived in this study would be useful in models examining cost-effectiveness of treatments for FCS.
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Affiliation(s)
- Louis S Matza
- Patient-Centered Research, Evidera, Bethesda, MD, USA
| | - Glenn A Phillips
- Value & Evidence Generation, Rhythm Pharmaceuticals, Boston, MA, USA
| | | | | | - Zahid Ahmad
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Rao SM, Galioto R, Sokolowski M, McGinley M, Freiburger J, Weber M, Dey T, Mourany L, Schindler D, Reece C, Miller DM, Bethoux F, Bermel RA, Williams JR, Levitt N, Phillips GA, Rhodes JK, Alberts J, Rudick RA. Multiple Sclerosis Performance Test: validation of self-administered neuroperformance modules. Eur J Neurol 2020; 27:878-886. [PMID: 32009276 DOI: 10.1111/ene.14162] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/07/2019] [Accepted: 12/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The purpose was to determine the test-retest reliability, practice effects, convergent validity and sensitivity to multiple sclerosis (MS) disability of neuroperformance subtests from the patient self-administered Multiple Sclerosis Performance Test (MSPT) designed to assess low contrast vision (Contrast Sensitivity Test, CST), upper extremity motor function (Manual Dexterity Test, MDT) and lower extremity motor function (Walking Speed Test, WST) and to introduce the concept of regression-based norms to aid clinical interpretation of performance scores using the MSPT cognition test (Processing Speed Test, PST) as an example. METHODS Substudy 1 assessed test-retest reliability, practice effects and convergent validity of the CST, MDT and WST in 30 MS patients and 30 healthy controls. Substudy 2 examined sensitivity to MS disability in over 600 MS patients as part of their routine clinic assessment. Substudy 3 compared performance on the PST in research volunteers and clinical samples. RESULTS The CST, MDT and WST were shown to be reliable, valid and sensitive to MS outcomes. Performance was comparable to technician-administered testing. PST performance was poorer in the clinical sample compared with the research volunteer sample. CONCLUSIONS The self-administered MSPT neuroperformance modules produce reliable, objective metrics that can be used in clinical practice and support outcomes research. Published studies which require patient voluntary consent may underestimate the rate of cognitive dysfunction observed in a clinical setting.
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Affiliation(s)
- S M Rao
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.,Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - R Galioto
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - M Sokolowski
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - M McGinley
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - J Freiburger
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - M Weber
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - T Dey
- Department of Quantitative Health Sciences, Learner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - L Mourany
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D Schindler
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.,Qr8Health, Boston, MA, USA
| | - C Reece
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D M Miller
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - F Bethoux
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - R A Bermel
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | | | | | - J Alberts
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Rhodes JK, Schindler D, Rao SM, Venegas F, Bruzik ET, Gabel W, Williams JR, Phillips GA, Mullen CC, Freiburger JL, Mourany L, Reece C, Miller DM, Bethoux F, Bermel RA, Krupp LB, Mowry EM, Alberts J, Rudick RA. Multiple Sclerosis Performance Test: Technical Development and Usability. Adv Ther 2019; 36:1741-1755. [PMID: 31054035 PMCID: PMC6824297 DOI: 10.1007/s12325-019-00958-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Indexed: 11/28/2022]
Abstract
Introduction In the clinic, the assessment of patients with multiple sclerosis (MS) is typically qualitative and non-standardized. Objectives To describe the MS Performance Test (MSPT), an iPad Air® 2 (Apple, Cupertino, CA, USA)-based neurological assessment platform allowing patients to input relevant information without the aid of a medical technician, creating a longitudinal, clinically meaningful, digital medical record. To report results from human factor (HF) and usability studies, and the initial large-scale implementation in a practice setting. Methods The HF study examined use-error patterns in small groups of MS patients and healthy controls (n = 14), the usability study assessed the effectiveness of patient interaction with the tool by patients with a range of MS disability (n = 60) in a clinical setting, and the implementation study deployed the MSPT across a diverse population of patients (n = 1000) in a large MS center for routine clinical care. Results MSPT assessments were completed by all users in the HF study; minor changes to design were recommended. In the usability study, 73% of patients with MS completed the MSPT, with an average administration time of 32 min; 85% described their experience with the tool as satisfactory. In the initial implementation for routine care, 84% of patients with MS completed the MSPT, with an average administration time of 28 min. Conclusion Patients with MS with varying disability levels completed the MSPT with minimal or no supervision, resulting in comprehensive, efficient, standardized, quantitative, clinically meaningful data collection as part of routine medical care, thus allowing for large-scale, real-world evidence generation. Funding Biogen. Trial Registration NCT02664324. Electronic supplementary material The online version of this article (10.1007/s12325-019-00958-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - David Schindler
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
- Qr8 Health, Boston, MA, USA
| | - Stephen M Rao
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | | | | | | | | | - Jaime L Freiburger
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lyla Mourany
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Christine Reece
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Deborah M Miller
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Francois Bethoux
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert A Bermel
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lauren B Krupp
- New York University Langone Medical Center, New York, NY, USA
| | | | - Jay Alberts
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Smith VM, Varsanik JS, Walker RA, Russo AW, Patel KR, Gabel W, Phillips GA, Kimmel ZM, Klawiter EC. Movement measurements at home for multiple sclerosis: walking speed measured by a novel ambient measurement system. Mult Scler J Exp Transl Clin 2018; 4:2055217317753465. [PMID: 29383266 PMCID: PMC5784463 DOI: 10.1177/2055217317753465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/25/2017] [Indexed: 11/29/2022] Open
Abstract
Background Gait disturbance is a major contributor to clinical disability in multiple sclerosis (MS). A sensor was developed to assess walking speed at home for people with MS using infrared technology in real-time without the use of wearables. Objective To develop continuous in-home outcome measures to assess gait in adults with MS. Methods Movement measurements were collected continuously for 8 months from six people with MS. Average walking speed and peak walking speed were calculated from movement data, then analyzed for variability over time, by room (location), and over the course of the day. In-home continuous gait outcomes and variability were correlated with standard in-clinic gait outcomes. Results Measured in-home average walking speed of participants ranged from 0.33 m/s to 0.96 m/s and peak walking speed ranged from 0.89 m/s to 1.51 m/s. Mean total within-participant coefficient of variation for daily average walking speed and peak walking speed were 10.75% and 10.93%, respectively. Average walking speed demonstrated a moderately strong correlation with baseline Timed 25-Foot Walk (rs = 0.714, P = 0.111). Conclusion New non-wearable technology provides reliable and continuous in-home assessment of walking speed.
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Affiliation(s)
| | | | | | - Andrew W Russo
- Massachusetts General Hospital, Harvard Medical School, USA
| | - Kevin R Patel
- Massachusetts General Hospital, Harvard Medical School, USA
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Abstract
Walking speed is an important indicator of worsening in a variety of neurological and neuromuscular diseases, yet typically is measured only infrequently and in a clinical setting. Passive measurement of walking speed at home could provide valuable information to track the progression of many neuromuscular conditions. The purpose of this study was to validate the measurement of walking speed by a shelf-top ambient measurement system (AMS) that can be placed in a patient's home. Twenty-eight healthy adults (16 male, 12 female) were asked to walk three pre-defined routes two times each (total of 168 traversals). For each traversal, walking speed was measured simultaneously by five sources: two independent AMSs and three human timers with stopwatches. Measurements across the five sources were compared by generalised estimating equations (GEE). Correlation coefficients compared pairwise for walking speeds across the two AMSs, three human timers, and three routes all exceeded 0.86 (p < .0001), and for AMS-to-AMS exceeded 0.92 (p < .0001). Aggregated across all routes, there was no significant difference in measured walking speeds between the two AMSs (p = .596). There was a statistically significant difference between the AMSs and human timers of 8.5 cm/s (p < .0001), which is comparable to differences reported for other non-worn sensors. The tested AMS demonstrated the ability to automatically measure walking speeds comparable to manual observation and recording, which is the current standard for assessing walking speed in a clinical setting. The AMS may be used to detect changes in walking speed in community settings.
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Affiliation(s)
| | | | - Carl de Moor
- b Value-based Medicine Group, Biogen , Cambridge , MA , USA
| | - Wendy Gabel
- b Value-based Medicine Group, Biogen , Cambridge , MA , USA
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Matza LS, Murray LT, Phillips GA, Konechnik TJ, Dennehy EB, Bush EN, Revicki DA. Qualitative Research on Fatigue Associated with Depression: Content Validity of the Fatigue Associated with Depression Questionnaire (FAsD-V2). Patient 2015; 8:433-43. [PMID: 25613915 PMCID: PMC4575372 DOI: 10.1007/s40271-014-0107-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Fatigue is one of the most common symptoms of major depressive disorder (MDD). The Fatigue Associated with Depression Questionnaire (FAsD) was developed to assess fatigue and its impact in patients with MDD. The current article presents the qualitative research conducted to develop and examine the content validity of the FAsD and FASD–Version 2 (FAsD–V2). Methods Three phases of qualitative research were conducted with patients recruited from a geographically diverse range of clinics in the US. Phase I included concept elicitation focus groups, followed by cognitive interviews. Phase II employed similar techniques in a more targeted sample. Phase III included cognitive interviews to examine whether minor edits made after Phase II altered comprehensibility of the instrument. Concept elicitation focused on patients’ perceptions of fatigue and its impact. Cognitive interviews focused on comprehension, clarity, relevance, and comprehensiveness of the instrument. Data were collected using semi-structured discussion guides. Thematic analyses were conducted and saturation was examined. Results A total of 98 patients with MDD were included. Patients’ statements during concept elicitation in phases I and II supported item development and content. Cognitive interviews supported the relevance of the instrument in the target population, and patients consistently demonstrated a good understanding of the instructions, items, response options, and recall period. Minor changes to instructions for the FAsD–V2 did not affect interpretation of the instrument. Conclusions This qualitative research supports the content validity of the FAsD and FAsD–V2. These results add to previous quantitative psychometric analysis suggesting the FAsD–V2 is a useful tool for assessing fatigue and its impact in patients with MDD.
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Affiliation(s)
- Louis S Matza
- Outcomes Research, Evidera, Bethesda, MD, 20814, USA.
| | | | | | | | - Ellen B Dennehy
- Eli Lilly and Company, Indianapolis, IN, USA
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
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Phillips GA, Mathias A, Coon CD, Agarwal SS, Sen R, Shah R, Ziemssen T. Psychometric Analyses to Inform Item Reduction and Evaluate Sensitivity of the Early Mobility Impairment Questionnaire for Multiple Sclerosis. Value Health 2014; 17:A403. [PMID: 27200970 DOI: 10.1016/j.jval.2014.08.924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | | | - R Sen
- Adelphi Values, Boston, MA, USA
| | - R Shah
- University of Mississippi, University, MS, USA
| | - T Ziemssen
- University Clinic Carl Gustav Carus, Dresden, Germany
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Phillips GA, Wyrwich KW, Guo S, Medori R, Altincatal A, Wagner L, Elkins J. Responder definition of the Multiple Sclerosis Impact Scale physical impact subscale for patients with physical worsening. Mult Scler 2014; 20:1753-60. [PMID: 24740371 PMCID: PMC4232315 DOI: 10.1177/1352458514530489] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: The 29-item Multiple Sclerosis Impact Scale (MSIS-29) was developed to examine the impact of multiple sclerosis (MS) on physical and psychological functioning from a patient’s perspective. Objective: To determine the responder definition (RD) of the MSIS-29 physical impact subscale (PHYS) in a group of patients with relapsing–remitting MS (RRMS) participating in a clinical trial. Methods: Data from the SELECT trial comparing daclizumab high-yield process with placebo in patients with RRMS were used. Physical function was evaluated in SELECT using three patient-reported outcomes measures and the Expanded Disability Status Scale (EDSS). Anchor- and distribution-based methods were used to identify an RD for the MSIS-29. Results: Results across the anchor-based approach suggested MSIS-29 PHYS RD values of 6.91 (mean), 7.14 (median) and 7.50 (mode). Distribution-based RD estimates ranged from 6.24 to 10.40. An RD of 7.50 was selected as the most appropriate threshold for physical worsening based on corresponding changes in the EDSS (primary anchor of interest). Conclusion: These findings indicate that a ≥7.50 point worsening on the MSIS-29 PHYS is a reasonable and practical threshold for identifying patients with RRMS who have experienced a clinically significant change in the physical impact of MS.
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Affiliation(s)
- Glenn A Phillips
- Health Economics and Outcomes Research, Global Market Access, Biogen Idec, 133 Boston Post Road, Weston, MA 02493, USA
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Matza LS, Wyrwich KW, Phillips GA, Murray LT, Malley KG, Revicki DA. The Fatigue Associated with Depression Questionnaire (FAsD): responsiveness and responder definition. Qual Life Res 2012; 22:351-60. [PMID: 22403040 PMCID: PMC3576557 DOI: 10.1007/s11136-012-0142-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2012] [Indexed: 11/30/2022]
Abstract
Purpose The Fatigue Associated with Depression Questionnaire (FAsD) was developed to assess fatigue and its impact among patients with depression. The purpose of this study was to examine the questionnaire’s responsiveness to change and identify a responder definition for interpretation of treatment-related changes. Methods Data were collected at baseline and at 6 weeks from patients with depression starting treatment with a new antidepressant. Results Of the 96 participants, 55.2% were women, with a mean age of 43.4 years. The total score and both subscales demonstrated statistically significant change with moderate to large effect sizes (absolute values ≥0.76). FAsD change scores were significantly correlated with change on the Brief Fatigue Inventory (r ≥ 0.73; p < 0.001). FAsD mean change scores discriminated among patient subgroups differing by degree of improvement in patient- and clinician-reported fatigue and depression. Responder definition for the two subscales and total score (0.67, 0.57, 0.62) was estimated primarily based on mean change among patients who reported a small but important improvement in fatigue. Discussion The FAsD was responsive to change, and the responder definition may be used when interpreting treatment-related change. Results add to previous findings suggesting the FAsD is a useful measure of fatigue among patients with depression.
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Affiliation(s)
- Louis S Matza
- Outcomes Research, United BioSource Corporation, 7101 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA.
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Matza LS, Phillips GA, Revicki DA, Ascher-Svanum H, Malley KG, Palsgrove AC, Faries DE, Stauffer V, Kinon BJ, Awad AG, Keefe RSE, Naber D. Validation of a patient interview for assessing reasons for antipsychotic discontinuation and continuation. Patient Prefer Adherence 2012; 6:521-32. [PMID: 22879738 PMCID: PMC3413072 DOI: 10.2147/ppa.s25635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The Reasons for Antipsychotic Discontinuation Interview (RAD-I) was developed to assess patients' perceptions of reasons for discontinuing or continuing an antipsychotic. The current study examined reliability and validity of domain scores representing three factors contributing to these treatment decisions: treatment benefits, adverse events, and distal reasons other than direct effects of the medication. METHODS Data were collected from patients with schizophrenia or schizoaffective disorder and their treating clinicians. For approximately 25% of patients, a second rater completed the RAD-I for assessment of inter-rater reliability. RESULTS All patients (n = 121; 81 discontinuation, 40 continuation) reported at least one reason for discontinuation or continuation (mean = 2.8 reasons for discontinuation; 3.4 for continuation). Inter-rater reliability was supported (kappas = 0.63-1.0). Validity of the discontinuation domain scores was supported by associations with symptom measures (the Positive and Negative Syndrome Scale for Schizophrenia, the Clinical Global Impression - Schizophrenia Scale; r = 0.30 to 0.51; all P < 0.01), patients' primary reasons for discontinuation, and adverse events. However, the continuation domain scores were not significantly associated with these other indicators. DISCUSSION Results support the reliability, convergent validity, and known-groups validity of the RAD-I for assessing patients' reasons for antipsychotic discontinuation. Further research is needed to examine validity of the RAD-I continuation section.
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Affiliation(s)
- Louis S Matza
- Outcomes Research, United BioSource Corporation, Bethesda, MD
- Correspondence: Louis S Matza, 7101 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA, Tel +1 301 664 7263, Fax +1 301 654 9864, Email
| | | | | | | | | | | | | | | | | | - A George Awad
- Department of Psychiatry and Behavioral Sciences; University of Toronto, Toronto, Canada
| | | | - Dieter Naber
- Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Matza LS, Phillips GA, Revicki DA, Ascher-Svanum H, Kaiser D, Stauffer V, Shorr JM, Kinon BJ. Development of a clinician questionnaire and patient interview to assess reasons for antipsychotic discontinuation. Psychiatry Res 2011; 189:463-8. [PMID: 21684017 DOI: 10.1016/j.psychres.2011.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 01/19/2011] [Accepted: 05/24/2011] [Indexed: 11/29/2022]
Abstract
Time to treatment discontinuation and rates of discontinuation are commonly used when evaluating effectiveness of antipsychotic medication. However, less is known about reasons for discontinuation. The purpose of this study was to develop two measures of reasons for discontinuation or continuation of antipsychotics for the treatment of schizophrenia. Based on literature review, a patient interview pilot study, and expert panel input, two measures were drafted: the clinician-reported Reasons for Antipsychotic Discontinuation/Continuation Questionnaire (RAD-Q) and the patient-reported Reasons for Antipsychotic Discontinuation/Continuation Interview (RAD-I). Patients and clinicians completed the draft measures and structured cognitive debriefing interviews. For the draft instruments, reasons for discontinuation/continuation were divided into 3 categories: therapeutic benefits (positive symptoms, negative symptoms, mood, cognition, functional status), adverse events, and reasons other than direct effects of the medication (e.g., cost, inadequate social support). In cognitive debriefings, 10 clinicians and 15 patients indicated that the RAD-Q and RAD-I were clear, easy to complete, and comprehensive. Clinicians and patients suggested minor revisions, and the instruments were revised accordingly. The RAD-Q and RAD-I appear to be useful instruments for assessing reasons for antipsychotic discontinuation and continuation. The next step is a psychometric evaluation of the measures in a larger sample.
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Affiliation(s)
- Louis S Matza
- Center for Health Outcomes Research, United BioSource Corporation, Bethesda, MD, USA.
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Ivanova JI, Birnbaum HG, Chen L, Duhig AM, Dayoub EJ, Kantor ES, Schiller MB, Phillips GA. Cost of post-traumatic stress disorder vs major depressive disorder among patients covered by medicaid or private insurance. Am J Manag Care 2011; 17:e314-e323. [PMID: 21851139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To compare healthcare costs and resource utilization among patients with post-traumatic stress disorder (PTSD) vs control subjects with major depressive disorder (MDD) in populations covered by Medicaid or private insurance. STUDY DESIGN Retrospective analysis of Medicaid and private insurance administrative claims data. METHODS Patients with at least 2 PTSD diagnoses during or after 1999, and at least 1 PTSD diagnosis during or after 2003, were identified from deidentified Medicaid claims from Florida, Missouri, and New Jersey (1999-2007) and from a privately insured claims database (1999-2008). Patients had continuous eligibility 6 months before (baseline) and 12 months after (study period) the index date and were aged 18 to 64 years. Potential control subjects having MDD without PTSD diagnosis were identified using similar selection criteria. Control subjects with MDD were matched to patients with PTSD on age, sex, state or region, employment status (private insurance only), index year, and race/ethnicity (Medicaid only). Study period per-patient utilization and costs, calculated as reimbursements to providers for medical services and prescription drugs, were compared using univariate and multivariate analyses. RESULTS Patients with PTSD had higher rates of other mental health disorders (eg, anxiety and bipolar disorder) and higher mental health-related resource use and costs than control subjects with MDD in both Medicaid and privately insured populations. The mean study period total direct healthcare costs were higher for patients with PTSD than for control subjects with MDD ($18,753 vs $17,990 for Medicaid and $10,960 vs $10,024 for private insurance, P <.05 for both). The difference in total direct costs was driven by higher mental health-related resource use for patients with PTSD. CONCLUSION Patients having PTSD had 4.2% to 9.3% higher mean annual per-patient healthcare costs compared with matched control subjects having MDD among patients covered by Medicaid or private insurance.
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Chen J, Ascher-Svanum H, Nyhuis AW, Case MG, Phillips GA, Schuh KJ, Hoffmann VP. Reasons for continuing or discontinuing olanzapine in the treatment of schizophrenia from the perspectives of patients and clinicians. Patient Prefer Adherence 2011; 5:547-54. [PMID: 22114469 PMCID: PMC3218116 DOI: 10.2147/ppa.s23255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the reasons for discontinuing or continuing olanzapine in patients with schizophrenia, from the perspectives of the patients and their clinicians. METHODS The Reasons for Antipsychotic Discontinuation/Continuation (RAD) is a pair of questionnaires assessing these reasons from the perspectives of patients and their clinicians. Outpatients with schizophrenia (n = 199) who were not acutely ill participated in a 22-week open-label study of olanzapine from November 2006 to September 2008. Reasons for continuing or discontinuing olanzapine (on a five-point scale), along with the single most important reason and the top primary reasons, were identified. Concordance between reasons given by patients and clinicians was assessed. RESULTS The top primary reasons for continuing olanzapine were patients' perceptions of improvement, improvement of positive symptoms, and improved functioning. The study discontinuation rate was low (30.2%), and only a subset of patients who discontinued reported reasons for medication discontinuation. The top primary reasons for discontinuing olanzapine were insufficient improvement or worsening of positive symptoms, adverse events, and insufficient improvement or worsening of negative symptoms. Ratings given by patients and clinicians were highly concordant. CONCLUSION The main reason for continuing or discontinuing olanzapine appears to be medication efficacy, especially for positive symptoms. Reasons for medication discontinuation differ somewhat from reasons for continuation, with a high level of concordance between patient and clinician responses.
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Affiliation(s)
| | - Haya Ascher-Svanum
- Eli Lilly and Company
- Correspondence: Haya Ascher-Svanum, Eli Lilly and Company, Lilly Corporate Center DC 4133, Indianapolis, IN, USA 46285, Tel +1 317 277 8713, Fax +1 317 276 7100, Email
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Ascher-Svanum H, Nyhuis AW, Stauffer V, Kinon BJ, Faries DE, Phillips GA, Schuh K, Awad AG, Keefe R, Naber D. Reasons for discontinuation and continuation of antipsychotics in the treatment of schizophrenia from patient and clinician perspectives. Curr Med Res Opin 2010; 26:2403-10. [PMID: 20812791 DOI: 10.1185/03007995.2010.515900] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify reasons for discontinuation and continuation of antipsychotic medications in the treatment of schizophrenia from the patients' and their clinicians' perspectives. RESEARCH DESIGN AND METHODS Two measures were previously developed to assess the Reasons for Antipsychotic Discontinuation/Continuation (RAD), one from the patient's perspective and another from the clinician's perspective. These measures were administered to acutely ill schizophrenia patients enrolled in a 12-week study of antipsychotic medications (N = 596) and to their clinicians. The RAD was assessed at baseline and at endpoint. Reasons were rated on a 5-point scale from 'primary reason' to 'not a reason.' The single most important reason was also identified. The 'single most important reason' and the 'primary reasons' for discontinuing the drug used prior to enrollment, and for discontinuing or continuing the study drug were identified. Levels of concordance between patients' and clinicians' reasons were assessed. CLINICAL TRIAL REGISTRATION The data source for this study is a clinical trial registered at www.clinicaltrials.gov (NCT00337662). MAIN OUTCOME MEASURES Reasons for Antipsychotic Discontinuation/Continuation (RAD). RESULTS Patients and clinicians identified several reasons for medication discontinuation and continuation (2.3 to 6.3 reasons, on average). The top 'single most important' reason for discontinuing the drug used prior to enrollment and for discontinuing the study drug was 'positive symptoms not sufficiently improved or made worse,' followed by 'medication-related adverse events.' The most frequent 'single most important' reason for medication continuation was 'improved positive symptoms,' followed by 'patient's perception of improvement,' and 'functional improvement.' A high level of concordance was observed between patients' and clinicians' ratings. CONCLUSIONS Medication efficacy appears to be the core driver of medication discontinuation and continuation, especially with regard to positive symptoms. There was a high level of concordance between patients' and clinicians' perspectives. Limitations include the study requirement that patients be at least moderately ill and experiencing acute psychotic exacerbation, a potential selection bias in the readiness to respond to measures, and small sample sizes for some analyses. Further research is needed to replicate findings in patients who are not acutely ill.
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Noordsy DL, Phillips GA, Ball DE, Linde-Zwirble WT. Antipsychotic adherence, switching, and health care service utilization among Medicaid recipients with schizophrenia. Patient Prefer Adherence 2010; 4:263-71. [PMID: 20694186 PMCID: PMC2915559 DOI: 10.2147/ppa.s6053] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate health care resource utilization in patients with schizophrenia who continued newly prescribed antipsychotic medications, compared with those switching to different treatments. METHODS Adults with schizophrenia in the California Medicaid (MediCal) database who initiated treatment with index medications in 1998-2001, were classified as having: 1) abandoned antipsychotic medications; 2) switched to another medication; or 3) continued with the index antipsychotic, for up to 6 months after the index date. RESULTS Of 2300 patients meeting eligibility criteria, 1382 (60.1%) continued index medications, 480 (20.9%) switched, and 438 (19.0%) abandoned antipsychotic treatment. Utilization in several resource categories occurred significantly more frequently among patients whose regimens were switched (vs those continuing index medications). These included using psychiatric (24.2% vs 14.5%; P < 0.001) or nonpsychiatric (31.5% vs 24.3%; P < 0.05) emergency services; being admitted to a hospital (10.6% vs 7.4%; P < 0.05); making nonpsychiatric outpatient hospital visits (43.3% vs 36.4%; P < 0.05) or nonpsychiatric physician visits (62.7% vs 56.4%; P < 0.05); and using other outpatient psychiatric (53.3% vs 40.7%; P < 0.001) or nonpsychiatric (82.7% vs 74.6%; P < 0.001) services. CONCLUSIONS Switching antipsychotic medications is associated with significantly increased health care resource utilization (vs continuing treatment).
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Affiliation(s)
- Douglas L Noordsy
- Department of Psychiatry, Dartmouth Medical School, Lebanon, NH, USA
- Correspondence: Douglas L. Noordsy, Department of Psychiatry, Dartmouth Medical School, 1 Medical Center Drive, Lebanon, NH 03756, USA, Tel +1 603 650 5805, Fax +1 603 650 7820, Email
| | - Glenn A Phillips
- Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
| | - Daniel E Ball
- Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
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Brown CM, Nwokeji E, Rascati KL, Zachry W, Phillips GA. Development of the Burden of Prior Authorization of Psychotherapeutics (BoPAP) Scale to Assess the Effects of Prior Authorization Among Texas Medicaid Providers. Adm Policy Ment Health 2009; 36:278-87. [DOI: 10.1007/s10488-009-0220-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 03/19/2009] [Indexed: 11/27/2022]
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Dunayevich E, Ascher-Svanum H, Zhao F, Jacobson JG, Phillips GA, Dellva MA, Green AI. Longer time to antipsychotic treatment discontinuation for any cause is associated with better functional outcomes for patients with schizophrenia, schizophreniform disorder, or schizoaffective disorder. J Clin Psychiatry 2007; 68:1163-71. [PMID: 17854239 DOI: 10.4088/jcp.v68n0801] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Time to all-cause treatment discontinuation is considered a composite proxy measure of treatment efficacy, safety, and tolerability. Longer time to discontinuation of antipsychotic medication for any cause has been shown to be associated with greater symptom improvements in the treatment of schizophrenia. This study examines whether longer time to all-cause medication discontinuation is also linked to better functional outcomes. METHOD Using pooled data from 4 randomized, double-blind antipsychotic trials of 24- to 28-weeks' duration, this study examined the association between time to all-cause treatment discontinuation and functional outcomes, as assessed by a disease-specific, clinician-rated measure (Quality of Life Scale [QLS]) and a generic, patient-reported measure (Medical Outcomes Study Short Form 36 [SF-36]). Patients in these trials had a DSM-IV diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective disorder. This post hoc analysis used Pearson partial correlations to assess relationships between time to treatment discontinuation and changes in functional scores, adjusting for baseline scores. Repeated measures analyses were also conducted to compare post-baseline functional outcome change over time between completers and noncompleters. RESULTS Longer time to all-cause treatment discontinuation was found to be significantly associated with greater improvements in all assessed functional domains (p < .05). Patients who completed their respective trials (46.8%, 761/1627) experienced significantly greater improvement in functional outcome measures (in 4 QLS domains and SF-36 mental health component summary score; all, p < .001) compared to patients who discontinued for any cause. In addition, greater symptom improvement was significantly associated with greater functional improvements in assessed domains. CONCLUSIONS Findings from this post hoc analysis illustrate the importance of longer treatment duration with antipsychotics for improving functional outcomes in the treatment of patients with schizophrenia.
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Phillips GA, Van Brunt DL, Roychowdhury SM, Xu W, Naber D. The relationship between quality of life and clinical efficacy from a randomized trial comparing olanzapine and ziprasidone. J Clin Psychiatry 2006; 67:1397-403. [PMID: 17017826 DOI: 10.4088/jcp.v67n0910] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine treatment-specific changes in health-related quality of life (QOL) among patients with schizophrenia and to assess the association between clinical and QOL improvement. METHOD This post hoc analysis used the findings of a 28-week, randomized, multicenter trial of patients with schizophrenia (DSM-IV) treated with olanzapine (10-20 mg/day) or ziprasidone (80-160 mg/day). Data were collected from August 2001 to December 2002. Efficacy was measured using the Positive and Negative Syndrome Scale (PANSS). Quality of life was assessed with the generic health self-administered Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) and the disease-specific expert-administered Heinrichs-Carpenter Quality of Life Scale (QLS). Mixed-effects-repeated-measures and last-observation-carried-forward approaches were used to assess the effects of treatment on QOL and the association of clinical outcomes to QOL outcomes. RESULTS Olanzapine- and ziprasidone-treated patients demonstrated similar improvement from baseline to endpoint on the SF-36 and QLS. All correlations between changes in PANSS scores and the SF-36 were significant (p < .001), ranging from -0.159 to -0.400. All correlations between changes in PANSS scores and the QLS were significant (p < .0001), ranging from -0.286 to -0.603. The correlations between the 2 QOL measures were generally significant but small to moderate in magnitude. CONCLUSIONS The results of this study indicate that, in patients with schizophrenia, olanzapine and ziprasidone treatment are associated with significant QOL and clinical improvements. Further, the significant correlation between change scores on the PANSS and QOL measures suggests that treatment-related clinical improvements are associated with improved health-related and disease-specific QOL. CLINICAL TRIALS REGISTRATION ClinicalStudyResults.org identifier 2347.
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Phillips GA, Shadish WR, Murray DM, Kubik M, Lytle LA, Birnbaum AS. The Center for Epidemiologic Studies Depression Scale With a Young Adolescent Population: A Confirmatory Factor Analysis. Multivariate Behav Res 2006; 41:147-163. [PMID: 26782908 DOI: 10.1207/s15327906mbr4102_3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The Center for Epidemiological Studies Depression scale (CES-D) was developed to assess the population prevalence of depression. The CES-D was developed and normed on an adult population. Since the CES-D's publication, various studies have both used and psychometrically assessed the scale for older adolescent populations. However, we found no report of the CES-D's psychometric properties for young adolescent populations. We conducted a confirmatory factor analysis of the CES-D with a large, young adolescent population that also included members of a number of different ethnic groups. We tested 12 models previously supported by factor analyses. Radloff's (1977) four-factor model (Depressed Affect, Positive Affect, Somatic Complaints, Interpersonal) was supported if the item "I felt that everything I did was an effort" is deleted, as this item has characteristics that are quite problematic in both the present data and in past data from adolescents. Second-order and hierarchical factor analyses fit the data well but suggested that Depressed Affect could not be distinguished from the General Depression factor. Given the high correlations among the four first-order factors, the standard scoring of the CES-D for one total score is justified.
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Schmitz KH, Lytle LA, Phillips GA, Murray DM, Birnbaum AS, Kubik MY. Psychosocial correlates of physical activity and sedentary leisure habits in young adolescents: the Teens Eating for Energy and Nutrition at School study. Prev Med 2002; 34:266-78. [PMID: 11817924 DOI: 10.1006/pmed.2001.0982] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Low levels of physical activity (PA) and highly sedentary leisure habits (SLH) in youth may establish behavioral patterns that will predispose youth to increased chronic disease risk in adulthood. The purpose of this paper was to examine associations of demographic and psychosocial factors with self-reported PA and SLH in young adolescents. METHODS A general linear mixed model predicted self-reported PA and SLH in the spring from demographic and psychosocial variables measured the previous fall in 3798 seventh grade students. RESULTS PA and SLH differed by race, with Caucasian students reporting among the highest PA and lowest SLH. Perceptions of higher academic rank or expectations predicted higher PA and lower SLH. Depressive symptomatology predicted higher SLH scores but not PA. Higher self-reported value of health, appearance, and achievement predicted higher PA and lower SLH in girls. Girls who reported that their mothers had an authoritative parenting style also reported higher PA and lower SLH. CONCLUSIONS Determinants of PA and SLH appear to differ from each other, particularly in boys. Development of effective programs to increase PA and/or decrease SLH in young adolescents should be based on a clear understanding of the determinants of these behaviors.
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Affiliation(s)
- Kathryn H Schmitz
- Division of Epidemiology, University of Minnesota, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454-1015, USA
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Murray DM, Phillips GA, Bimbaum AS, Lytle LA. Intraclass correlation for measures from a middle school nutrition intervention study: estimates, correlates, and applications. Health Educ Behav 2001; 28:666-79. [PMID: 11720271 DOI: 10.1177/109019810102800602] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article presents the first estimates of school-level intraclass correlation for dietary measures based on data from the Teens Eating for Energy and Nutrition at School study. This study involves 3,878 seventh graders from 16 middle schools from Minneapolis-St. Paul, Minnesota. The sample was 66.8% White, 11.2% Black, and 7.0% Asian; 48.8% of the sample was female. Typical fruit and vegetable intake was assessed with a modified version of the Behavior Risk Factor Surveillance System questionnaire. Twenty-four-hour dietary recalls were conducted by nutritionists using the Minnesota Nutrition Data System. Mixed-model regression methods were used to estimate variance components for school and residual error, both before and after adjustment for demographic factors. School-level intraclass correlations were large enough, if ignored, to substantially inflate the Type I error rate in an analysis of treatment effects. The authors show how to use the estimates to determine sample size requirements for future studies.
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Affiliation(s)
- D M Murray
- Department of Psychology, University of Memphis, Tennessee 38152-3230, USA.
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Hu X, Phillips GA. GPT.EXE: a powerful tool for the visualization and analysis of general processing tree models. Behav Res Methods Instrum Comput 1999; 31:220-34. [PMID: 10495804 DOI: 10.3758/bf03207714] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper introduces GPT.EXE, a computer program for designing and implementing general processing tree (GPT) models. First, designing and building GPT models using this program is discussed. The second major emphasis is a description of various statistical procedures that can be carried out with GPT.EXE. There is also a brief section on the on-line documentation of this program. Throughout the text, pictures of windows from the program are displayed to help explain the procedures being described by the text.
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Affiliation(s)
- X Hu
- Department of Psychology, University of Memphis, TN 38152, USA.
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Abstract
Radiolabeled pure [4-14C]cholesterol was kept at 60 degrees C under air to autoxidize for 5 weeks, after which approximately 12% cholesterol oxidation products were formed. The mixture, suspended in gelatin, was given to rabbits by gastric gavage. Rabbits were killed 4, 24, and 48 h after treatment. Cholesterol and its autoxidation products were separated by thin-layer chromatography into 5 fractions and radioactivities of each fraction were measured. Percentages of each fraction of cholesterol oxidation products and cholesterol in the original mixture before administration and in the rabbit sera after administration were similar, suggesting that the rates of absorption of cholesterol oxidation products are not significantly different from that of cholesterol. Lipoproteins were fractionated by ultracentrifugation into VLDL, LDL and HDL. Radioactivities of each fraction in lipoproteins separated by thin layer chromatography showed that fractions containing cholestane-3 beta,5 alpha,6 beta-triol, 7 alpha- and 7 beta-hydroxycholesterol and 7-ketocholesterol were more selectively transported in VLDL, whereas most of the 25-hydroxycholesterol was present in LDL. HDL contained only minute amounts of cholesterol oxidation products.
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Phillips GA. Cheap shots: quality medical TV on a tight budget. Biomed Commun 1981; 9:26. [PMID: 10249512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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