Systematic review and meta-analysis of the reproducibility of patient self-reported joint counts in rheumatoid arthritis

2021 ◽  
pp. jrheum.201439
Author(s):  
Sanketh Rampes ◽  
Vishit Patel ◽  
Ailsa Bosworth ◽  
Clare Jacklin ◽  
Deepak Nagra ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Meta Analysis ◽  
Annual Review ◽  
Strong Correlations ◽  
Moderate Correlation ◽  
Good Reliability ◽  
Patient Reported ◽  
Patient Groups ◽  
Monitoring Treatment ◽  
Monitoring Treatment Response

Objective To assess the reproducibility of patient-reported tender and swollen joint counts of RA patients compared to trained clinicians. Methods We conducted a systematic literature review and meta-analysis of studies comparing patient-reported tender and/or swollen joint counts (TJC and SJC) to clinician counts in patients with rheumatoid arthritis. We calculated a pooled summary estimates for correlation. Agreement was compared using a Bland and Altman approach. Results 14 studies were included in the meta-analysis. There were strong correlations between clinician and patient TJC, 0.78 (95% CI: 0.76, 0.80), and clinician and patient SJC, 0.59 (95% CI: 0.54, 0.63). TJC had good reliability ranging from 0.50 to 0.85. SJC had moderate reliability ranging from 0.28 to 0.77. Agreement for TJC reduced for higher TJC values, suggesting a positive bias for self-reported TJC, which was not observed for SJC. Conclusion This meta-analysis has identified a strong correlation for patient-reported and clinician TJC, and a moderate correlation for SJC. Patient-reported joint counts may be suitable for use in annual review for patients in remission and in monitoring treatment response for patients with rheumatoid arthritis. However, they are likely not appropriate for decisions on commencement of biologics. Further research is needed to identify patient groups where patient-reported joint counts are unsuitable.

Reevaluation of the Role of Duration of Morning Stiffness in the Assessment of Rheumatoid Arthritis Activity

2009 ◽  
Vol 36 (11) ◽  
pp. 2435-2442 ◽  
Author(s):  
NASIM A. KHAN ◽  
YUSUF YAZICI ◽  
JAIME CALVO-ALEN ◽  
JOLANTA DADONIENE ◽  
LAURE GOSSEC ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Roc Curve ◽  
Morning Stiffness ◽  
Health Assessment ◽  
Analysis Of Covariance ◽  
Interactive Effects ◽  
Moderate Correlation ◽  
Mixed Effect ◽  
Patient Reported

Objective.To evaluate the utility of the duration of morning stiffness (MS), as a patient-reported outcome (PRO), in assessing rheumatoid arthritis (RA) disease activity.Methods.We acquired information on 5439 patients in QUEST-RA, an international database of patients with RA evaluated by a standard protocol. MS duration was assessed from time of waking to time of maximal improvement. Ability of MS duration to differentiate RA activity states, based on Disease Activity Score (DAS)28, was assessed by analysis of variance; and a receiver-operating characteristic (ROC) curve was plotted for discriminating clinically active (DAS28 > 3.2) from less active (DAS28 ≤ 3.2) RA. Mixed-effect analysis of covariance (ANCOVA) models were used to assess the utility of adding MS duration to Routine Assessment of Patient Index Data (RAPID)3, a PRO index based on physical function, pain, and general health (GH), in predicting the 3-variable DAS28 (DAS28v3).Results.MS duration had moderate correlation (r = 0.41–0.48) with pain, Health Assessment Questionnaire, and GH; and weak correlation (r = 0.23–0.39) with joint counts and erythrocyte sedimentation rate. MS duration differed significantly among patients with different RA activity (p < 0.001). The area under the ROC curve of 0.74 (95% CI 0.72–0.75) showed moderate ability of MS duration to differentiate clinically active from less active RA. ANCOVA showed significant interactive effects between RAPID3 and the MS duration categories (p = 0.0005) in predicting DAS28v3. The effect of MS was found to be clinically important in patients with the low RAPID3 scores (< 6) in whom the presence of MS may indicate clinically active disease (DAS28v3 > 3.2).Conclusion.MS duration has a moderate correlation with RA disease activity. Assessment of MS duration may be clinically helpful in patients with low RAPID3 scores.

‘I’m an expert in me and I know what I can cope with’: Patient expertise in rheumatoid arthritis

2014 ◽  
Vol 10 (3) ◽  
pp. 249-261 ◽  
Author(s):  
Tessa Sanderson ◽  
Jo Angouri
Keyword(s):  
Rheumatoid Arthritis ◽  
Meta Analysis ◽  
Healthcare Systems ◽  
Specific Knowledge ◽  
Active Involvement ◽  
Domain Specific ◽  
Access To Health ◽  
Patient Expertise ◽  
Domain Specific Knowledge ◽  
The Uk

The active involvement of patients in decision-making and the focus on patient expertise in managing chronic illness constitutes a priority in many healthcare systems including the NHS in the UK. With easier access to health information, patients are almost expected to be (or present self) as an ‘expert patient’ (Ziebland 2004). This paper draws on the meta-analysis of interview data collected for identifying treatment outcomes important to patients with rheumatoid arthritis (RA). Taking a discourse approach to identity, the discussion focuses on the resources used in the negotiation and co-construction of expert identities, including domain-specific knowledge, access to institutional resources, and ability to self-manage. The analysis shows that expertise is both projected (institutionally sanctioned) and claimed by the patient (self-defined). We close the paper by highlighting the limitations of our pilot study and suggest avenues for further research.

The Patient-Reported Outcomes Measurement Information System in spine surgery: a systematic review

2019 ◽  
Vol 30 (3) ◽  
pp. 405-413 ◽  
Author(s):  
Brittany E. Haws ◽  
Benjamin Khechen ◽  
Mundeep S. Bawa ◽  
Dil V. Patel ◽  
Harmeet S. Bawa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Information System ◽  
Patient Reported Outcomes ◽  
Neck Disability Index ◽  
Measurement Information ◽  
Strong Correlations ◽  
Comprehensive Overview ◽  
Outcomes Measurement ◽  
Patient Reported ◽  
Measurement Information System

OBJECTIVEThe Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to provide a standardized measure of clinical outcomes that is valid and reliable across a variety of patient populations. PROMIS has exhibited strong correlations with many legacy patient-reported outcome (PRO) measures. However, it is unclear to what extent PROMIS has been used within the spine literature. In this context, the purpose of this systematic review was to provide a comprehensive overview of the PROMIS literature for spine-specific populations that can be used to inform clinicians and guide future work. Specifically, the authors aimed to 1) evaluate publication trends of PROMIS in the spine literature, 2) assess how studies have used PROMIS, and 3) determine the correlations of PROMIS domains with legacy PROs as reported for spine populations.METHODSStudies reporting PROMIS scores among spine populations were identified from PubMed/MEDLINE and a review of reference lists from obtained studies. Articles were excluded if they did not report original results, or if the study population was not evaluated or treated for spine-related complaints. Characteristics of each study and journal in which it was published were recorded. Correlation of PROMIS to legacy PROs was reported with 0.1 ≤ |r| < 0.3, 0.3 ≤ |r| < 0.5, and |r| ≥ 0.5 indicating weak, moderate, and strong correlations, respectively.RESULTSTwenty-one articles were included in this analysis. Twelve studies assessed the validity of PROMIS whereas 9 used PROMIS as an outcome measure. The first study discussing PROMIS in patients with spine disorders was published in 2012, whereas the majority were published in 2017. The most common PROMIS domain used was Pain Interference. Assessments of PROMIS validity were most frequently performed with the Neck Disability Index. PROMIS domains demonstrated moderate to strong correlations with the legacy PROs that were evaluated. Studies assessing the validity of PROMIS exhibited substantial variability in PROMIS domains and legacy PROs used for comparisons.CONCLUSIONSThere has been a recent increase in the use of PROMIS within the spine literature. However, only a minority of studies have incorporated PROMIS for its intended use as an outcomes measure. Overall, PROMIS has exhibited moderate to strong correlations with a majority of legacy PROs used in the spine literature. These results suggest that PROMIS can be effective in the assessment and tracking of PROs among spine populations.

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