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Background: Medication adherence is essential for improving the health outcomes of patients. Various patient-reported outcome measures (PROMs) have been developed to measure medication adherence in patients. However, no study has summarized the psychometric properties of these PROMs to guide selection for use in clinical practice or research., Objective: This study aims to evaluate the quality of the PROMs used to measure medication adherence., Methods: This study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the EMBASE, PubMed, Cochrane Library, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. The PROMs were then evaluated based on the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines., Results: A total of 121 unique medication adherence PROMs from 214 studies were identified. Hypotheses testing for construct validity and internal consistency were the most frequently assessed measurement properties. PROMs with at least a moderate level of evidence for ≥5 measurement properties include the Adherence Starts with Knowledge 20, Compliance Questionnaire-Rheumatology, General Medication Adherence Scale, Hill-Bone Scale, Immunosuppressant Therapy Barrier Scale, Medication Adherence Reasons Scale (MAR-Scale) revised, 5-item Medication Adherence Rating Scale (MARS-5), 9-item MARS (MARS-9), 4-item Morisky Medication Adherence Scale (MMAS-4), 8-item MMAS (MMAS-8), Self-efficacy for Appropriate Medication Adherence Scale, Satisfaction with Iron Chelation Therapy, Test of Adherence to Inhalers, and questionnaire by Voils. The MAR-Scale revised, MMAS-4, and MMAS-8 have been administered electronically., Conclusions: This study identified 121 PROMs for medication adherence and provided synthesized evidence for the measurement properties of these PROMs. The findings from this study may assist clinicians and researchers in selecting suitable PROMs to assess medication adherence., (©Yu Heng Kwan, Si Dun Weng, Dionne Hui Fang Loh, Jie Kie Phang, Livia Jia Yi Oo, Dan V Blalock, Eng Hui Chew, Kai Zhen Yap, Corrinne Yong Koon Tan, Sungwon Yoon, Warren Fong, Truls Østbye, Lian Leng Low, Hayden Barry Bosworth, Julian Thumboo. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.10.2020.)

Background: Medication adherence is important in managing the progression of chronic diseases. A promising approach to reduce cognitive burden when measuring medication adherence lies in the use of computer-adaptive tests (CATs) or in the development of shorter patient-reported outcome measures (PROMs). However, the lack of an item bank currently hampers this progress., Objective: We aim to develop an item bank to measure general medication adherence., Methods: Using the preferred reporting items for systematic review and meta-analysis (PRISMA), articles published before October 2019 were retrieved from PubMed, Embase, CINAHL, the Cochrane Library, and Web of Science. Items from existing PROMs were classified and selected ("binned" and "winnowed") according to standards published by the Patient-Reported Outcomes Measurement Information System (PROMIS) Cooperative Group., Results: A total of 126 unique PROMs were identified from 213 studies in 48 countries. Items from the literature review (47 PROMs with 579 items for which permission has been obtained) underwent binning and winnowing. This resulted in 421 candidate items (77 extent of adherence and 344 reasons for adherence)., Conclusions: We developed an item bank for measuring general medication adherence using items from validated PROMs. This will allow researchers to create new PROMs from selected items and provide the foundation to develop CATs., (©Yu Heng Kwan, Livia Jia Yi Oo, Dionne Hui Fang Loh, Jie Kie Phang, Si Dun Weng, Dan V Blalock, Eng Hui Chew, Kai Zhen Yap, Corrinne Yong Koon Tan, Sungwon Yoon, Warren Fong, Truls Østbye, Lian Leng Low, Hayden Barry Bosworth, Julian Thumboo. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 08.10.2020.)

Aim: Axial spondyloarthritis (axSpA) affects patients in the prime of their economic productivity. We aim to identify factors associated with poor work productivity in patients with axSpA in Singapore., Methods: A cross-sectional study was performed in two tertiary centers in Singapore. Consecutive adult patients ≥21 years fulfilling Assessment in Spondyloarthritis International Society (ASAS) 2009 criteria for axSpA were recruited. Data on social demographics, clinical, treatment modalities and patient-reported outcome measures (PROMs) were collected. Work productivity was assessed by the Work Productivity and Activity Impairment scale (WPAI:SpA). Factors associated with presenteeism, absenteeism, work productivity loss and activity impairment were evaluated., Results: A total of 156 patients with axSpA were included: 72.4% employed, 80.1% male, 86.5% Chinese, median (Q1:Q3) age and duration of illness 36.7 (28.7:47.9) years, and 6.3 (1.6:12.2) years respectively. The mean (SD) activity impairment was 28.2% (24.3%). Among employed patients, mean (SD) absenteeism, presenteeism and work productivity loss was 4.5% (13.7%), 24.9% (19.9%) and 27.6% (23.2%), respectively. In multivariable analysis, absenteeism was associated with disease duration (P = .02) and EuroQol-5D (EQ-5D) (P = .04). Presenteeism was associated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥4 (P = .04), Bath Ankylosing Spondylitis Functional Index (BASFI) (P < .01) and EQ-5D (P = .02). Work productivity loss was associated with BASFI (P = .02) and EQ-5D (P < .01). Activity impairment was associated with age (P = .04), BASDAI ≥ 4 (P < .01), BASFI (P < .01), EQ-5D (P < .01)., Conclusion: Active disease, reduced physical function and poorer quality of life are associated with reduced work productivity in patients with axSpA in Singapore. Addressing these factors can potentially improve work productivity in patients with axSpA., (© 2019 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Objectives: To assess the validity and reliability of the Assessment of Spondyloarthritis International Society Health Index (ASAS HI) among patients with axial spondyloarthritis (axSpA) in Singapore., Methods: We collected data from English-speaking patients with axSpA seen at a dedicated axSpA clinic in a Singapore tertiary referral hospital from 2017 to 2018. Face validity of the English version of ASAS HI was assessed through cognitive debriefing interviews (CDIs). Structural validity was assessed with confirmatory factor analysis. Convergent construct validity was assessed with 12 a priori hypotheses about the magnitude and direction of correlations between the ASAS HI summary score and other patient-reported outcome measures. Internal consistency was assessed using Cronbach's alpha. Test-retest reliability was assessed by intraclass correlation coefficient (ICC). Measurement error was assessed by analyzing smallest detectable change (SDC)., Results: Ten patients (age range 22-46 years, 50% male) participated in CDIs and face validity was supported. Among 108 patients (median age: 37 [21-77], 80.6% males), unidimensionality was confirmed (comparative fit index = 0.960, Tucker-Lewis Index = 0.952, root mean square error of approximation = 0.038, standardized root mean residuals = 0.068, model Chi-square test P = 0.1251) in the 17-item ASAS HI. The ASAS HI showed good internal consistency of 0.83 and excellent test-retest reliability (ICC = 0.95; 95% CI 0.91-0.98) when baseline was compared with week 2. SDC was 1.02. Convergent validity was supported as hypotheses were confirmed in 100% of the results., Conclusions: This study supports the ASAS HI as a valid and reliable measure of health status for use in patients with axSpA in Singapore., (© 2019 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Objectives: To evaluate factors associated with patient-physician discordance in a multiethnic Asian cohort of psoriatic arthritis (PsA) patients., Methods: We used data from a prospective cohort of consecutive patients with PsA fulfilling the Classification Criteria for Psoriatic Arthritis, recruited from a single center in Singapore. Sociodemographic, clinical data and patient-reported outcomes were collected using a standardized protocol at baseline, 4 months, 8 months, 1 year, 2 years and 5 years. patient-physician discordance was defined as patient global assessment minus physician global assessment (PGA-PhGA). We evaluated variables associated with patient-physician discordance using generalized linear regression to control for within-subject effect., Results: One hundred and fortytwo patients (51.4% male, 66.2% Chinese, mean [SD] age and duration of illness 51.1 [13.8] years and 27.5 [98.3] months) were recruited at baseline. Paired results for PGA and PhGA were available for 291 visits with median (interquartile range) follow-up time of 11.6 (17) months. In univariable analysis, duration of illness, fatigue, pain, tender and swollen joint count, dactylitis count, and health-related quality of life (Short Form-36) domains were significantly correlated with patient-physician discordance. In multivariable analysis, age, fatigue level, pain score were positively associated with patient-physician discordance, while swollen joint count and mental health were negatively associated with patient physician discordance., Conclusions: Increased age, higher fatigue levels, higher pain score  and poorer mental health may explain underestimation of disease activity by physicians. Physicians' overestimation of disease activity may be explained by higher swollen joint counts., (© 2019 The Authors. International Journal of Rheumatic Diseases published by Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Aims: To identify quality of life (QoL) domains and subdomains relevant to patients with different spondyloarthritis (SpA) subtypes in Singapore, and to assess how identified QoL domains and subdomains map onto currently used patient-reported outcome measures (PROMs)., Methods: Nine focus group discussions (FGDs), including two previously conducted FGDs from the Updating the Psoriatic Arthritis Core Domain Set Study, were conducted with patients with SpA in Singapore. The FGDs were organized by SpA subtype and language spoken. All FGDs were audio-taped, transcribed verbatim. After thematic analysis through open and axial coding, the domains were organized using the World Health Organization Quality of Life (WHOQOL) framework. Identified QoL domains and subdomains were mapped to currently used PROMs., Results: The nine FGDs included 51 patients. In total, 27 domains and 92 subdomains were identified and then organized within the 7 broad categories of the WHOQOL framework. Patients in Singapore were more concerned about "financial resources, " "work satisfaction" and "positive feelings" while less concerned about "freedom, physical safety and security" than patients in Western countries. "Home environment" and "work satisfaction" emerged as unique QoL domains relevant to patients with axial SpA (axSpA). PROMs for psoriatic arthritis (PsA) can capture both identified domains of PsA and axSpA., Conclusions: A wide range of QoL domains and subdomains are relevant to SpA patients in Singapore, and there appears to be minimal differences in their relative importance between SpA subtypes. This study supports the development and validation of common QoL-specific PROMs for usage in SpA., (© 2018 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Objectives: This systematic review aimed to identify studies investigating measurement properties of patient reported outcome measures (PROMs) for spondyloarthritis (SpA), and to evaluate their methodological quality and level of evidence relating to the measurement properties of PROMs., Methods: This systematic review was guided by the preferred reporting items for systematic review and meta-analysis (PRISMA). Articles published before 30 June 2017 were retrieved from PubMed ® , Embase ® , and PsychINFO ® (Ovid). Methodological quality and level of evidence were evaluated according to recommendations from the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)., Results: We identified 60 unique PROMs from 125 studies in 39 countries. Twenty-one PROMs were validated for two or more SpA subtypes. The literature examined hypothesis testing (82.4%) most frequently followed by reliability (60.0%). A percentage of 77.7% and 42.7% of studies that assessed PROMs for hypothesis testing and reliability, respectively had "fair" or better methodological quality. Among the PROMs identified, 41.7% were studied in ankylosing spondylitis (AS) only and 23.3% were studied in psoriatic arthritis (PsA) only. The more extensively assessed PROMs included the ankylosing spondylitis quality of life (ASQoL) and bath ankylosing spondylitis functional index (BASFI) for ankylosing spondylitis, and the psoriatic arthritis quality of life questionnaire (VITACORA-19) for psoriatic arthritis., Conclusion: This study identified 60 unique PROMs through a systematic review and synthesized evidence of the measurement properties of the PROMs. There is a lack of validation of PROMs for use across SpA subtypes. Future studies may consider validating PROMs for use across different SpA subtypes., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Aim: To identify the factors associated with patient-physician discordance in patients with axial spondyloarthritis (axSpA) in an Asian population., Methods: A cross-sectional study was conducted in two tertiary referral centers in Singapore. Patients with axSpA who fulfilled Assessment in Ankylosing Spondylitis International Working Group 2009 criteria for axSpA were included in the study. Socio-demographics, clinical, laboratory and patient-reported outcomes data were collected during study visits from 2014 to 2015. We performed univariate and multivariate linear regression analyses to evaluate the factors associated with patient-physician discordance, which we defined as the difference between Patient Global Assessment and Physician Global Assessment., Results: Included in the study were 298 axSpA patients: 82% male, 81% Chinese, median age 40 (20-78) years, median disease duration 9 (0.1-48) years. 80% were on non-steroidal anti-inflammatory drugs and 23% on biologics. In univariate analysis, current age (β: 0.18, ρ = 0.06), duration of disease (β: 0.34, ρ = 0.03), post-secondary education level (β: -10.82, ρ = 0.03), global pain score (β: 0.33, ρ < 0.01), Bath Ankylosing Spondylitis Functional Index (β: 2.80, ρ < 0.01), Ankylosing Spondylitis Disease Activity Score C-reactive protein (β: 4.63, ρ < 0.01) and current use of biologics (β: 10.97, ρ < 0.01) were associated with patient-physician discordance. In multivariate analysis, global pain score (β: 0.32, ρ < 0.01), post-secondary education level (β: -12.80, ρ = 0.01) and current biologics use (β: 16.21, ρ < 0.01) were associated with patient-physician discordance., Conclusion: Higher global pain score, lower educational level and current biologics use were associated with greater patient-physician discordance. These factors should be considered during shared decision making., (© 2018 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Objective: We aimed to provide an up-to-date synthesis of the effectiveness of patient reported outcome measures (PROMs) use to self-monitor symptoms compared to conventional follow-up care in patients with rheumatic diseases. We also compared the effect of providing feedback via PROMs to a control group in which PROMs feedback was not provided. Methods: This review was guided by the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. Articles published before October 2023 were retrieved from PubMed Ⓡ , Cochrane Library Ⓡ , Embase Ⓡ , and PsycINFO Ⓡ (Ovid). Studies were included if (1) they compared PROMs use compared against not using PROMs, (2) used PROMs as an intervention with feedback provided to healthcare professionals/patients to compare against PROMs use but no feedback was provided. Methodological quality and level of evidence were evaluated according to the Risk of Bias tool and the Risk of Bias in Non-randomized Studies of Interventions tool. Results: A total of 15, 571 articles were screened, 5 articles met the inclusion criteria, and 3 additional articles were identified from handsearching. Most studies reported positive results on symptom control, health-related quality of life, patient perception, shared decision making, and a reduction in clinic visits. No studies reported on survival/mortality. In general, we found conflicting evidence regarding whether feedback from physicians improved patient satisfaction in clinical care. Conclusion: We identified 8 articles through a systematic review and synthesised evidence on their effectiveness. There is a lack of studies comparing PROMs use to conventional care in rheumatic diseases. Future studies should explore the implications of using PROMs in clinical care. [ABSTRACT FROM AUTHOR]

Background: The management of diabetes is complex. There is growing recognition of the use of patient-reported outcome measures (PROMs) as a standardized method of obtaining an outlook on patients' functional status and well-being. However, no systematic reviews have summarized the studies that investigate the measurement properties of diabetes PROMs.Objective: Our aims were to conduct a systematic review of studies investigating the measurement properties of diabetes PROMs by evaluating the methodological quality and overall level of evidence of these PROMs and to categorize them based on the outcome measures assessed.Methods: This study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the Embase, PubMed, and PsychINFO databases. The PROMs were evaluated with the COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) guidelines.Results: A total of 363 articles evaluating the measurement properties of PROMs for diabetes in the adult population were identified, of which 238 unique PROMs from 248 studies reported in 209 articles were validated in the type 2 diabetes population. PROMs with at least a moderate level of evidence for ≥5 of 9 measurement properties include the Chinese version of the Personal Diabetes Questionnaire (C-PDQ), Diabetes Self-Management Instrument Short Form (DSMI-20), and Insulin Treatment Appraisal Scale in Hong Kong primary care patients (C-ITAS-HK), of which the C-PDQ has a "sufficient (+)" rating for >4 measurement properties. A total of 43 PROMs meet the COSMIN guidelines for recommendation for use.Conclusions: This study identified and synthesized evidence for the measurement properties of 238 unique PROMs for patients with type 2 diabetes and categorized the PROMs according to their outcome measures. These findings may assist clinicians and researchers in selecting appropriate high-quality PROMs for clinical practice and research.Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020180978; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020180978. [ABSTRACT FROM AUTHOR]