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Background: There is no medication adherence scale available in Sindhi language currently. Hence, the Sindhi speaking population will either use a translator or provide their medical history in another language for documentation of medical conditions. This poses a challenge in monitoring and evaluating adherence to medications within this linguistic community. Aim: The aim of this study was to translate and validate the Sindhi version of the General Medication Adherence Scale (GMAS-S) in patients with chronic diseases. Methods: This was a cross-sectional study of 4 months duration and was conducted in out-patient department of a university affiliated hospital in Karachi, Pakistan. All adults with chronic diseases, who were on long-term medications, and able to read and understand Sindhi language were invited. Convenience sampling was employed and a questionnaire consisting of demographic questions and the Sindhi version of GMAS was used. The translation of the scale was carried out. Confirmatory factor analysis (CFA) was conducted, and a structural equation model (SEM) was developed. Fit indices, namely, goodness of fit index (GFI), adjusted goodness of fit index (AGFI), Tucker Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA) were reported. Reliability was assessed using Cronbach’s alpha (α), intraclass correlation coefficient (ICC), corrected item-to-total correlation (ITC) and item deletion. Data were analysed through IBM SPSS version 23 and IBM AMOS version 25. The study obtained ethical clearance. Results: A total of 150 responses were analysed. The reliability of the Sindhi version of GMAS was (α) = 0.696. The intraclass correlation coefficient (ICC) was reported at 0.696 (95% CI: 0.618–0.763). The values for the fit indices were as follows: χ2 /df = 1.84, GFI = 0.918, TLI = 0.920, CFI = 0.942, AGFI = 0.864, and RMSEA = 0.075. All values except AGFI were in the acceptable ranges and indicated good fitness. Most participants (80.7%) appeared non-adherent to their medications. Conclusion: The results of the study demonstrate that the Sindhi version of the GMAS is a valid and reliable scale to measure adherence in Sindhi speaking persons with chronic diseases. [ABSTRACT FROM AUTHOR]

Aim: To carry out cross‐culture adaptation and validation of the English version of Rheumatoid Arthritis Knowledge Assessment Scale (RAKAS) in patients with rheumatoid arthritis (RA). Methods: A cross‐sectional study was conducted for 2 months in 2 tertiary care hospitals in Karachi, Pakistan. Sample size was calculated based on item‐subject ratio. The translation was carried out using standard procedures for translation and cross‐culture adaptation. The validation process included estimation of discrimination power, item difficulty index, factorial, convergent, construct and known group validities and reliability. Reliability of the scale was estimated using Kuder‐Richardson Formula 20 and a value of σ2 ≥ 0.6 was acceptable. SPSS v23, Remark Classic OMR v6 software and MedCalc Statistical Software v16.4.3, were used to analyze the data. The study was approved by the relevant ethics committee (IRB#NOV:15). Results: The mean score was 7.68 ± 2.52 (95% CI: 7.31‐8.05) for 177 patients. The σ2 = 0.601, that is, >0.6, test‐retest reliability ρ =.753, P <.05. The average discrimination power = 47.27, average Item Difficulty Index = 0.557. The fit indices were acceptable in a range that established its factorial validity and average factor loading was ≥0.7 which established convergent validity. A significant association (χ2 = 33.074, P <.01) between score interpretation and previous counseling by pharmacists established its construct validity. A significant association (χ2 = 19.113, P <.05) between score interpretation and patient occupation established known group validity. Conclusion: The English version of RAKAS was deemed a reliable and validated tool to measure knowledge about disease in Pakistani patients with RA. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to estimate annual direct cost attributed to rheumatoid arthritis (RA) treatment from a patient's perspective using real‐world patient follow‐up data from hospitals' electronic database. Methods: A prospective 1‐year study was conducted in rheumatology clinics of tertiary care hospitals of Karachi, Pakistan. Cost‐of‐illness methodology was used and all patient data related to costs of rheumatologist visits, physical therapy sessions, medications, assistive devices and laboratory investigations were obtained directly in printed hardcopies from patient electronic databases using their medical record numbers. Transportation cost was calculated from patient‐reported log books. Data were analyzed through IBM SPSS version 23. Patients were asked to sign a written consent and the study was ethically approved. Results: The mean age of patients (N = 358) was 48 years. Most patients (73.7%) were female, married (86%) and had basic education (71.8%). Average cost of rheumatologist visits was PKR 11 510.61 (USD: 72.05) while it was PKR 66 947.37 (USD: 419.07) for physical therapy sessions. On average, medicines and medical devices costs were estimated at PKR 10 104.23 (USD: 63.25) and PKR 7848.48 (USD: 49.13) respectively. Cost attributed to diagnostic and laboratory charges was PKR 1962.12 (USD: 12.28) and travel expense was PKR 6541 (USD: 40.95). The direct expenditure associated with managing RA was PKR 37 558 (USD: 235.1). All costs were reported per annum. Conclusion: Patient with RA in Pakistan pay a considerable amount of their income for managing their condition. Most patients have no provision for insurance which is a need considering the nature of the disease and associated productivity loss that would significantly lower income as the disease progresses. [ABSTRACT FROM AUTHOR]

Background: Non-adherence to physical therapy ranges from 14 to 70%. This could adversely affect physical functioning and requires careful monitoring. Studies that describe designing and validation of adherence measuring scales are scant. There is a growing need to formulate adherence measures for this population. The aim was to develop and validate a novel tool named as the General Rehabilitation Adherence Scale (GRAS) to measure adherence to physical therapy treatment in Pakistani patients attending rehabilitation clinics for musculoskeletal disorders.Methods: A month-long study was conducted in patients attending physical therapy sessions at clinics in two tertiary care hospitals in Karachi, Pakistan. It was done using block randomization technique. Sample size was calculated based on item-to-respondent ratio of 1:20. The GRAS was developed and validated using content validity, factor analyses, known group validity, and sensitivity analysis. Receiver operator curve analysis was used to determine cut-off value. Reliability and internal consistency were measured using test-retest method. Data was analyzed through IBM SPSS version 23. The study was ethically approved (IRB-NOV:15).Results: A total of 300 responses were gathered. The response rate was 92%. The final version of GRAS contained 8 items and had a content validity index of 0.89. Sampling adequacy was satisfactory, (KMO 0.7, Bartlett's test p-value< 0.01). Exploratory factor analysis revealed a 3-factor model that was fixed and confirmed at a 2-factor model. Incremental fit indices, i.e., normed fit index, comparative fit index and Tucker Lewis index, were reported > 0.95 while absolute fit index of root mean square of error of approximation was < 0.03. These values indicated a good model fit. The value for Cronbach (α) was 0.63 while it was 0.77 for McDonald's (ω), i.e., acceptable. Test-retest reliability coefficient was 0.88, p < 0.01. Education level was observed to affect adherence (p < 0.01). A cut-off value of 12 was identified. The sensitivity and accuracy of the scale was 95%, and its specificity was 91%.Conclusion: The scale was validated in this study with satisfactory results. The availability of this tool would enhance monitoring for adherence as well as help clinicians and therapists address potential areas that may act as determinants of non-adherence. [ABSTRACT FROM AUTHOR]

Aim: Rheumatoid arthritis (RA) is a chronic progressive disabling disease that mainly affects joints. Studies documenting Pakistani patients' knowledge regarding RA disease are lacking and there is a need for such endeavor. The purpose of this study was to develop and validate a novel research tool to document patient knowledge about RA disease. Methods: A novel research instrument known as the rheumatoid arthritis knowledge assessment scale (RAKAS) which consisted of 13 items, was formulated by a rheumatology panel and used for this study. This study was conducted in rheumatology clinics of three tertiary care hospitals in Karachi, Pakistan. The study was conducted in March–April 2018. Patients were recruited using a randomized computer‐generated list of appointments. Sample size was calculated based on item‐to‐respondent ratio of 1:15. The validities, factor structure, sensitivity, reliability and internal consistency of RAKAS were assessed. The study was approved by the institutional Ethics Committee. Results: A total of 263 patients responded to the study. Content validity was 0.93 and response rate was 89.6%. Factor analysis revealed a 3‐factor structure. Fit indices, namely normed fit index (NFI), Tucker Lewis index (TLI), comparative fit index (CFI) and root mean square of error approximation (RMSEA) were calculated with satisfactory results, that is, NFI, TLI and CFI > 0.9, and RMSEA < 0.06. Internal consistency (α) was 0.62, that is, acceptable. All items had a high discrimination index, that is, >19 and difficulty index <0.95. Sensitivity and specificity of RAKAS were above 90%. The tool established construct and known group validities. Conclusion: A novel tool to document disease knowledge in patients with RA was formulated and validated. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to develop a novel tool known as patient satisfaction feedback on counselling (PSF) questionnaire and documented patient satisfaction following pharmacist counselling using the tool. Methods: A 2‐month cross‐sectional study was conducted at Clifton Hospital Pharmacy in Karachi, Pakistan, using a novel questionnaire in both English and Urdu languages after face and content validation. Convenient sampling was employed, and data were analysed by SPSS v22. The study was approved by Ethics Committee of Clifton Hospital (Letter#23‐18). Key findings: Content validity index and reliability were reported at 0.83 and 0.88. All items loaded on a single factor. A total of 350 patients participated in the study. The response rate was 67.1%. Most patients were adults (70%), married (66%), graduates (64%), employed (42%) and resided in urban localities (92%). Most patients suffered from chronic illness (68%) and had no comorbidity (78%). Half of patients had previous exposure of pharmacist counselling (52%). Average counselling time was around 8–9 min (X = 8.7, SD = 4.3). More than half of patients (56%) were willing to pay an average cost of PKR 346 (US $ 3) for a pharmacist counselling session, and 60% of patients were satisfied with counselling. A significant correlation was reported between patient satisfaction rating and amount willing to pay (q = 0.284, P < 0.001), and duration of counselling (q = 0.592, P < 0.001). Conclusion: Patients appeared satisfied with counselling. Age, education, comorbidity, illness type and duration, health insurance, number of medicines prescribed, urban residence and previous counselling exposure were determinants of patient satisfaction. Most notable finding was patients' willingness to pay for counselling should this service be charged that increased with patient satisfaction. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The study was aimed at identifying the potential barriers to polio rehabilitation treatment in patients of Karachi, Pakistan. METHODS: A mix-methods study was conducted in the city of Karachi, Pakistan for 6 months which gathered data from polio survivors as well as physical therapists who were involved in rehabilitation treatment of polio patients. The study had a quantitative part supplemented by a questionnaire and a qualitative part in which in-depth interviews were conducted. It was approved by the Ethical Committee of Research Review Board, Clifton Hospital and Board of Advance Study and Research (BASR) of Hamdard University, Madinatul Hikmah, Karachi, Pakistan. RESULTS: A total of 102 physical therapists (PT) and 120 polio survivors consented to participate. The mean age of the PT was 36.1+6.4 years. Majority (77.5%) of PT was male and with work experience of over 10 years (44.1%). The mean age of the polio survivors was 30.6+8.4 years. Majority had low monthly family income i.e. PKR 15000 (US$ 147.38). Major barrier perceived by physical therapists was financial constraint (41.2%). Patients of Pashtun ethnicity (34.3%) were also perceived as a major barrier itself. Major and minor barriers perceived by polio survivors were financial constraint (95%) and treatment attendance (68.3%) respectively. CONCLUSION: Pakistan's polio rehabilitation program is hindered by financial issues for most part coupled with low family income and directs treatment costs borne by patients. Directs treatment costs were found to be the biggest barrier to rehabilitation treatment. [ABSTRACT FROM AUTHOR]

Background: The objective of this study is to evaluate the effectiveness of pharmacist intervention in improving disease knowledge, adherence to treatment, health-related quality of life (HRQoL) and direct cost of treatment. The study also documents patient satisfaction with pharmacist counselling as a quality control measure.Methods/design: This is a randomized, single-blind, two-arm, controlled trial in patients with rheumatoid arthritis visiting outpatient rheumatology clinics in Karachi, Pakistan. We will enroll patients with established diagnosis of rheumatoid arthritis over 3 months. The patients would be randomized through a computer-generated list into the control group, i.e., usual care or into the intervention group, i.e., pharmaceutical care, in a ratio of 1:1, after providing signed written consent. The study will take place in two patient-visits over the course of 3 months. Patients in the intervention group would receive intervention from the pharmacist while those in the control group will receive usual care. Primary outcomes include change in mean score from baseline (week 0) and at follow up (week 12) in disease knowledge, adherence to medications and rehabilitation/physical therapy. The secondary outcomes include change in the mean direct cost of treatment, HRQoL and patient satisfaction with pharmacist counselling.Discussion: This is a novel study that evaluates the role of the pharmacist in improving treatment outcomes in patients with rheumatoid arthritis. The results of this trial could set the foundation for future delivery of care for this patient population in Pakistan. The results of this trial would be published in a peer-reviewed journal.Trial Registration: ClinicalTrials.gov, NCT03827148 . Registered on February 2019. [ABSTRACT FROM AUTHOR]