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Dropout is a common and serious problem in psychological research and practice. When participants terminate treatment prematurely, this may have methodological and clinical consequences. The aim of this study was to identify predictors of dropout in a sample of patients (N = 217) with sub-threshold and mild panic disorder treated with a public mental health intervention programme based on cognitive-behavioural principles. Three groups of possible baseline predictors were selected from the literature: (1) socio-demographic, (2) personal, and (3) illness-related variables. A total of 51 (23.5%) participants were classified as dropouts. Dropouts were further subdivided into pretreatment dropouts (n = 17) who attended no course sessions at all and regular dropouts (n = 34) who attended 1–5 course sessions. Multivariable logistic regression analyses were used to identify independent predictors of dropout. Few variables were significantly associated with increased odds of dropout and the total explained variance was small. Fewer years of education was the only independent predictor of total dropout and male gender was associated with more pretreatment dropout. No independent predictors were found for regular dropout. It can be concluded that it is difficult to precisely predict dropout risk in patients participating in a public mental health intervention for panic symptoms.

Item does not contain fulltext OBJECTIVE: The aim of this study was to identify baseline predictors of achieving patient-perceived satisfactory improvement (PPSI) in pain after 6 months of treat to target in patients with early RA. METHODS: Baseline and 6 month data were used from patients included in the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study. Simple and multivariable logistic regression analyses were used to identify significant predictors of achieving an absolute improvement of 30 mm or a relative improvement of 50% on a visual analogue scale for pain. RESULTS: At 6 months, 125 of 209 patients (59.8%) achieved an absolute PPSI and 130 patients (62.2%) achieved a relative PPSI in pain. Controlling for baseline pain, having symmetrical arthritis was the strongest independent predictor of achieving an absolute [odds ratio (OR) 3.17, P = 0.03] or relative (OR 3.44, P = 0.01) PPSI. Additionally, anti-CCP positivity (OR 2.04, P = 0.04) and having

To evaluate and compare the measurement precision and sensitivity to change of the Health Assessment Questionnaire disability index (HAQ DI), the Short Form 36 physical functioning scale (PF-10), and simulated Patient-Reported Outcomes Measurement Information System (PROMIS) physical function computer adaptive tests (CATs) with 5, 10, and 15 items, using item response theory-based simulation studies.The measurement precision of the various physical function instruments was evaluated by calculating root mean square errors (RMSEs) between true physical function levels (latent physical function score) and estimated physical function levels. Measurement precision was evaluated at 9 levels of physical function, with 5,000 simulated response patterns per level. Sensitivity to change was evaluated by the ability of a simple statistical test to detect simulated change scores of small to moderate magnitude (standardized effect sizes 0.20, 0.35, and 0.50).RMSEs were smaller for the PROMIS physical function 15-item CAT (CAT-15) and CAT-10 than for the HAQ DI and PF-10 across all levels of the latent physical function scale. Only marginal improvement in performance was observed for the CAT-15 compared with the CAT-10, and the CAT-5 performed quite similarly to the HAQ DI and PF-10 across most levels of the latent physical function scale. Substantially improved sensitivity to change was observed for the CAT-10 compared with the HAQ DI and PF-10, particularly in detecting moderate effect sizes.Clearly higher measurement precision was observed for the PROMIS CAT compared with the HAQ DI and PF-10. Higher reliability also translated into lower sample size requirements for detecting changes in clinical status.

To evaluate the reliability of a crosswalk, developed in The Netherlands, between the Health Assessment Questionnaire (HAQ) disability index (DI) and the Short Form 36 physical functioning scale (PF-10) in a sample of patients with various rheumatic diseases in the US.Baseline data from patients with rheumatoid arthritis (RA; n = 29,020), fibromyalgia (FM; n = 3,776), and systemic lupus erythematosus (SLE; n = 1,609) participating in the National Data Bank for Rheumatic Diseases were analyzed. Reliability of the crosswalk was evaluated by calculating intraclass correlation coefficients (ICCs), and agreement between observed and predicted scores was evaluated using the Bland-Altman approach. RESULTS. The crosswalk produced reliable conversions for both the HAQ DI (ICC range 0.70-0.77) and PF-10 (ICC range 0.73-0.78) in all 3 disease groups. The mean difference between observed and expected scores was close to zero in US patients with RA. For all 3 disease groups, the limits of agreement were fairly wide and conversion at the level of individual patients is not recommended.The crosswalk produced reliable conversions at the group level in a crosscultural setting and can be used to convert HAQ DI to PF-10 scores and vice versa in US patients with RA, FM, or SLE.

Contains fulltext : 127702.pdf (Publisher’s version ) (Open Access) OBJECTIVE: To calibrate the Dutch-Flemish version of the PROMIS physical function (PF) item bank in patients with rheumatoid arthritis (RA) and to evaluate cross-cultural measurement equivalence with US general population and RA data. METHODS: Data were collected from RA patients enrolled in the Dutch DREAM registry. An incomplete longitudinal anchored design was used where patients completed all 121 items of the item bank over the course of three waves of data collection. Item responses were fit to a generalized partial credit model adapted for longitudinal data and the item parameters were examined for differential item functioning (DIF) across country, age, and sex. RESULTS: In total, 690 patients participated in the study at time point 1 (T2, N = 489; T3, N = 311). The item bank could be successfully fitted to a generalized partial credit model, with the number of misfitting items falling within acceptable limits. Seven items demonstrated DIF for sex, while 5 items showed DIF for age in the Dutch RA sample. Twenty-five (20%) items were flagged for cross-cultural DIF compared to the US general population. However, the impact of observed DIF on total physical function estimates was negligible. DISCUSSION: The results of this study showed that the PROMIS PF item bank adequately fit a unidimensional IRT model which provides support for applications that require invariant estimates of physical function, such as computer adaptive testing and targeted short forms. More studies are needed to further investigate the cross-cultural applicability of the US-based PROMIS calibration and standardized metric.

Contains fulltext : 139118.pdf (Publisher’s version ) (Open Access) BACKGROUND: The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are two commonly used measures of inflammation in rheumatoid arthritis (RA). As current RA treatment guidelines strongly emphasize early and aggressive treatment aiming at fast remission, optimal measurement of inflammation becomes increasingly important. Dependencies with age, sex, and body mass index have been shown for both inflammatory markers, yet it remains unclear which inflammatory marker is affected least by these effects in patients with early RA. METHODS: Baseline data from 589 patients from the DREAM registry were used for analyses. Associations between the inflammatory markers and age, sex, and BMI were evaluated first using univariate linear regression analyses. Next, it was tested whether these associations were independent of a patient's current disease activity as well as of each other using multiple linear regression analyses with backward elimination. The strengths of the associations were compared using standardized beta (beta) coefficients. The multivariate analyses were repeated after 1 year. RESULTS: At baseline, both the ESR and CRP were univariately associated with age, sex, and BMI, although the association with BMI disappeared in multivariate analyses. ESR and CRP levels significantly increased with age (beta-ESR = 0.017, p < 0.001 and beta-CRP = 0.009, p = 0.006), independent of the number of tender and swollen joints, general health, and sex. For each decade of aging, ESR and CRP levels became 1.19 and 1.09 times higher, respectively. Furthermore, women demonstrated average ESR levels that were 1.22 times higher than that of men (beta = 0.198, p = 0.007), whereas men had 1.20 times higher CRP levels (beta = -0.182, p = 0.048). Effects were strongest on the ESR. BMI became significantly associated with both inflammatory markers after 1 year, showing higher levels with increasing weight. Age continued to be significantly associated, whereas sex remained only associated with the ESR level. CONCLUSIONS: Age and sex are independently associated with the levels of both acute phase reactants in early RA, emphasizing the need to take these external factors into account when interpreting disease activity measures. BMI appears to become more relevant at later stages of the disease.

Disability is a common problem in patients with gout. Recently, the Health Assessment Questionnaire Disability Index (HAQ-DI) was recommended for assessing patient-reported activity limitations in gout. However, few studies have explored experiences and issues of disability from the perspective of gout patients themselves. The objectives of this study were to explore disability issues in patients with gout and to examine the content validity of the HAQ-DI in this patient group. Two studies were performed: a semi-structured interview study with seven male gout patients and a cross-sectional survey study among 34 other patients with gout. In both studies, specific examples of activity limitations were elicited using open-ended methods. The survey study additionally aimed to quantify the relevance of the activities listed in the HAQ-DI. Most patients experienced several gout attacks in the previous year. Limitations were reported to occur during a flare, but patients were generally not limited between attacks. During an attack, patients mainly experienced limitations related to mobility, especially walking and climbing stairs. Patients also mentioned limitations in activities related to domestic life, such as gardening and doing housework. Limitations related to self-care or activities requiring the use of the upper extremities were rarely mentioned. Corresponding HAQ-DI items were skewed towards very low disability scores over the past week. Assessments of gout-related disability should particularly focus on mobility and lower extremity functioning and should consider the intermittent nature of the disease. The HAQ-DI may not adequately meet these requirements, suggesting the need to explore other measures of gout-related disability.

Objective: Although treat-to-target (T2T) strategies are effective in early RA patients, important individual variations exist in the course towards remission. Growth mixture modeling (GMM) provides more insight into this heterogeneity by identifying subgroups of patients with similar response patterns. This study aimed to identify distinct trajectories of disease activity in early RA patients following a T2T strategy, during their first year. Methods: Data on various clinical and patient-reported measures were collected from the DREAM remission induction cohort. GMM was applied to examine the impact of T2T on subgroups characterized by different types of growth trajectories, as measured with the Disease Activity Score for 28 joints. Results: Three distinct trajectories of disease activity were found. The normative trajectory contained most patients (82.6%), showing a quickly decreasing disease activity, stabilizing at remission after 9 months. This group performed best on clinical and patient-reported measures over time and were more likely to be men. A smaller group (14.1%) also approached remission, but demonstrated a slower response to treatment. Finally, a minority (3.3%) showed no improvement after 1 year, despite an initial quick decrease in disease activity during the first months of treatment. Conclusion: Disease activity in early RA patients during the first year of a T2T strategy does not follow a linear pattern, nor is a single developmental trajectory applicable to all patients. Future studies should attempt to identify more specific risk factors for poor outcome to enable early identification of patients in need of alternative therapeutic approaches.

BACKGROUND: Previous studies in patients with hip and knee osteoarthritis (OA) have advocated the relevance of assessing the number of painful joint sites, other than the primary affected joint, in both research and clinical practice. However, it is unclear whether joint-pain comorbidities can simply be summed up. METHODS: A total of 401 patients with hip or knee OA completed questionnaires on demographic variables and joint-pain comorbidities. Rasch analysis was performed to evaluate whether a sum score of joint-pain comorbidities can be calculated. RESULTS: Self-reported joint-pain comorbidities showed a good fit to the Rasch model and were not biased by gender, age, disease duration, BMI, or patient group. As a group, joint-pain comorbidities covered a reasonable range of severity levels, although the sum score had rather low reliability levels suggesting it cannot discriminate well among patients. CONCLUSIONS: Joint-pain comorbidities, in other than the primary affected joints, can be summed into a joint pain comorbidity score. Nevertheless, its use is discouraged for individual decision making purposes since its lacks discriminative power in patients with minimal or extreme joint pain.

Background Although item response theory (IRT) appears to be increasingly used within health care research in general, a comprehensive overview of the frequency and characteristics of IRT analyses within the rheumatic field is lacking. An overview of the use and application of IRT in rheumatology to date may give insight into future research directions and highlight new possibilities for the improvement of outcome assessment in rheumatic conditions. Therefore, this study systematically reviewed the application of IRT to patient-reported and clinical outcome measures in rheumatology. Methods Literature searches in PubMed, Scopus and Web of Science resulted in 99 original English-language articles which used some form of IRT-based analysis of patient-reported or clinical outcome data in patients with a rheumatic condition. Both general study information and IRT-specific information were assessed. Results Most studies used Rasch modeling for developing or evaluating new or existing patient-reported outcomes in rheumatoid arthritis or osteoarthritis patients. Outcomes of principle interest were physical functioning and quality of life. Since the last decade, IRT has also been applied to clinical measures more frequently. IRT was mostly used for evaluating model fit, unidimensionality and differential item functioning, the distribution of items and persons along the underlying scale, and reliability. Less frequently used IRT applications were the evaluation of local independence, the threshold ordering of items, and the measurement precision along the scale. Conclusion IRT applications have markedly increased within rheumatology over the past decades. To date, IRT has primarily been applied to patient-reported outcomes, however, applications to clinical measures are gaining interest. Useful IRT applications not yet widely used within rheumatology include the cross-calibration of instrument scores and the development of computerized adaptive tests which may reduce the measurement burden for both the patient and the clinician. Also, the measurement precision of outcome measures along the scale was only evaluated occasionally. Performed IRT analyses should be adequately explained, justified, and reported. A global consensus about uniform guidelines should be reached concerning the minimum number of assumptions which should be met and best ways of testing these assumptions, in order to stimulate the quality appraisal of performed IRT analyses.

To evaluate the crosscultural measurement equivalence of the US and Dutch Health Assessment Questionnaire II (HAQ-II) in rheumatoid arthritis (RA).Item response theory (IRT) analyses were performed on US (n = 18,747) and Dutch (n = 1,022) HAQ-II data to evaluate the equivalence of crosscultural item performance. The observed inconsistencies were modeled by assigning country-specific item parameters to biased items. The impact of crosscultural item bias on the comparability of the Dutch and US total scores was analyzed by evaluating the agreement between physical function levels estimated from an IRT model with country-specific item parameters for biased items and physical function levels estimated from the original model that did not account for cultural bias.Two items showed significant crosscultural bias. However, the agreement in physical function estimates between the respecified and original models was very high, with an intraclass correlation coefficient0.99 and Bland-Altman limits of agreement ranging from -0.08 to -0.01 on a latent scale with a mean of 0 and an SD of 1.This study suggests that the Dutch and US HAQ-II produce total scores that can be interpreted interchangeably across countries in RA studies, despite some minor bias at the item level.

Fibromyalgia (FM) is a disorder characterised by chronic widespread pain in soft tissues, especially in muscles. Previous research has demonstrated a higher muscle fibre conduction velocity (CV) in painful muscles of FM patients. The primary goal of this study was to investigate whether there is also a difference in CV in non-painful, non-tender point (TP) related muscles between FM patients and controls. The secondary goal was to explore associations between the CV, the number of TPs and the complaints in FM.Surface electromyography (sEMG) was performed on the biceps brachii muscle of female FM patients (13) and matched healthy controls (13). Short static contractions were applied with the arm unloaded and loaded at 5% and 10% of maximum voluntary force. The CV was derived by cross-correlation method (CV-cc) and inter-peak latency method (CV-ipl). TP score and Fibromyalgia Impact Questionnaire (FIQ) were performed in all participants. Correlations were calculated between the CVs, TP score and items of the FIQ.In FM patients, the CV was higher than in the controls (CV-cc p=0.005; CV-ipl p=0.022). The CV was correlated with the number of TPs in FM patients (r=0.642 and 0.672 for CV-cc and CV-ipl, respectively). No correlations were found between the CV and any aspect of health status on the FIQ.The results demonstrate abnormally high muscle membrane conduction velocity in FM, even in non-TP muscles. In addition, a relationship has been found between the high membrane velocity and the number of TPs.

A prospective open-label study comparing the efficacy and safety of methotrexate (MTX) and chloroquine (CQ) in articular and cutaneous manifestations of systemic lupus erythematosus (SLE).Consecutive SLE patients were randomly assigned to either 10 mg MTX weekly or 150 mg CQ daily during 24 weeks. Outcome measures were: numbers of swollen and tender joints, duration of morning stiffness, visual analog scale (VAS) for articular pain, physician global assessment index, patient global assessment index, SLE Disease Activity Index (SLEDAI), disappearance of skin rash and erythrocyte sedimentation rate (ESR).Forty-one patients consented to participate, 15 were allocated in the MTX group and 26 in the CQ group. Two patients on MTX dropped out due to side-effects and two in the CQ group, one due to side-effects and one due to inefficacy. Baseline demographic, clinical and laboratory parameters of the two groups were nearly identical. In both groups the clinical and laboratory parameters improved significantly over 24 weeks, except the ESR in the MTX group. The results of the outcome measures at the end of the trial did not differ significantly between the two groups, except morning stiffness (P0.05 in favor of the MTX group) and ESR (P0.01 in favor of the CQ group). Rise of serum alanine aminotransferase was observed in two cases in the MTX group and in none in the CQ group.Low-dose MTX appears to be as effective as CQ in patients with articular and cutaneous manifestations of SLE, having an acceptable toxicity profile. Results of this prospective study need to be confirmed in a larger study.

Background Currently, no validated instruments are available to measure the health status of Bangladeshi patients with fibromyalgia (FM). The aims of this study were to cross-culturally adapt the modified Fibromyalgia Impact Questionnaire (FIQ) into Bengali (B-FIQ) and to test its validity and reliability in Bangladeshi patients with FM. Methods The FIQ was translated following cross-cultural adaptation guidelines and pretested in 30 female patients with FM. Next, the adapted B-FIQ was physician-administered to 102 consecutive female FM patients together with the Health Assessment Questionnaire (HAQ), selected subscales of the SF-36, and visual analog scales for current clinical symptoms. A tender point count (TPC) was performed by an experienced rheumatologist. Forty randomly selected patients completed the B-FIQ again after 7 days. Two control groups of 50 healthy people and 50 rheumatoid arthritis (RA) patients also completed the B-FIQ. Results For the final B-FIQ, five physical function sub-items were replaced with culturally appropriate equivalents. Internal consistency was adequate for both the 11-item physical function subscale (α = 0.73) and the total scale (α = 0.83). With exception of the physical function subscale, expected correlations were generally observed between the B-FIQ items and selected subscales of the SF-36, HAQ, clinical symptoms, and TPC. The B-FIQ was able to discriminate between FM patients and healthy controls and between FM patients and RA patients. Test-retest reliability was adequate for the physical function subscale (r = 0.86) and individual items (r = 0.73-0.86), except anxiety (r = 0.27) and morning tiredness (r = 0.64). Conclusion This study supports the reliability and validity of the B-FIQ as a measure of functional disability and health status in Bangladeshi women with FM.

Objective: To examine the structural validity, internal consistency, test-retest reliability, and construct validity of the 5-item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale in patients with osteoarthritis (OA). Methods: A cross-sectional sample of 224 outpatients with OA completed a survey containing the Dutch PEPPI-5 and other standardized measures assessing perceived health-management skills, general self-efficacy, social support, and health-related quality of life. A subsample of 100 patients completed the PEPPI-5 again approximately 3 weeks later. Results: Confirmatory factor analysis demonstrated good fit for a unidimensional model of the PEPPI-5. Additionally, the scale showed high internal consistency (alpha = 0.92) and fair test-retest reliability (ICC = 0.68). As hypothesized, the PEPPI-5 was strongly correlated with perceived health-management skills, moderately with social support and psychosocial aspects of health, and not with physical aspects of health. Contrary to expectations, however, it was not correlated with general self-efficacy. Conclusion: The Dutch PEPPI-5 demonstrated adequate validity and reliability in patients with OA. Practice implications: The PEPPI-5 is a brief and appropriate tool for measuring self-efficacy of patients with OA to interact with their physicians. Additional research into its sensitivity to change is needed before it can be confidently recommended as an outcome measure in intervention studies. (C) 2011 Elsevier Ireland Ltd. All rights reserved

Objective To develop a culturally adapted Bengali version of the Short Form-36 (SF-36) Health Survey and to test its acceptability, reliability, and validity in patients with rheumatoid arthritis (RA). Study Design and Setting The US English SF-36 was translated into Bengali after established cross-cultural adaptation procedures. The questionnaire was interviewer administered to 125 consecutive outpatients with RA and readministered after 2 weeks to 40 randomly selected patients. Results Most participants (86.4%) did not have any problem in understanding the Bengali SF-36 and 98.4% of the questionnaires were fully completed. Only the role-physical and role-emotional scales showed substantial floor and ceiling effects. Principal component analysis confirmed that the hypothesized two-factor structure and tests of scaling assumptions were 100% successful for all eight scales expect physical functioning (98.8%) and general health (77.5%). Cronbach's α was higher than 0.78 and the test–retest reliability was high (r > 0.82) for all scales. Correlations with other disease activity parameters were generally as expected and summary scores were able to discriminate between relevant subgroups. Conclusion The interviewer-administered Bengali SF-36 appears to be an acceptable, reliable, and valid instrument for measuring health-related quality of life in Bangladeshi patients with RA. The questionnaire should be further evaluated in people from the general population and in patients with different medical conditions

Background The aim of this study was to systematically review the content validity and measurement properties of all physical function (PF) scales which are currently validated for use with patients with rheumatoid arthritis (RA). Methods Systematic literature searches were performed in the Scopus and PubMed databases to identify articles on the development or psychometric evaluation of PF scales for patients with RA. The content validity of included scales was evaluated by linking their items to the International Classification of Functioning Disability and Health (ICF). Furthermore, available evidence of the reliability, validity, responsiveness, and interpretability of the included scales was rated according to published quality criteria. Results The search identified 26 questionnaires with PF scales. Ten questionnaires were rated to have adequate content validity. Construct validity, internal consistency, test-retest reliability and responsiveness was rated favourably for respectively 15, 11, 5, and 6 of the investigated scales. Information about the absolute measurement error and minimal important change scores were rarely reported. Conclusion Based on this literature review, the disease-specificHAQ and the generic SF-36 can currently be most confidently recommended to measure PF in RA for most research purposes. The HAQ, however, was frequently associated with considerable ceiling effects while the SF-36 has limited content coverage. Alternative scales that might be better suited for specific research purposes are identified along with future directions for research.

Acceptance of pain appears as an important factor in pain research and in practice. Different measurement instruments were developed, among which the Chronic Pain Acceptance Questionnaire (CPAQ;McCracken, Vowles & Eccleston, 2004). In this study possible psychometric problems with the Dutch version of the CPAQ are investigated. Different models of the CPAQ, among which the general two-factor model (subscales Activity Engagement and PainWillingness), were tested in confirmatory factor analysis (N = 584). None of the models met the established fit criteria for adequate fit. It is concluded that the factor structure of the Dutch version of the CPAQ can not be confirmed; the scale as such should be rejected as a useful measurement instrument. Alternative questionnaires to measure acceptance of pain (ICQ, PaSol, PIPS) are suggested

Objective To examine the association between self-expressed information needs and corresponding observed health and lifestyle issues in elderly people. Methods Data were used from the 2006 community health survey in Utrecht, a medium-sized city in the Netherlands. Data of 1634 people aged 55 years and older were available for analyses (response 64%). Multivariate logistic regression analyses were used to examine possible associations between expressed information needs and variables on demographics, lifestyle risk behaviours, physical and psychosocial health. Results Several significant associations were found between information needs and corresponding health and lifestyle problems. However, the explanatory power of the observed problems was generally low, explaining only 7% of the informational needs on lifestyle, and 17% and 28% of the informational needs on physical and psychosocial health, respectively. Conclusions The findings suggest that prevention amongst the elderly should not be solely based on information needs, but also on observed lifestyle and health. Implications for the use of different approaches of prevention and behavioural models underlying interventions are discussed.

Purpose To investigate whether the Stanford Health Assessment Questionnaire Disability Index (HAQ-DI) can serve as a generic instrument for measuring disability across different rheumatic diseases and to propose a scoring method based on item response theory (IRT) modeling to support this goal. Methods The HAQ-DI was administered to a cross-sectional sample of patients with confirmed rheumatoid arthritis (n = 619), osteoarthritis (n = 125), or gout (n = 102). The results were analyzed using the generalized partial credit model as an IRT model. Results It was found that 4 out of 8 item categories of the HAQ-DI displayed substantial differential item functioning (DIF) over the three diseases. Further, it was shown that this DIF could be modeled using an IRT model with disease-specific item parameters, which produces measures that are comparable for the three diseases. Conclusion Although the HAQ-DI partially functioned differently in the three disease groups, the measurement regarding the disability level of the patients can be made comparable using IRT methods.

The Health Assessment Questionnaire (HAQ) disability index (DI) is the most common self-reported measure of physical disability in rheumatoid arthritis (RA). Recently, the HAQ-II was developed in the US as a short, valid, and reliable alternative using Rasch analysis. Our objective was to compare the scaling properties of the HAQ DI and HAQ-II in Dutch patients with RA.We used data from 472 patients with confirmed RA. Internal construct validity of the HAQ versions was assessed using Rasch analysis. Additionally, external construct validity was assessed by examining correlates with other outcome measures.The HAQ DI had a large floor effect, with 9.5% of the patients indicating no disability compared with 4.3% for the HAQ-II. Both versions were unidimensional and adequately fit the Rasch model, containing only 1 nonfitting item. Additionally, 2 HAQ-II items demonstrated overfit and a high residual correlation, suggesting overlap or redundancy in item content. The HAQ-II demonstrated better item separation, indicating that it covered a wider range of physical function. Item difficulty estimates were reasonably well spread for the HAQ-II, whereas the HAQ DI items tended to cluster around similar difficulty levels. Both scales contained several items with differential item functioning by sex, age, or disease duration. Both scales demonstrated the expected pattern of correlations with other outcome measures.The results indicate that both the HAQ DI and HAQ-II are psychometrically robust measures of physical function. The Rasch-developed HAQ-II, however, has several favorable scaling properties, including a better scale length and a reduced floor effect.

To examine the comparative internal and external responsiveness of the generic Medical Outcome Study Short Form-36 Health Survey (SF-36) and disease-specific measures in patients with rheumatoid arthritis (RA).Data were collected from 280 RA patients starting anti-tumor necrosis factor treatment. A total of 168 patients completed a questionnaire including the SF-36, the Arthritis Impact Measurement Scales 2 (AIMS2), the Health Assessment Questionnaire (HAQ), a visual analog scale for general health (VAS-GH), and an 11-point numerical rating scale for pain (NRS pain) at baseline and after 12 months. Internal responsiveness was evaluated with paired samples t-tests and standardized response means (SRM). External responsiveness was investigated with receiver-operating characteristic statistics and Spearman rank-order correlation coefficients. A health transition item was used as the external indicator of change.No significant differences in internal and external responsiveness were found between the SF-36 and disease-specific measures within the domains physical function, pain, and psychological function. In the domain social function, the SF-36 was more responsive than the AIMS2. In the domain general health, the SF-36 was less responsive (only internal) than the AIMS2 and VAS-GH.Our study showed comparable internal and external responsiveness of the SF-36 compared with disease-specific measures (AIMS2, HAQ, NRS pain) in all health domains, except social function and general health domains. The assumption that disease-specific measures are more responsive to detect intervention-related changes over time is not confirmed by our data.

Contains fulltext : 53171.pdf (Publisher’s version ) (Closed access) OBJECTIVES: To examine priorities for health status improvement in patients with active rheumatoid arthritis (RA) during anti-tumour necrosis factor (TNF) treatment. METHODS: Data were used from 173 patients with RA starting treatment with TNF-blocking agents. Outcome measures included assessment of health status with the Arthritis Impact Measurement Scales 2 (AIMS2) at baseline and after 3 and 12 months. The AIMS2 contains a priority list from which patients are asked to select from 12 areas of health the 3 in which they would most like to see improvement. RESULTS: After 1 year of treatment, 10 out of 12 areas of health on the AIMS2 were significantly improved. The most commonly selected priorities for improvement at baseline were pain (88%), hand and finger function (57%), walking and bending (42%), mobility (33%), and work (29%). At group level, this priority ranking remained largely unchanged during treatment. After adjustment for multiple comparisons, only pain was selected significantly less often at 3 and 12 months (71% at both assessments). Within individual patients, however, priorities often changed. Changes in the priority of pain were related to the achieved level of patient-perceived pain and disease activity. CONCLUSIONS: This study shows that, at the group level, patients' priorities for improvement are fairly stable during 12 months of anti-TNF therapy, despite major improvements in health status. Although pain reduction becomes somewhat less important, it remains the most commonly selected priority. In contrast, individual patient priorities are not stable over the course of treatment and appear to be associated with differences in disease state.

it has been suggested that patients from Mediterranean cultures tend to report more intense pain than their Northern or Western European counterparts in comparable medical conditions. However, empirical data to support this hypothesis are limited. The goals of the present study were to examine differences in pain intensity reports between Dutch and Egyptian women with rheumatoid arthritis (RA) and to examine the influence of possible confounding variables using multivariate analyses. We performed a cross-sectional study in 30 Dutch and 42 Egyptian women with comparable RA, matched for age and disease duration. Pain intensity was measured on a 100-mm graphic rating scale. Additionally, we assessed physical function, radiographic joint damage, progression of RA, disease activity, number of swollen and tender joints, medication, rheumatoid factor, and socioeconomic variables. The progression of RA and radiographic damage were not significantly different between Egyptian and Dutch patients. However, the Egyptian population reported significantly worse pain and physical function and demonstrated higher disease activity. Multiple linear regression analysis showed that the country of residence and the number of tender and swollen joints were significant independent determinants of pain reports. The results provide some support for the idea that there are ethnocultural differences in pain reports between Egyptian and Dutch women with RA, although the mechanisms underlying these differences remain unclear. Perspective: This article shows that after controlling for differences in demographic, socioeconomic, and clinical variables, Egyptian women with RA reported more pain than Dutch women with RA. Clinicians and investigators should recognize that cultural or ethnic factors may play an important role in patients' pain reports. (C) 2007 by the American Pain Society

Background Severe fatigue is prevalent in patients with rheumatic diseases and has significant impact on patients “quality of life”. However, qualitative studies revealed that fatigue symptoms remain undiscussed in the consultations with health professionals. Objectives Aim of this study was to describe the perceived importance of, satisfaction with and efficacy in fatigue-related communication with rheumatologists and rheumatology nurses from the perspective of the patient and to relate these perceptions to disease characteristics such as severity of fatigue, physical functioning and psychological distress. Methods 127 patients (88% female, mean age=64 years) with a rheumatic disease filled out an online survey consisting of a fatigue-specific version of the PEPPI-5, MAF, HAQII, HADS and items on importance, satisfaction and experienced roles in fatigue-related communication. Data were analyzed with correlational and hierarchical regression analyses. Results Only 10% of patients evaluated fatigue-related communication as (rather) not important, 45% were satisfied with the actual communication and 77% reported that the patient had to take the initiative for fatigue-related communication. Mean score on perceived efficacy regarding fatigue-related communication (16.15, SD=4.25) was lower than those in previous studies on perceived self-efficacy in communication in general. Multivariate analyses revealed depressive symptoms as the main correlate of perceived efficacy in fatigue-related communication. Conclusions Fatigue-related communication emerged as an important topic from the patient perspective. However, satisfaction with and perceived self-efficacy in fatigue-related communication are lower compared to general patient-physician communication in chronic diseases. Possible explanations for this difference will be discussed. References ten Klooster, P. M., Oostveen, J. C., Zandbelt, L. C., Taal, E., Drossaert, C. H., Harmsen, E. J., et al. (2012). Further Validation of the 5-Item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) Scale in Patients With Osteoarthritis. Journal of Patient Education and Counseling, 125-130. Disclosure of Interest None declared

BackgroundThe 28-joint Disease Activity Score (DAS28) combines scores on a 28-tender and swollen joint count (TJC28 and SJC28), a patient-reported measure for general health (GH), and an inflammatory marker (either the erythrocyte sedimentation rate [ESR] or the C-reactive protein [CRP]) into a composite measure of disease activity in rheumatoid arthritis (RA). This study examined the reliability of the DAS28 in patients with early RA using principles from generalizability theory and evaluated whether it could be increased by adjusting individual DAS28 component weights.MethodsPatients were drawn from the DREAM registry and classified into a "fast response" group (N = 466) and "slow response" group (N = 80), depending on their pace of reaching remission. Composite reliabilities of the DAS28-ESR and DAS28-CRP were determined with the individual components' reliability, weights, variances, error variances, correlations and covariances. Weight optimization was performed by minimizing the error variance of the index.ResultsComposite reliabilities of 0.85 and 0.86 were found for the DAS28-ESR and DAS28-CRP, respectively, and were approximately equal across patients groups. Component reliabilities, however, varied widely both within and between sub-groups, ranging from 0.614 for GH ("slow response" group) to 0.912 for ESR ("fast response" group). Weight optimization increased composite reliability even further. In the total and "fast response" groups, this was achieved mostly by decreasing the weight of the TJC28 and GH. In the "slow response" group, though, the weights of the TJC28 and SJC28 were increased, while those of the inflammatory markers and GH were substantially decreased.ConclusionsThe DAS28-ESR and the DAS28-CRP are reliable instruments for assessing disease activity in early RA and reliability can be increased even further by adjusting component weights. Given the low reliability and weightings of the general health component across subgroups it is recommended to explore alternative patient-reported outcome measures for inclusion in the DAS28.

Background: The SF-36 physical functioning scale (PF-10) and the Health Assessment Questionnaire disability index (HAQ-DI) are the most frequently used instruments for measuring self-reported physical function in rheumatoid arthritis (RA). The objective of this study was to develop a crosswalk between scores on the PF-10 and HAQ-DI in RA. Methods: Item response theory (IRT) methods were used to co-calibrate both scales using data from 1791 RA patients. The appropriateness of a Rasch-based crosswalk was evaluated by comparing it with crosswalks based on a two-parameter and a multi-dimensional IRT model. The accuracy of the final crosswalk was cross-validated using baseline (n = 532) and 6-month follow-up (n = 276) data from an independent cohort of early RA patients. Results: The PF-10 and HAQ-DI adequately fit a unidimensional Rasch model. Both scales measured a wide range of functioning, although the HAQ-DI tended to better target lower levels of functioning. The Rasch-based crosswalk performed similarly to crosswalks based on the two-parameter and multidimensional IRT models. Agreement between predicted and observed scale scores in the cross-validation sample was acceptable for group-level comparisons. The longitudinal validity in discriminating between disease response states was similar between observed and predicted scores. Conclusion: The crosswalk developed in this study allows for converting scores from one scale to the other and can be used for group-level analyses in patients with RA.

Objectives To compare functional limitations in patients with chronic gout and matched patients with rheumatoid arthritis (RA) as measured with the HAQ-DI and PF-10. Methods Consecutive patients with crystal deposition proven gout (n=102) or with RA (n=619) visiting the outpatient rheumatology clinic of the hospital in Enschede, the Netherlands completed the HAQ-DI and PF-10. Gout patients were matched to patients with RA on sex, age (± 5 years) and disease duration (±5 years). Ninety-three patients with gout could be successfully matched to 93 patients with RA. The HAQ-DI contains 20 items measuring physical disabilities over the past week in eight categories of daily living. Items are scored on a 4-point rating scale from 0 (without any difficulty) to 3 (unable to do). A total score is calculated by averaging the highest score in each category if at least six categories are completed. The PF-10 is the physical functioning scale of the multidimensional SF-36v2. It measures current limitations in a variety of physical activities using 10 items. Items are scored from 1 (yes, limited a lot) to 3 (no, not limited at all). Scores on the PF-10 items are summed and linearly transformed to range between 0 and 100, with higher scores indicating better functioning. Results In both disease groups mean age was 59 (± 12) years, mean disease duration was 7 (±9) years and 86% of patients were male. Median PF-10 scores did not significantly differ between patients with gout or with RA and ceiling effects (no limitations) were similar (6.7% versus 6.5%) (see table). However, patients with RA had significantly worse HAQ-DI total scores than patients with gout, and ceiling effects were significantly lower in RA than in gout. Analysis of HAQ-DI category scores showed that gout patients had less limitations in activities that involve the upper extremities such as Dressing, Eating, Hygiene and Grip than RA patients, while scores for activities mostly involving the lower extremities were similar. Image/graph: Conclusions Gout patients have less functional limitations than RA patients according to HAQ-DI total scores, while according to PF-10 scores gout patients and RA patients do not significantly differ in functional limitations. HAQ-DI seems to underestimate the functional limitations of gout patients compared to RA patients because of the inclusion of activities involving upper extremities, which may be less relevant for patients with gout. On the other hand PF-10 seems to underestimate the functional limitation of patients with RA because of the emphasis on activities involving lower extremities. Disclosure of Interest None Declared

Background Modern treatment strategies are highly successful in reducing disease activity in rheumatoid arthritis (RA). However, changes in clinical measures of disease activity may not always correspond with a patient’s own opinions of improvement. Objectives To identify subjective predictors of self-reported health changes in patients with a good clinical response after one year of treatment in a tight control study. Methods Data from newly diagnosed patients of the Dutch Rheumatoid Arthritis Monitoring (DREAM) remission induction cohort who completed baseline and 12 months assessments was used for this study. Patients who achieved a good DAS28 response at 12 months were selected for analysis 1 . Subjective change in health was assessed with the SF-36 health transition question (Compared to one year ago, how would you rate your health in general now?). Scores were dichotomized (improved vs not improved) for analysis. Binary logistic regression analysis was performed to identify predictors of patient reported health changes. Twelve month changes in DAS28 scores was added as predictor in the first step; changes in scores on SF-36 subscales were added in a second step. The general health scale of the SF-36 was excluded. Cohen’s standardized effect size (e.s.) statistic (d) was calculated for 12 month change scores of significant predictors and compared between improvers and non-improvers Results A good DAS28 response after 12 months of treatment was achieved by 162 (57%) out of 282 patients. Of these, 40 (24.7%) did not consider their health to have improved since starting treatment (non-improvers). Baseline SF-36 subscale scores did not significantly differ between improvers and non-improvers. Twelve month change scores in bodily pain (OR = 1.03, p = 0.04) and vitality (OR = 1.03, p = 0.04) were significant multivariate predictors of self-reported health improvement. About 19% of the variance in self-reported health changes was explained by the final model (Nagelkerke’s R 2 = 0.19), whereas the model containing only DAS28 change scores explained about 6% of variance (Nagelkerke’s R 2 = 0.06). Mean (SD) bodily pain scores improved from 38.9 (± 18.6) to 74.7 (±19.8) over 12 months for improvers (e.s.= 1.87) and from 41.8 (±19.8) to 62.9 (±19.6) for non-improvers (e.s.= 1.06). Mean (SD) vitality scores improved from 52.8 (±19.8) to 66.7 (±16.8) in improvers (e.s. = 0.71) and from 53.12 (±18.9) to 56.56 (±18.9) for non-improvers (e.s. = 0.17). Conclusions The majority of patients with a good DAS28 response after one year of tight control treatment also considered their health to have improved. However, a substantial minority did not consider their health to have improved, despite significant clinical improvements in disease activity. These results suggest that clinical improvements do not necessarily equate to improved subjective health. One possible explanation is that pain and fatigue are patient reported outcomes that may not be adequately represented in current clinical outcome measures in RA research. References Fransen J, van Riel PL. The Disease Activity Score and the EULAR response criteria. Clin Exp Rheumatol 2005;23(5 Suppl 39):S93-9. Disclosure of Interest None Declared

INTRODUCTION: Patient-reported physical function is an established outcome domain in clinical studies in rheumatology. To overcome the limitations of the current generation of questionnaires, the Patient-Reported Outcomes Measurement Information System (PROMIS®) project in the USA has developed calibrated item banks for measuring several domains of health status in people with a wide range of chronic diseases. The aim of this study was to translate and cross-culturally adapt the PROMIS physical function item bank to the Dutch language and to pretest it in a sample of patients with arthritis. METHODS: The items of the PROMIS physical function item bank were translated using rigorous forward-backward protocols and the translated version was subsequently cognitively pretested in a sample of Dutch patients with rheumatoid arthritis. RESULTS: Few issues were encountered in the forward-backward translation. Only 5 of the 124 items to be translated had to be rewritten because of culturally inappropriate content. Subsequent pretesting showed that overall, questions of the Dutch version were understood as they were intended, while only one item required rewriting. CONCLUSIONS: Results suggest that the translated version of the PROMIS physical function item bank is semantically and conceptually equivalent to the original. Future work will be directed at creating a Dutch-Flemish final version of the item bank to be used in research with Dutch speaking populations.