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Objective Patient self‐assessed joint counts, if accurate and reliable, could potentially serve as a useful clinical assessment tool in rheumatoid arthritis (RA). This systematic review examines the effect of patient training on the inter‐rater reliability of joint counts between patients and clinicians. Methods The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A search was performed in PubMed, Embase, Cochrane Library, and CINAHL for articles that incorporated patient training and measured the reliability of patient self‐assessed joint counts in RA. Articles were included if they reported on the inter‐rater reliability between patient and clinician joint counts in both trained and untrained patients with RA. Data were extracted on characteristics of patients, structure and components of the training interventions, joint count reliability of patients with and without training, and patient feedback on training interventions. The relevant data were summarized and described. Results Multiple training methods have been studied (n = 5), including in‐person sessions run by rheumatologists and instructional videos on the joint examination. Overall, training improved the reliability of patient self–joint counts, with more marked improvement in reliability of swollen joint counts than tender joint counts. Patients had positive feedback when surveyed on their experiences with training. Conclusion Various training modalities (in‐person and video‐based) may be effective at improving reliability of patient self–joint counts. More research is needed on this topic, with potential areas for future research including 1) comparison between the efficacy of different modalities of training, and 2) impact of patient factors (education level and disease severity) on the efficacy of training.

Introduction Inflammatory bowel disease (IBD) is a group of chronic gastrointestinal diseases with frequent systemic complications that are incurable according to current knowledge. These diseases adversely affect various areas of life, lowering patients' quality of life. One of the most frequently reported symptoms is fatigue. Aim Translation and validation of the IBD-F patient self-assessment scale with a Polish IBD population. Material and methods After consent from the author of the questionnaire had been obtained, the questionnaire was translated using the forward- and back-translation method. After arriving at the final Polish version of the questionnaire and ensuring that the questions and statements were comprehensible, the questionnaire was validated with a group of 129 IBD patients. Results High values of intraclass correlation coefficient (ICC) were achieved for overall results in both parts of the IBD-F questionnaire between test and retest (values exceeding 0.75). A high Cronbach's α consistency coefficient was achieved for the entire IBD-F questionnaire, both in the test and in the retest (0.968 and 0.975, respectively). Broken down into parts, Cronbach's α coefficient for Section I (presence and severity of fatigue) of the IBD-F questionnaire was 0.883, and for Section II (impact of fatigue on the person's life) it was 0.966. All patients evaluating the Polish version of the IBD-F questionnaire deemed the content of the questions comprehensible. Conclusions The analysis of the results obtained, the Polish version of the IBD-F questionnaire was considered valid, reliable, and clinically useful.

Background and objective: The aim of this study was to evaluate the utility of two items in vocal fold paresis and paralysis screening after thyroid and parathyroid surgery: patient self-assessment of voice using the Voice Handicap Index and computer-based acoustic voice analysis using the Multi-Dimensional Voice Program. Methods: This was a prospective study of 181 patients who underwent thyroid or parathyroid surgery over a 1-year study period (2017). Preoperatively, all patients underwent laryngoscopic vocal fold inspection and acoustic voice analysis, and they completed the Voice Handicap Index questionnaire. Postoperatively, all patients underwent laryngoscopy prior to hospital discharge; 2 weeks after the surgery, they completed the Voice Handicap Index questionnaire a second time. Two weeks postoperatively, patients with vocal fold paresis or paralysis and 20 randomly selected controls without vocal fold paresis or paralysis underwent a follow-up acoustic voice analysis. Results: Fourteen patients had a new postoperative vocal fold paresis or paralysis. Postoperatively, the total Voice Handicap Index score was significantly higher (p = 0.040) and the change between preoperative and postoperative scores was greater (p = 0.028) in vocal fold paresis or paralysis patients. A total postoperative Voice Handicap Index score > 30 had 55% sensitivity, and 90% specificity, for vocal fold paresis or paralysis. In the postoperative Multi-Dimensional Voice Program analysis, vocal fold paresis or paralysis patients had significantly more jitter (p = 0.044). Postoperative jitter > 1.33 corresponded to 55% sensitivity, and 95% specificity, for vocal fold paresis or paralysis. Conclusions: In identifying postoperative vocal fold paresis or paralysis, patient self-assessment and jitter in acoustic voice analysis have high specificity but poor sensitivity. Without routine laryngoscopy, approximately half of the patients with postoperative vocal fold paresis or paralysis could be overlooked. However, if the patient has no complaints of voice disturbance 2 weeks after thyroid or parathyroid surgery, the likelihood of vocal fold paresis or paralysis is low.

Background Patient waiting time at outpatient departments is directly related to patient satisfaction and quality of care, particularly in patients visiting the general internal medicine outpatient departments for the first time. Moreover, reducing wait time from arrival in the clinic to the initiation of an examination is key to reducing patients’ anxiety. The use of automated medical history–taking systems in general internal medicine outpatient departments is a promising strategy to reduce waiting times. Recently, Ubie Inc in Japan developed AI Monshin, an artificial intelligence–based, automated medical history–taking system for general internal medicine outpatient departments. Objective We hypothesized that replacing the use of handwritten self-administered questionnaires with the use of AI Monshin would reduce waiting times in general internal medicine outpatient departments. Therefore, we conducted this study to examine whether the use of AI Monshin reduced patient waiting times. Methods We retrospectively analyzed the waiting times of patients visiting the general internal medicine outpatient department at a Japanese community hospital without an appointment from April 2017 to April 2020. AI Monshin was implemented in April 2019. We compared the median waiting time before and after implementation by conducting an interrupted time-series analysis of the median waiting time per month. We also conducted supplementary analyses to explain the main results. Results We analyzed 21,615 visits. The median waiting time after AI Monshin implementation (74.4 minutes, IQR 57.1) was not significantly different from that before AI Monshin implementation (74.3 minutes, IQR 63.7) (P=.12). In the interrupted time-series analysis, the underlying linear time trend (–0.4 minutes per month; P=.06; 95% CI –0.9 to 0.02), level change (40.6 minutes; P=.09; 95% CI –5.8 to 87.0), and slope change (–1.1 minutes per month; P=.16; 95% CI –2.7 to 0.4) were not statistically significant. In a supplemental analysis of data from 9054 of 21,615 visits (41.9%), the median examination time after AI Monshin implementation (6.0 minutes, IQR 5.2) was slightly but significantly longer than that before AI Monshin implementation (5.7 minutes, IQR 5.0) (P=.003). Conclusions The implementation of an artificial intelligence–based, automated medical history–taking system did not reduce waiting time for patients visiting the general internal medicine outpatient department without an appointment, and there was a slight increase in the examination time after implementation; however, the system may have enhanced the quality of care by supporting the optimization of staff assignments.

Background: The vocal assessment process should con-sider the multidimensionality involved in the demonstration of a voice disorder. Auditory perceptual assessment is the most commonly used clinical voice assessment method (gold standard) for evaluation of voice disorders. However, it has been heavily criticized because it is subjective and classifies severity of vocal disorders but does not address the impact of the vocal disorder has on quality of life which may go beyond the level of perceived voice change. So, it is possible that self-assessment instruments capture a different aspect of the vocal function that cannot be derived from auditory-perceptual or acoustic analysis.Aim of Study: The aim of this work is to investigate the correlation between grade of dysphonia obtained by auditory perceptual assessment, acoustic measures and the degree of handicap a patient experiences (as measured by the Arabic VHI) as a result of their voice disorder.Study Design: This was a descriptive cross-sectional study.Patients and Methods: 70 adult patients with voice com-plaints referred for voice evaluation in the Unite of Phoniatrics, Ain Shams University were included in this study aged 18 years-60 years and 35 normal adult subjects as a control group. Auditory perceptual assessment, acoustic analysis, and appli-cation of Arabic VHI questionnaire were done for all cases.Results: A significant correlation was found between grade of dysphonia and functional subscale of the Arabic VHI. Significant correlation was found between grade of dysphonia and amplitude perturbation quotient (APQ%) and shimmer percent (Shim%).Significant correlation was found between Arabic VHI total score and average fundamental frequency (F0), significant correlation between functional subscale of the Arabic VHI and average fundamental frequency (F0) and jitter percent (Jitt%) and near significant correlation between physical subscale of the Arabic VHI and average fundamental frequency.Conclusion: Auditory perceptual assessment, acoustic analysis and patient's vocal self-assessment measure different aspects of the voice and are not interchangeable. These measures provide complementary rather than redundant infor-mation.

Availability of surgical site infection (SSI) surveillance rates challenges clinicians, healthcare administrators and leaders and the public. The purpose of this report is to demonstrate the consequences patient self-assessment strategies have on SSI reporting rates. We performed SSI surveillance among patients undergoing general surgery procedures, including telephone follow-up 30 days after surgery. Additionally we undertook a separate validation study in which we compared patient self-assessments of SSI with surgeon assessment. Finally, we performed a meta-analysis of similar validation studies of patient self-assessment strategies. There were 22/266 in-hospital SSIs diagnosed (8.3%), and additional 16 cases were detected through the 30-day follow-up. In total, the SSI rate was 16.8% (95% CI 10.1–18.5). In the validation survey, we found patient telephone surveillance to have a sensitivity of 66% (95% CI 40–93%) and a specificity of 90% (95% CI 86–94%). The meta-analysis included five additional studies. The overall sensitivity was 83.3% (95% CI 79–88%), and the overall specificity was 97.4% (95% CI 97–98%). Simulation of the meta-analysis results divulged that when the true infection rate is 1%, reported rates would be 4%; a true rate of 50%, the reported rates would be 43%. Patient self-assessment strategies in order to fulfill 30-day SSI surveillance misestimate SSI rates and lead to an erroneous overall appreciation of inter-institutional variation. Self-assessment strategies overestimate SSIs rate of institutions with high-quality performance and underestimate rates of poor performance. We propose such strategies be abandoned. Alternative strategies of patient follow-up strategies should be evaluated in order to provide valid and reliable information regarding institutional performance in preventing patient harm.

With 40 million amputees living in poor countries with limited access to health care, there is a significant need for novel prosthetic solutions. This paper presents our preliminary results to develop sustainable prostheses for five upper-extremity amputee patients in Colombia, South America. We utilized a patient-centric methodology, engaging patients at every stage in an effort to increase their satisfaction with their prosthetic and to assess clinical usefulness. We identified patient-specific criteria and compared existing open source hardware systems using the Design Thinking methodology. Finally, we present these data to further the development of myoelectric prosthetics as part of cyber-physical systems.

Hospital malnutrition is an under-recognized issue that leads to a variety of adverse outcomes, especially for older adults. Food/fluid intake (FFI) monitoring in hospital can be used to identify those who are improving and those who need further treatment. Current monitoring practices such as calorie counts are impractical for all patients and a patient-completed tool, if valid, could support routine FFI monitoring. The aim of this research was to determine whether the patient-completed My Meal Intake Tool (M-MIT) can accurately represent FFI at a single meal.Cross-sectional, multi-site.Four acute care hospitals in Canada.120 patients (65+ yrs, adequate cognition).Participants completed M-MIT for a single meal. Food and fluid waste was visually estimated by a research dietitian at each hospital. Sensitivity (Se), specificity (Sp) and overall agreement were calculated for both food and fluid intake by comparing M-MIT and dietitian estimations to determine criterion validity of M-MIT. Patient and research dietitian comments were used to make revisions to the M-MIT.Using a cut-point of ≤50% intake, Se was 76.2% and 61.9% and Sp was 74.0% and 80.5% for solid and fluids respectively (p0.001). M-MIT identified a greater proportion of participants (37.2%) as having low FFI (≤50%) than dietitians (25.0%), as well as a greater proportion identified with low fluid intake (28.3% vs. 24.6%). Modest revisions were made to improve the tool.This study has demonstrated initial validity of M-MIT for use in older patients with adequate cognition. Use of M-MIT could promote FFI monitoring as a routine practice to make clinical decisions about care.

PURPOSE To develop and conduct preliminary testing of a causality assessment tool for patients, for potential use in encouraging both discussions with clinicians about suspected adverse drug reactions (ADRs) and reporting to authorities. METHODS Ten causality statements, developed from qualitative studies involving patients, with a scoring system allowing categorization, were embedded in a questionnaire which also included a symptom checklist and additional details about one suspected ADR and medicine, selected for causality assessment. Patients with experiences of suspected ADRs were involved in cognitive interviews (15), piloting (20) and psychometric testing (120). Test-retest reliability, construct validity and criterion-related validity were evaluated, through repeated causality assessment, comparison with a visual analogue scale assessing certainty of causality and comparison with causality assessment using World Health Organization-Uppsala Monitoring Centre (WHO-UMC) criteria, respectively. The study involved outpatients at a university hospital in northeast Thailand. RESULTS Ninety-eight patients completed causality assessment twice: both causality scores (Spearman rs = 0.715; p

OBJECTIVE Patients can potentially monitor disease activity of RA through self-assessed swollen joints (clinical synovitis), but reliability is poor. The objective is to evaluate the use of education by US feedback on the ability of patients to assess for clinical synovitis in RA. METHODS We performed a 6 month, single-centre, randomized controlled trial on patients with established RA to study the effect of education on self-assessment of joints that included initial brief patient training on tender (TJC) and swollen (SJC) joint counts followed by US feedback every 3 months vs standard care without education. Patient and physician independently performed 28-joint counts at each visit. Outcome variables included the percentage of patients with good agreement with physician-derived swollen joints [prevalence-adjusted bias-adjusted kappa (PABAK) >0.6] as well as agreement in the SJC (Bland and Altman 95% limits of agreement), feasibility/patient satisfaction survey and disease activity at 6 months. RESULTS Of the 101 randomized patients, 95 were included (51 in the education arm and 44 in the standard care arm). At 6 months there was a significant difference in the proportion of patients with swollen joint PABAK >0.6 in the education arm compared with standard care (98 vs 85%, P = 0.02). Limits of agreement for the SJC difference between physician and patients were reduced only in the education arm. The training method is considered feasible, with 94% of patients reporting it as useful. A trend of higher rates of disease remission (28-joint DAS

Introduction : We report on one surgeon’s clinical experience with the 2 and 4 corner Raz bladder suspension performed for the treatment of stress urinary incontinence (alone or associated with cystocoele repair) in a consecutive patient cohort between 2003 and 2012 reporting short and longer term results. Materials and Methods : We performed a retrospective study of consecutive patients who underwent a 2 or 4 corner Raz bladder suspension by one surgeon (EHA ) to treat stress urinary incontinence over a period of time from Jan 1 2003 -Sept 2012. 3 month and longer term outcomes was determined by patient self assessment including validated questionnaires. Results : 98.7% of 82 patients reported no stress incontinence at 3 months Longer term follow-up was available on 48 (65%) patients. Of those lost to follow up, 8 were deceased. Mean age was 66.1 years. Mean follow up was 48.2 months (range 4-111months). 21 of the 48 (44%)patients were beyond 48 months. 41 of 48 (85%) patients were either delighted, pleased or mostly satisfied. 42 of 48 patients (87.5 %) had 50 % or more improvement. Pad use of 2.6 decreased to 0.9 pads with P value less than 0.0001. Conclusion : The Raz bladder suspension has good short and longer term results in relieving stress incontinence in addition to low morbidity and lower costs without the use of any mesh product.

Pain can provide important information to be used in treating illness. But since there is no medical device that can directly measure a patient’s pain, physicians and medical staff must rely on patients themselves to indicate the location and intensity of their pain. This task is typically accomplished using instruments that facilitate patients expressing their pain in terms of abstract schema that correlate to medical formalisms for quantifying pain. This paper examines the preliminary development and testing of PAIN-T, a novel system utilizing successful elements from existing pain assessment approaches along with the unique capabilities of multitouch tablet computers to allow patients to easily and accurately asses their own pain with a minimum of instruction and assistance.

Background:Correlating patient perception of nasal obstruction sidedness to causative anatomy is important in surgical planning. The accuracy of patient-perceived asymmetry of nasal obstruction, as regards objective measures, is described.Methods:Cross-sectional study of patients undergoing nasal airflow assessment. Unilateral obstruction was assessed using visual analogue scale scores and anterior rhinomanometry, without decongestion. Subjective obstruction asymmetry was defined using either the absolute score difference (rightvsleft) or the minimal clinically important difference, derived statistically. Correlation between subjective and objective obstruction measures was assessed.Results:In 145 patients (mean age ± standard deviation, 42.8 ± 16.6 years; 54.5 per cent female), objective obstruction was right-sided in 32.4 per cent, left-sided in 36.6 per cent and symmetrical in 31.0 per cent. Subjective perception of obstruction sidedness had a sensitivity and specificity of 86.9 and 41.1 per cent, respectively, using the minimal clinically important difference. Positive predictive value was 59.4 per cent using absolute score difference and 53.7 per cent using minimal clinically important difference. Receiver operator characteristic curve analysis indicated correlation between subjective and objective measures (p Conclusion:Subjective perception of nasal obstruction asymmetry has limited accuracy. Corroboration with objective airway assessment may be helpful in patients whose symptoms are incongruous with clinical findings.

The French Flare instrument (FI) aims to identify flares in rheumatoid arthritis between consultation. The objective of the present study was to present both concurrent and criterion validity of the Danish version of FI, as compared to DAS28-CRP. The study was a cross-sectional study comparing FI with DAS28-CRP among patients with rheumatoid arthritis (RA) in connection with the same outpatient visit. The study population consisted of 117 prevalent patients diagnosed with RA according to the ACR 1987/2010 criteria. Consecutive patients were included in the study in relation to their outpatient treatment at the Department of Rheumatology, Aarhus University Hospital, Denmark between 01 October 2012 and 31 December 2012. The sensitivity and specificity were 85.4 (95 % CI, 72.2; 93.9) and 50.7 (95 % CI, 38.4; 63.0), respectively. The positive predictive value was 53.6 (95 %CI, 47.0; 60.1) and the negative predictive value 83.9 (95 % CI, 71.7; 91.5). Positive and negative likelihood ratio were 1.73(95 % CI, 1.33; 2.26) and 0.29 (95 % CI, 0.14; 0.59). Tests with high sensitivity and small LR are most useful for ruling out the disease. Hence, our findings indicate that FI works well in ruling out a flare among patients with RA.

Objective To develop a preliminary version of a post-doctor visit self-assessment tool that patients with hypertension can use to evaluate their communication behaviors. High-quality communication between patient and doctor may have a positive effect on blood pressure control in hypertensive patients. Patients’ communicative behaviors such as asking questions influence those of doctors, but most existing measurement tools assess doctors’ behaviors rather than patients’. Methods The tool is intended for use by African American or Caucasian American adults with hypertension, regardless of literacy level. The project included theory-based development of the item pool, usability testing (8 individuals), and cognitive response testing (13 additional individuals). Main results After multiple iterations, the preliminary version includes 138 items in 7 theory-based domains. Conclusion and Practice Implications The self-assessment tool is ready for testing of item and scale reliability and validity and consequent item reduction. This tool could prove useful in trials evaluating whether patients with hypertension who learn to be better communicators are more likely to achieve blood pressure control. In addition, because it asks patients to reflect on their use of specific behaviors that can be learned, the tool might also help patients in clinical practice to assume more active roles during their medical interactions.

Objective The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of the safe use of iodinated and gadolinium contrast and to know the standards of practice regarding their use in the pregnant and lactating patient. Conclusion The activities in this article guide the participant to more safely administer intravenous contrast agents to pregnant and lactating patients.

A questionnaire for patient self-assessment of shoulder function was designed. It was based on the internationally accepted Rowe score.Explanations and photographs were added to the various parameters to make them easier to understand for the patients. A total of 95 patients completed the assessment form. The validity was tested by a correlation analysis comparing the questionnaire with the original score.The questionnaire demonstrated a reproducible and significant (p0.001), very high correlation (r0.9) in the overall results and a moderate to very high correlation within single parameters (r0.68).Based on these results, it can be concluded that a valid and reproducible assessment of the original score is possible with the new questionnaire. Self-evaluation allows reliable assessment which is not dependent on the examiners or location, resulting in a higher number of patients reachable for follow-up studies.

Background Shoulder outcome scores that include range of motion (ROM) and apprehension signs are limited by the need for direct involvement of the physician. Patient-reported outcome measures are patient centered and self-administered, and they can help physicians track the patient's progress between office visits and for long-term follow-up once the patient has been discharged. Methods Thirty consecutive patients completed a form before their 6-month follow-up after surgery on the labrum or capsule as a result of instability or pain related to instability. The form included bilateral ROM, apprehension, and instability episodes. The same parameters were measured by the physician during the visit. The patient's and physician's responses were compared. The primary outcome was the percentage agreement with exact and approximate agreement. Results Exact agreement was moderate for forward elevation at 56.6%; fair for abduction and external rotation at 90° at 24.5% and 34%, respectively; and poor for internal rotation at 90° and external rotation with the arm at the side at 2.6% and 12%, respectively. Approximate agreement within a range of positive or negative 20° range was very good for forward elevation (94%), abduction (92%), and external rotation at 90° (87%); moderate for external rotation with the arm at the side; and fair for internal rotation at 90°. There was 70% agreement regarding apprehension, 93% regarding subluxation events, and 100% regarding redislocation events. Conclusion Some measures of shoulder ROM showed a moderate to high level of agreement between patient-reported measurements and the physician's measurements. This method for short- and long-term follow-up could potentially replace routine clinic visits.

Implications for practice and research Patient self-monitoring of disease activity can improve tight control of rheumatoid arthritis (RA). Nurse-led care can be used in the monitoring and management of comorbidities associated with RA. Further research should assess wider acceptability, as well as the clinical and cost-effectiveness of a patient self-monitoring approach.

Aims: The aim of this is to evaluate the reliability of the urine dipstick test by patients' self-assessment for urinary tract infection (UTI) screening and to determine the validity of urine dipstick test. Settings: Rehabilitation Department, Srinagarind Hospital, Thailand. Study Design: A diagnostic study. Subjects and Methods: This study compared the urine dipstick test (index test) with the National Institute on Disability and Rehabilitation Research (NIDRR) criteria (gold standard test) in spinal cord injury (SCI) patients. The urine dipstick test informed positive and negative results. Besides the NIDRR criteria classified as UTI and no UTI. The interrater reliability was measured in the sense of Kappa whereas the validity of urine dipstick test was reported in terms of sensitivity, specificity, positive likelihood ratio (LR) (+LR), negative LR (−LR), positive predictive value (PPV), and negative predictive value (NPV). Results: Out of the 56 participants, the kappa of urine dipstick test for leukocyte esterase, nitrite, and combined leukocyte esterase and nitrite were 0.09, 0.21, and 0.52, respectively. The nitrite urine dipstick test showed the highest sensitivity (90%). The combined leukocyte esterase and nitrite urine dipstick test gave the highest specificity (87%), PPV (60%), NPV (93%), and +LR (5.63). Conclusions: The interrater reliability of combined leukocyte esterase and nitrite urine dipstick test was moderate agreement. The combined leukocyte esterase and nitrite urine dipstick test showed high level of both sensitivity and specificity. The combined leukocyte esterase and nitrite urine dipstick test should be promoted for patients' self-assessment for UTI screening in SCI patients.

The Flare instrument (FI) is a French self-administrated questionnaire used to identify flares in disease activity in patients with rheumatoid arthritis. In addition to a total score, the FI has two subscales: one relating to joint symptoms and one relating to general symptoms. The objective of this study was to translate and adapt the French FI into Danish and to determine the reliability of the FI in a consecutive cohort of patients with RA. The FI was translated according to international guidelines, tested among 10 patients and 5 health professionals, and adapted. Test-retest reliability was determined by the standard error of the measurement (SEM) and the intra class correlation coefficients (ICC). The FI was administered to 50 patients with rheumatoid arthritis from an outpatient clinic of a university hospital and re-administered after 10 days. The patients had a mean age of 65.3 years (SD 12.0) and mean disease duration of 18.1 years (range 2–47 years). We found an excellent reliability with ICC higher than 0.95 and SEM between 0.44 and 0.63. Best reliability was found in the total FI score. Thus, the results of the present study show that the FI is a feasible and reliable tool for evaluation of flares in patients with rheumatoid arthritis.

Background Patient-derived self-assessment potentially minimizes loss of valuable outcomes data, conserves medical resources, and benefits patients by saving valuable time out of work and travel expenses. The purpose of this study was to determine the physician-patient correlation of a patient-derived outcomes questionnaire that assesses range of motion (ROM) and strength after shoulder arthroplasty. Methods One hundred twenty consecutive patients completed a home-based questionnaire before their 1-year postoperative visit after shoulder arthroplasty. The questionnaire contained demographic information such as age, gender, type of surgery, education level, and income. Diagram-based questions, in which patients were asked to identify the image representing their own active shoulder ROM in various planes, were included. Patients were asked to perform a strength examination using premeasured zip-lock bags filled with water that correspond to predetermined weights up to 2.72 kg. The κ statistics were used to assess the degree of agreement between the patient's self-assessment and the clinician's measures. Results The κ statistics indicated moderate clinician-patient agreement (0.5-0.59) on items related to ROM and substantial to almost perfect agreement (0.62-0.92) on items related to strength (forward flexion and abduction). A majority of patients (>88%) correctly estimated their ROM within 1 grade of the clinician's measurement. Patients tended to err toward overestimating their ROM. Conclusions This patient-derived questionnaire provides a moderate to high level of agreement with clinician assessment. This assessment questionnaire may be an important tool in facilitating both clinical and research follow-up of patient outcomes after shoulder arthroplasty.

Before their first appointment at a pulsed dye laser clinic, 76 patients with a variety of vascular abnormalities completed a pretreatment assessment pack containing personal and demographic questions and the SF-36 Health Questionnaire, a self-report instrument for assessment of health status. These patients continued to receive laser treatment at approximately 3-monthly intervals. At 3 months and again at 6 months after their initial visit, the patients were sent postal follow-up packs containing the SF-36 Questionnaire and questions requesting information on: (a) opinions of the treatment itself; (b) the result in terms of clearance of coloration and (c) effect of treatment result on everyday life. The response rate to the follow-up questionnaire was 71% at 3 months and 60% at 6 months. Of the eight dimensions of health measured by the SF-36 Health Questionnaire, only mental health was found to be significantly improved at 6 months after initiation of treatment, and this improvement was dependent on gender, pertaining only to women. Information gained from the patients' perceptions of their treatment showed that opinions of the service delivery and advice and information offered were good. Overall, at the 6 month follow-up period, 83% of responders were satisfied with the treatment result, and the majority were pleased with its effect on their everyday life.

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environment. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site. Any question is fair game.

Between 1991 and 1994, 74 patients received total hip replacements with metal on metal articulation. The results of these patients with 74 hips who had a 6-month to 4-year (average, 2.2 years average) followup are reported. Patients were prospectively evaluated by the Harris hip score, a patient self assessment form, and radiographs. The average postoperative Harris hip score was 91. Patient self assessment forms showed that 95% of the patients scored their results as excellent or good. No patient had revision for loosening, but 1 underwent revision surgery for recurrent dislocation. Serial radiographs have not revealed loosening or osteolysis. Wear could not be measured radiographically. Twenty-seven of the patients had bilateral total hip replacements with 1 hip being metal on polyethylene; the patients could not detect any difference between the 2 hips. The satisfactory short term results from the contemporary metal on metal articulation investigated in this study are encouraging and warrant continued study.

One hundred three consecutive patients with primary glenohumeral degenerative joint disease completed standard questionnaires regarding their general health status (Short Form-36) and the function of their shoulder (Simple Shoulder Test). These patients' self-assessed health status indicated overall bodily pain, physical functioning, and physical role fulfillment scores that were significantly below those of population-based control groups. Self-assessed shoulder functions were likewise consistently below those of patients with normal shoulders. These deficits clearly indicated the problems that the patients desired to have resolved by treatment. The use of self-assessment questionnaires to routinely characterize patients with shoulder conditions is practical in the context of a busy practice. These data enable surgeons to understand the condition from the patient's perspective. This understanding should be central to the planning of treatment and to the evaluation of treatment effectiveness.

Background— Assessment of dyspnea, fatigue, and physical disability is fundamental to the monitoring of patients with heart failure (HF). A plethora of patient-reported measures exist, but most are too burdensome or imprecise to be useful in clinical practice. New techniques used for computer adaptive tests (CATs) may be able to address these problems. The purpose of this study was to build a CAT for patients with HF. Methods and Results— Item banks of 74 queries (“items”) were developed to assess self-reported physical disability, fatigue, and dyspnea. All queries were administered to 658 adults with HF to build 3 item banks. The resulting HF-CAT was administered to 100 patients with ancillary HF (New York Heart Association I, 11%; II, 53%; III and IV, 36%). In addition, the physical function and vitality domains of the SF-36 Health Survey questionnaire, an established shortness-of-breath scale, and the Minnesota Living with Heart Failure Questionnaire were applied. The HF-CAT assessment took 3:09±1:52 minutes to complete and score. All HF-CAT scales demonstrated good construct validity through high correlations with the corresponding SF-36 Health Survey physical function ( r =−0.87), vitality ( r =−0.85), and shortness-of-breath ( r =0.84) scales. Simulation studies showed a more precise measurement of all HF-CAT scales over a larger range than comparable static tools. The HF-CAT scales identified significant differences between patients classified by the New York Heart Association symptom criteria, similar to the Minnesota Living with Heart Failure Questionnaire. Conclusions— A new CAT for patients with HF was built using modern psychometric methods. Initial results demonstrate its potential to increase the feasibility and precision of patient self-assessments of symptoms of HF with minimized respondent burden. Clinical Trial Registration— URL: http://www.projectreporter.nih.gov . Unique identifier: 1R43HL083622-01.

The post-thrombotic syndrome (PTS) is a frequent and burdensome disease, but no gold standard test exists to diagnose it. The value of patient-reported outcomes (PROs) in recording transient signs/symptoms, thereby possibly improving diagnosis/monitoring and subsequent clinical care in some diseases, is increasingly being recognized. For example, PROs have been successfully used in cancer, rheumatoid arthritis, and endometriosis. In this context, we describe a patient-reported questionnaire (the Patient-Tracked Symptoms questionnaire) that contains questions on the presence of signs/symptoms of PTS. This questionnaire has face validity and was successfully used in the Home-LITE trial. It could prove valuable in monitoring patient symptoms, especially in home-based patients who do not have regular contact with hospital clinicians. Patients who report symptoms can then undergo follow-up assessment by health care professionals at their next clinic visit. The Patient-Tracked Symptoms questionnaire could help clinicians to recognize the PTS early, enabling them to initiate treatment promptly.

Background: The modified Rankin Scale (mRS) is a commonly used disability scale in clinical trials pertaining to acute stroke. Previous studies suggest that requiring the use of certification programs can improve the accuracy of mRS grading. We developed two mRS video tools for use in the multinational ATACH II trial. These tools train medical professionals on assessing mRS and enable patients, or their caregivers, to ascertain their own mRS score. Methods: After conducting a thorough literature review and interviewing numerous accomplished neurologists, we focused the development of our mRS resources around two concepts: key differentiating points and standard interview questions. The certification program consists of two elements: an educational video and an assessment. The educational video describes the mRS scale in four formats: Power Point slides with narrator explanation, simulated clinical interviews, videos of patients outside of the clinical setting, and narrator overview of specific levels. After watching this video, users proceed to the assessment where they are asked to assess the mRS score of six patients based on visual assessment and specific answers to the six foundation interview questions. Users are required to assess all six scenarios correctly in order to pass. Results: To date 61 individuals have taken the certification course and test. 54 passed (88.5%) and 7 failed (11.4%) the test. The pass rate was very high in physicians and study coordinators (95.7% and 80.6%). Conclusion: A novel web based tool for mRS certification is described. We are currently designing validation studies for each of these tools. Pilot study is undergoing to validate the patient self assessment grading.

Background Emergency departments deal with large patient loads on a day-to-day basis. The importance of patient self-assessment in the triage process has not been fully considered when determining the need for hospital admission. Objective To determine the validity of a series of self-administered triage questions in determining the need for hospitalisation in the emergency setting. Design Prospective cohort study. Setting Emergency department in a tertiary-care, municipal hospital in Japan. Participants 5380 consecutive walk-in patients visiting the emergency department of Okazaki City Hospital were asked to self-evaluate the urgency and severity of their condition and their perceived need for hospital admission. These patients were then assessed by emergency physicians blinded to the results from each patient9s self-assessment. Main outcome measures Sensitivity, specificity and likelihood ratios were calculated for each self-assessment by comparing these with findings from assessments made by emergency physicians. Results Patient-perceived need for hospitalisation had a sensitivity of 0.79 (95% CI 0.76 to 0.82) and a specificity of 0.93 (95% CI 0.92 to 0.93) in determining hospital admission. The positive and negative likelihood ratios for self-assessments were 10.68 (95% CI 9.59 to 11.90) and 0.22 (95% CI 0.19 to 0.26), respectively, in the diagnosis of hospital admission (p Conclusions The patient self-triage questions concerning condition with five categories (medication only to life threatening) seem to supplement the triage process for hospital admission in emergency departments.

Contains fulltext : 69018.pdf (Publisher’s version ) (Closed access) The objective of this article was to investigate whether there were discrepancies between the physician interview and a patient's self-assessment questionnaire on the functional results after surgery for pelvic organ prolapse. Before their follow-up appointment, 79 patients were sent a validated urogynaecological questionnaire. At the follow-up visit, the physician interviewed the patients using a checklist with ten symptoms and scored the items as present or absent. Seventy-two patients (91.1%) attended the follow-up visit and had completed the questionnaire. There was poor to slight agreement between the interview score and the self-reported responses to the questionnaire on all items. This was illustrated by low kappa coefficients. The physician was more optimistic about the outcome of the operation than was justified according to the answers to a patient self-assessment questionnaire. We therefore recommend the use of validated questionnaires to evaluate surgical outcome because they provide a more realistic (objective) view of the functional results.

Background Body image and HRQL are significant issues for patients with scoliosis due to cosmetic deformity, physical and psychological symptoms, and treatment factors. A selective review of scoliosis literature revealed that self report measures of body image and HRQL share unreliable correlations with radiographic measures and clinician recommendations for surgery. However, current body image and HRQL measures do not indicate which aspects of scoliosis deformity are the most distressing for patients. The WRVAS is an instrument designed to evaluate patient self assessment of deformity, and may show some promise in identifying aspects of deformity most troubling to patients. Previous research on adolescents with scoliosis supports the use of the WRVAS as a clinical tool, as the instrument shares strong correlations with radiographic measures and quality of life instruments. There has been limited use of this instrument on adult populations. Methods The WRVAS and the SF-36v2, a HRQL measure, were administered to 71 adults with scoliosis, along with a form to report age and gender. Preliminary validation analyses were performed on the WRVAS (floor and ceiling effects, internal consistency and collinearity, correlations with the SF-36v2, and multiple regression with the WRVAS total score as the predictor, and SF-36v2 scores as outcomes). Results The psychometric properties of the WRVAS were acceptable. Older participants perceived their deformities as more severe than younger participants. More severe deformities were associated with lower scores on the Physical Component Summary Score of the SF-36v2. Total WRVAS score also predicted Physical Component Summary scores. Conclusion The results of the current study indicate that the WRVAS is a reliable tool to use with adult patients, and that patient self assessment of deformity shared a relationship with physical rather than psychological aspects of HRQL. The current and previous studies concur that revision of the WRVAS is necessary to more accurately represent the diversity of scoliosis deformities. Ability to identify disturbing aspects of deformity could potentially be improved by evaluating each WRVAS items against indicators of pain, physical/psychosocial function, and self image from previous measures such as the SRS, SF-36 or BSSQ-deformity.

Background: In a previous study, the authors evaluated factors that contribute to patient satisfaction with breast reconstruction, using a comprehensive chart review and questionnaire. The results of part of this questionnaire, regarding patients' rating of the cosmetic result of their breast reconstruction, are presented in this article. Methods: The questionnaire was mailed to 267 patients, 214 questionnaires (80.1 percent) were returned, and 200 contained a response to the question rating the overall cosmetic outcome of breast reconstruction (Fig. 1). To conduct a statistical analysis, the data were collapsed into two smaller groups. An excellent or good result was considered a favorable outcome, while lower responses were unfavorable outcomes. Results: The outcome was rated as excellent by 82 patients, good by 76 patients, fair by 31 patients, and poor by 11 patients. A significant association was found between overall cosmesis and breast size, shape, or scars. Conclusion: It should not be assumed that patients' responses regarding satisfaction with reconstruction will reflect their specific feelings regarding cosmetic results.

Background Patients can potentially monitor disease activity in rheumatoid arthritis (RA) by performing self-assessment of joint counts. However, reliability of self-assessed swollen joint count is generally poor [1]. Objectives To evaluate the use of education by using feedback from ultrasound (US) images on the ability of patients to assess swollen joints in RA. Methods Study design: 6-month single centre unblinded randomized controlled trial, stratified by age and disease activity. Patients: Consecutive patients with established RA. Intervention: (i) education on self-assessment of joints: initial brief patient training on tender (TJC) and swollen (SJC) joint counts, followed by US feedback for areas of active synovitis every 3 months (EUS) versus (ii) standard care (no education on self-assessment and feedback with US). Patient and physician independently performed 28-joint counts at each study visit, with US feedback for areas of active synovitis provided for patients in the intervention arm only, at end of each visit. Outcome variables: Primary: Agreement at “joint” level - Proportion of patients with good agreement with physician derived swollen joints (i.e. prevalence-adjusted bias adjusted kappa, PABAK more than 0.6). Secondary: Agreement at “patient” level: i.e. SJC between patients and physician using Bland and Altman 95% limits of agreement, disease activity indices between the 2 groups, proportion of patients achieving remission, feasibility and patient satisfaction survey according to a 5-point Likert scale on the joint count training method by US. Results Ninety-two out of 101 patients completed the study (n=48 EUS, n=44 standard care). There were no differences in baseline characteristics. Mean age was 54.5±12.8 yrs, disease duration 6.3±6.0 yrs, with mean Disease Activity Score (DAS28) 3.3±1.1 (26% in DAS28 remission). At 6 months, the proportion of patients with swollen joint PABAK>0.6 was greater in the EUS arm compared to standard care (98% vs. 82%, p=0.009). The Bland and Altman limits of agreement for SJC difference between physician and patients were reduced only in the EUS arm. At 6 months, there were no significant inter-group differences in disease activity although a trend to higher DAS28 remission in the EUS arm (46% vs. 28% in standard care, p=0.08). Training with US was considered feasible (15-20 minutes) with 94% of patients reporting it as useful for appreciating their own disease activity. Conclusions A short course of patient education with US feedback can improve patient-physician reliability for the assessment of swollen joints. Larger studies with longer follow up are required to evaluate the clinical benefits. References Cheung et al. Sem Arthritis Rheum 2013 (nov 13) [Epub ahead of print] Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2203

Marked daily fluctuations may occur in the pattern and degree of gastroesophageal reflux (GOR) and in patients' symptoms. The aim of this study was to observe how patients' self-assessment of their symptoms on the day of a 24-h pH test correlates with the likely outcome of the test and the potential value in repeating it.367 patients with symptoms suggestive of GOR underwent 24-h pH tests. Fifty-eight patients had repeat studies. Patients assessed the severity of their test-day symptoms as 'better than typical', 'typical' or 'worse than typical'.A 'typical' or 'worse than typical' day was more likely to produce an abnormal test result (P0.0001). A normal first test on a 'better than typical' day was more likely to be followed by an abnormal second test than a normal first test on a 'typical' or 'worse than typical' day (55% versus 22%; P = 0.025). The symptom index score, the total acid exposure time on the first test and the presence of oesophagitis were not associated with an abnormal second test (P not significant).Patients' self-assessment of the severity of their test-day symptoms should be included in the interpretation of 24-h pH tests for suspected GOR. Patients with a normal pH test on a 'better than typical day warrant a repeat test.

Objectives. To assess the validity of severity classes on the erectile function (EF) domain of the International Index of Erectile Function by determining their relationship with the self-assessment of EF, before and after treatment, in an independent cohort of patients. Methods. Two hundred forty-seven men with clinically diagnosed erectile dysfunction (ED) and in a stable heterosexual relationship were enrolled in a randomized, double-blind, multicenter, placebo-controlled, parallel-group, 12-week, flexible-dose study. Patients assessed their degree of ED as severe, moderate, minimal/mild, or no problem at baseline and after treatment. They also responded to the six questions of the EF domain, with the total score indicating the following degrees of ED: severe, EF score 1 to 10; moderate, EF score 11 to 16; mild to moderate, EF score 17 to 21; mild, EF score 22 to 25; and no ED, EF score 26 to 30. Descriptive profiles of the two diagnostic instruments were compared. The correlations between the instruments were evaluated with Kendall’s tau-b at baseline, after treatment at 12 weeks, and at change from baseline. Results. The two measures gave generally similar descriptive profiles of ED severity. The correlations were 0.65 (95% confidence interval 0.57 to 0.73) at baseline, 0.86 (95% confidence interval 0.83 to 0.89) after 12 weeks of treatment, and 0.73 (95% confidence interval 0.67 to 0.79) at change from baseline. Conclusions. The moderate-to-high correlation between the patients’ self-assessment of EF and the EF domain of the International Index of Erectile Function provides a validation of this domain for the reliable diagnostic classification of ED severity.

Background The current T2T and EULAR recommendations ( e.g. measures of disease activity must be obtained and documented regularly [1]. Nurses should promote self-management skills in order that patients might achieve a greater self efficacy and improvement [2]) are difficult to apply in daily practice Objectives To evaluate the impact of a nurse led program of patient self-assessment of disease activity on the management of Rheumatoid Arthritis (RA). Methods Study design: Prospective, randomized, controlled, open, 6-month trial (NCT #0131652) . Participants 1/ Patients : Consecutive RA attending a clinic of the 20 participating centers were invited .2/ Nurses :all participated at a 1.5 day training session prior the start of the study. 3/ Treating rheumatologists : aware of the study but not of its primary objective. Study treatment: a program including: 1) a video explaining both the interest, calculation and interpretation of the DAS28-ESR, 2) Training of a self joint assessment, 3) A booklet and a calculator permitting the patient to report the results of his/her “auto” DAS28-ESR and to show the results to his/her treating rheumatologist. Treatment allocation:After written informed consent, the treatment was allocated randomly via en electronic system (e.g. either this above program or an evaluation of potential co-morbidities (not reported here). Outcome variables: Primary : percentage of patients with a change in DMARD therapy during the 6 months follow-up period. Other variables : changes in symptomatic parameters. Results There was no difference in the baseline characteristics of the 970 recruited patients (488 and 482 in the active and control groups respectively): Age: 58±11 years, female gender: 79%, disease duration: 11[6.2-19.1] years, DAS28-ESR: 3.1±1.3, mHAQ: 0.25[0.00-0.62]; RAID: 2.7[1.3-4.3]. At the month 6 visit, the % patients bringing back a completed booklet was 89%. During the 6 months follow-up period, a DMARD therapy was changed in 17.2% vs. 10.9% in the active vs. control group ( p =0.0012) (OR=1.70 [1.17-2.19]). During the time of the study, there was no statistically significant inter-group differences (-0.10 [-0.10;0.3], p=0.41; -0.03 [-0.25; 0.18], p=0.761; -0.01 [-0.05; 0.04], p=0.806, in the DAS28-ESR, HAQ and RAID in the active vs . control group respectively. Conclusions This study demonstrates the short term impact of a nurse leaded patient self assessment of RA disease activity program. Longer term follow up of patients is required to better evaluate the clinical benefit of this program References Smolen J.S. et al ; Ann Rheum Dis 2010; 69, 631-7 Van Eijk-Hustings y. et al . Ann Rheum Dis. 2012; 71, 13-9 Acknowledgements This study was conducted thanks to a grant from the French National Research Program ( PHRC) and thanks to an unrestricted grant from Roche Ltd France Disclosure of Interest None Declared

Background As the opportunities for web-based self management, support and clinical decision-making across chronic diseases increase, there is an urgent need to explore reliable means of eliciting self-reported symptoms and disease activity scores from patients with rheumatoid arthritis (RA) (1). A patient derived Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) based on self-report joint count, if reliable, could serve as an important marker of disease activity in RA. The reliability of patient self-assessment of tender and swollen joints has been examined (2), but the reliability of patient-derived scores seems to have escaped much attention. Objectives To examine the test-retest reliability of the DAS28-CRP with three and four variables, the SDAI and the CDAI when based on patient self-assessment of tender and swollen joints, and to assess the agreement of these scores with corresponding physician derived scores in patients with RA. Methods 30 out-clinic RA patients with stable disease were included. A joint count was performed by the patient and by an experienced physician at two visits 1 week apart. Test-retest reliability was expressed as the least significant difference (LSD = 1.96 x SD of test-retest differences), as the LSD in percent of the mean of the score (%LSD) which may be considered as the measurement error and as intra-individual coefficients of variation (CV i ) = (√0.5x d i 2 ) /mean i (3-5). Results Mean age was 60±15 years, mean disease duration 15±6 years. 77% were females, 75% were erosive and 70% were sero-positive. Mean values (±SD) (visit 1) was 4.1±5.2 for TJC, 3.7±2.4 for SJC, 33±28 (0-100) for patient global assessment (GA), 22.3±21.8 (0-100) for physician GA and 7.9±6.5 for CRP (mg/l). The means of correspondingphysician and patient derived s cores were nearly identical. The LSDs (%LSD) between physician and patient derived scores (visit 1) were: DAS28-CRP(4v) 0.9 (24.9), DAS28-CRP(3v) 1.0(27.8), SDAI 7.3 (51.3) and CDAI 7.3 (54.3). Similar results were found for duplicate physician and patient-derived scores. CV i s for patient and physician derived scores were not significantly different for neither DAS28-CRP(3), DAS28-CRP(4), SDAI nor CDAI. CV i s for SDAI and CDAI were similar but were significantly higher than for DAS28-CRP(3) and DAS28-CRP(4) (p Conclusions Disease activity scores based on patient and physician reported joint counts agreed closely on group level. On the individual level, LSDs between patient and physician derived scores were considerable but corresponded to both patient and physician intra-observer LSDs. Thus, scores based on patient-performed joint counts may be an alternative to traditional physician-derived scores in patients with stable disease. More studies are needed to examine the value of patient self-assessment of disease activity scores. References Barton JL et al. J Rheumatol 2009;36:2635-41. 2) Solomon M et al. J Med Internet Res 2012;14:e32. 3) Bland JM, Altman DG. Lancet 1986;1:307-10. 4) Gluer CC et al. Osteoporos Int 1995;5:262-70. 5. Madsen OR. Spine 1996 21:2770-6. Disclosure of Interest None Declared