The Impact of Obesity in the UAE: Real-world Physician and Patient Perspectives

BackgroundNo available studies demonstrate validity and meaningful change thresholds of Work Productivity and Activity Impairment (WPAI) questionnaire in patients with migraine. In this post-hoc analysis, we assessed reliability, validity, responsiveness, and meaningful within-patient change from baseline to Month 3 for Work Productivity and Activity Impairment (WPAI) domain scores in patients with episodic migraine (EM) or chronic migraine (CM).MethodThe Phase 3, multicenter, randomized, double-blind, placebo-controlled CONQUER study (NCT03559257, N = 462) enrolled patients with EM or CM who failed two to four categories of prior preventive medication in past ten years. The analyses were performed for WPAI domain scores (absenteeism, presenteeism, overall work productivity, and non-work-related activity impairment). Migraine Specific Quality of Life Questionnaire version 2.1 (MSQv2.1) domain scores (Role Function-Restrictive [RFR] and Role Function-Preventive [RFP]), and monthly migraine headache days were used as anchors. Responder criteria were changes from baseline to Month 3 for each of these anchors and were defined as: increase in MSQ-RFR by ≥ 25.71 points and MSQ-RFP by ≥ 20.00 points and a 50% reduction in monthly migraine headache days. Assessments were performed for overall population, and patients with EM or CM. The meaningful change threshold was determined based on Youden index, Phi coefficient and sensitivity.ResultsOf 462 randomized patients, 444 who completed WPAI questionnaire were included in post-hoc analysis. Test–retest reliability over 3 months in a stable subgroup revealed moderate correlations for non-work-related Activity Impairment (ICC = 0.446) presenteeism (ICC = 0.438) and a fair correlation for overall work productivity loss (ICC = 0.360). At baseline, all correlations between WPAI domain scores and continuous anchor variables exceeded recommended threshold of ≥ 0.30, except for WPAI domain scores with number of monthly migraine headache days. Patients achieving pre-specified responsiveness thresholds for monthly migraine headache days, and MSQ-RFP, MSQ-RFR from baseline to Month 3 (responders) showed significant improvements in WPAI domain scores compared with non-responders (P < 0.001). The meaningful change thresholds of -20 (% unit) were identified for WPAI domain scores.ConclusionIn conclusion, WPAI has sufficient validity, reliability, responsiveness, and appropriate interpretation standards to assess the impact of EM or CM on presenteeism and overall work productivity loss and non-work-related activity impairment.Trial registrationNCT number of CONQUER study, NCT03559257.

Purpose The University of Arizona Integrative Health Center (UAIHC) was an innovative membership-supported integrative medicine (IM) adult primary care clinic in Phoenix, Arizona. UAIHC delivered healthcare using an integrative medicine model that combined conventional and complementary medical treatments, including nutrition, mind-body medicine, acupuncture, manual medicine, health coaching, educational classes, and groups. Results from pre-post evaluation of patient-reported outcomes on several standardized measures are presented here. Methods UAIHC patients completed surveys at baseline and after 12 months of continuous integrative primary care. Patients reported on perceived changes in health outcomes as measured by Short-Form Health Survey (SF-12 general, mental, and physical health), Perceived Stress Scale (PSS4), Work Productivity and Activity Impairment Questionnaire (WPAI), World Health Organization Well-Being Index (WHO-5), Pain Visual Analog Scale (VAS), Fatigue Severity Scale (VAS; FSS), Generalized Anxiety Disorder Scale (GAD2), Patient Health Questionnaire for depression (PHQ2), Pittsburgh Sleep Quality Index (PSQI) global rating of sleep quality, and the Behavioral Risk Factor Surveillance System (BRFSS; nutrition, exercise, and physical activity). Overall differences between time points were assessed for statistical significance. Patient demographics are also described. Results 177 patients completed baseline and follow-up outcome measures. Patients were predominantly white, female, college-educated, and employed. Baseline to one-year follow-up results indicate statistically significant improvements (p <.05) on all but perceived stress (PSS-4) and work absenteeism (WPAI). Clinical impact and/or practical effects are reported as percent change or standardized effect sizes whenever possible. Other demographic and descriptive information is summarized. Conclusions Following one year of IM primary care at UAIHC, patient-reported outcomes indicated positive impacts in several areas of patients' lives: mental, physical, and overall health; work productivity; sleep quality; pain; fatigue; overall well-being; and physical activity.

BACKGROUND: Patients with transfusion-dependent thalassemia require lifelong blood transfusions and iron chelation therapy. Iron overload associated with regular blood transfusion leads to a significant defect in the health-related quality of life (HRQoL) of patients with transfusion-dependent thalassemia. Quality of life has become a significant component of care, and it is therefore necessary to focus on the HRQoL of patients with transfusion-dependent thalassemia. OBJECTIVES: To assess the HRQoL of children with transfusion-dependent thalassemia, identify the sociodemographic and clinical characteristics that affect the HRQoL, and identify the risk factors for poor HRQoL in children with transfusion-dependent thalassemia. STUDY DESIGN: A descriptive cross-sectional study was used to address the study&amp;rsquo;s objectives. SETTING: A representative sample was recruited from the Dubai Thalassemia Center in the United Arab Emirates (UAE). PARTICIPANTS: A total of 68 children with transfusion-dependent thalassemia aged 2-18 years. INTERVENTION: PedsQL 4.0 was applied to assess the HRQoL. The total HRQoL score was treated as the dependent variable in the study. Regression analysis was applied to study the effect of sociodemographic and clinical characteristics on HRQoL. RESULTS: This study included 68 children with transfusion-dependent thalassemia. Among them, 55.9% fell into the 13-18-year age group, and 42.6% were male. In addition, 57.4% were non-UAE nationals, and 44.1% of the children had less than 10,000 AED as monthly household income. The median (IQR) physical health summary score was 89.9 (15.6) and the psychosocial health summary score was 90.0 (10.3). Total PedsQL scores were significantly higher for younger children, those with a higher monthly household income, and those without complications. Older children were significantly correlated with lower total, physical, and psychosocial health summary PedsQL scores, whereas lower monthly household income was significantly correlated with lower total and psychosocial health summary PedsQL scores. Controlling for other variables, increasing age of patients was associated with worse total PedsQL scores. CONCLUSIONS: Children with transfusion-dependent thalassemia and their families require long-term support for the prevention of physical and mental problems associated with this disease.

Patients with ulcerative colitis, a type of inflammatory bowel disease, report negative impacts of disease symptoms on work-related outcomes, including absenteeism and presenteeism. As a way to better understand the impact of this disease and its treatment on work-related outcomes, the current review examines the use of the Work Productivity and Activity Impairment Questionnaire (WPAI), a patient-reported outcomes measure of absenteeism, presenteeism, and impairment in other activities, in studies of patients with ulcerative colitis. This review assesses the measurement properties of the WPAI in this patient population: its reliability, construct validity, ability to detect change, and responsiveness to effective treatments. Relevant data were extracted from 13 sources (journal articles and conference posters) identified following a systematic review of the published and gray literature. The evidence supports the WPAI as having test-retest reliability (reproducibility) over time; convergent validity, as indicated by moderate correlations with measures of quality of life and moderate-to-strong correlations with measures of disease activity; known-groups validity, as indicated by differences in WPAI scores between patients with active and inactive disease; ability (sensitivity) to detect change, as indicated by substantial improvement in scores for patients who achieve remission, accompanied by substantial worsening of scores for patients who relapse; and, responsiveness to treatment, with improvements in scores following treatments that reduce disease activity. Limitations included a lack of available evidence from randomized-controlled trials that could speak more directly to the WPAI’s responsiveness to treatment. In conclusion, we recommend the use of the WPAI for measuring work outcomes in both observational studies and interventional trials that include patients with ulcerative colitis.

Prevalence and factors associated with infectious intestinal diseases in Ras Al Khaimah, United Arab Emirates, 2017: A population-based cross-sectional study

BackgroundUnmet medical need continues to be significant in patients with systemic lupus erythematosus (SLE) despite the use of advanced therapies (AT) to control active disease. Fatigue, end-organ damage, and low...

A New Validation of the Spanish Work Productivity and Activity Impairment Questionnaire—Crohn's Disease Version

Background and aims: Patient-reported outcomes (PROs) will become increasingly important as primary endpoints in future clinical trials. We aimed to evaluate the relationship between health-related quality of life (HRQoL) and the combination of patient-reported clinical symptoms (ClinPRO2) and Mayo endoscopic subscore (MES) in patients with ulcerative colitis (UC). Methods: We conducted a prospective cross-sectional study of 90 consecutive UC patients who were scheduled for sigmoidoscopy or colonoscopy. All patients completed the following questionnaires: (1) self-rated rectal bleeding and stool frequency (ClinPRO2); (2) Short Inflammatory Bowel Disease Questionnaire (SIBDQ); (3) European Quality of Life 5-Dimensions 3-Level (EQ5D3L); (4) Work Productivity and Activity Impairment questionnaire (WPAI); (5) Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); and (6) Hospital Anxiety and Depression Scale (HADS). The endoscopic images were graded according to the MES. “No symptoms” was defined as a symptom score of 0, and “mucosal healing” was defined as MES score of 0–1. Correlations between the combined ClinPRO2 and MES with HRQoL were assessed using Spearman’s correlation coefficients. Results: The combination of the ClinPRO2 and MES was well correlated to SIBDQ (r = −0.70), EQ5D3L (r = −0.51), WPAI (r = 0.62), FACIT-F (r = −0.58), and HADS-depression (r = 0.45). SIBDQ scores had strong correlations with FACIT-F (r = 0.86), WPAI (r = −0.80), and HADS-depression (r = −0.75) (p < 0.05 for all correlations). Patients with no symptoms reported the greatest all HRQoL scores. Conclusions: In patients with ulcerative colitis, the combination of a ClinPRO2 and the MES had good correlation with the SIBDQ. In addition, SIBDQ was well correlated to the various HRQoL.

Background:Clinical EULAR Sjögren’s syndrome disease activity index (clinESSDAI) and EULAR Sjögren’s syndrome patient-reported index (ESSPRI) are commonly utilized clinical trial endpoints, reflecting disease activity and patient-reported symptomatology, respectively. The relationship...

To investigate the relationship between serum C-reactive protein (CRP) levels and work impairment in patients with ankylosing spondylitis (AS) based on real-world evidence. Outpatients with confirmed AS at Chinese PLA General Hospital were recruited consecutively by Smart-phone SpondyloArthritis Management System (SpAMS) from April 2016 to April 2018. The relationship between CRP and work productivity and activity impairment questionnaire (WPAI) were evaluated. Five hundred and fifty-one outpatients with AS in paid employment were recruited. The presenteeism, overall work impairment, and activity impairment rates increased by 1.4% (1.1%, 1.8%), 1.1% (0.5%, 1.6%), and 1.7% (1.3%, 2.1%), respectively, for every 10 mg/L increase in the CRP level (all P value<0.01). However, the CRP level was not associated with absenteeism after adjusting for covariates [0.5%(-0.4%, 1.0%),P>0.05]. There is a significant association between increased serum CRP levels at baseline and the previous 7-day work impairment in patients with AS. Higher CRP levels contribute to worse presenteeism, overall work impairment, and activity impairment rates, which suggests the necessity of monitoring CRP on treatment, and also indicates that anti-inflammatory therapy may be effective for improving work productivity.

IntroductionThe current Global Initiative for Chronic Obstructive Lung Disease Strategy makes limited references to the variability of chronic obstructive pulmonary disease (COPD) symptoms according to the time of day patients...

6138 Background: Patient-reported outcomes (PROs) in clinical trials provide insight into the Pt experience but are often limited to the time the Pt is undergoing therapy, since PRO collection typically stops when Pts progress. In an OCS, Pts are observed in a real world setting and followed longitudinally through the course of their disease. To assess the impact of disease progression (PD) on PROs, we have initiated a PRO substudy in VIRGO, a MBC disease OCS. Methods: A literature review was performed to assess potential PRO instruments for study inclusion. Cognitive debriefings were conducted with 10 MBC Pts to assess acceptability, length, frequency, and preferred mode of administration for these instruments. Results: The following instruments were selected: MD Anderson Symptom Inventory (MDASI), the Activity Level Scale (ALS) from the Rotterdam Symptom Checklist, and the Work Productivity and Activity Impairment Questionnaire (WPAI). Participants in the cognitive debriefing completed these instruments in 10-30 minutes, 100% reported this duration to be appropriate in length, 80% stated that monthly frequency was reasonable, and 70% preferred internet as mode of administration. Based on these findings, PRO substudy data are collected monthly for MDASI and ALS, and quarterly for the WPAI until death, study discontinuation, or 5 years of follow up. PRO data collection via a secure internet-based website or IVRS began on 9/14/2009. As of 1/5/2010, 65 Pts have enrolled in the PRO substudy. 63% of Pts provided data through the internet, and 29% through IVRS; 8% are unknown due to new enrollment. Conclusions: VIRGO is currently the largest prospective OCS in MBC. The implementation of the PRO substudy demonstrates that PRO collection is viable in a large OCS. The PRO substudy will be a valuable longitudinal dataset of patient-reported symptoms, activities of daily living, and work productivity. These data will provide a unique understanding of MBC Pts long-term experience through the course of their disease and the relationship between PROs and disease progression. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Genentech Genentech Roche Genentech, Outcome Sciences, Inc.

Health disorders may affect negatively work productivity of individuals, leading to absence from work (absenteeism) and/or decreased functioning in the workplace (presenteeism). To assess the health-related work productivity of the adult population in Hungary by the Work Productivity and Activity Impairment questionnaire (WPAI). A cross-sectional survey was performed in 2019 involving a sample (n = 2023) representative for the adult population of Hungary. Socio-demographic characteristics were recorded. Health-related productivity of the participants was assessed by the WPAI questionnaire, health status was measured by the EQ-5D-3L measurement tool and the Minimum European Health Module (MEHM). Descriptive statistics were performed, subgroups were compared by Mann-Whitney and Kruskal-Wallis tests. Spearman's rank correlation was applied to analyze the relationship between WPAI, age and EQ-5D-3L index score. Among those in a paid job (n = 1194, 59%), altogether 70 respondents (6%) were absent from work during the week before the survey, which resulted in an average 1.9 (SD = 8.5) work hours loss per week. Presenteeism occurred in 166 (14%) cases. The average absenteeism was 3.6%, presenteeism was 4.4%, and activity impairment in the total sample was 9.5%. Absenteeism did not correlate with age and did not differ significantly across socio-demographic subgroups. Presenteeism was the highest among actively working retired people, disability pensioners and part-time employees. Presenteeism correlated moderately (r = -0.379), absenteeism weakly (r = -0.113) with EQ-5D-3L index. Correlation was significant between activity impairment and age (r = 0.412) as well as the EQ-5D-3L index score (r = -0.592). All WPAI items showed significant worsening across MEHM status levels. This is the first study in Hungary to present population reference values with the WPAI. Productivity loss due to presenteeism deserves special attention from the employers as well as from decision makers in the labour, health and social sectors. Orv Hetil. 2020; 161(36): 1522-1533.

SAT0091 Towards A Patient Global Measure to Assess At-Work Productivity Loss in Patients with Inflammatory Arthritis and Osteoarthritis: A Qualitative Study

Background Inflammatory arthritis (IA) and osteoarthritis (OA) often impact on the worker9s performance whilst at work due to ill health (i.e. presenteeism). A number of global measures have been developed to assess presenteeism in clinical studies. However, limited information is available on the correlation between these measures and the construct validity of these measures. Objectives To i) determine the correlation between four global measures of presenteeism and ii) to evaluate the construct validity of these measures. Methods The main aim of this international observational study (7 countries in Europe and Canada), recruiting patients with IA (RA, PsA or AS) or OA in paid employment, was to investigate content and construct validity of global presenteeism measures. Patients completed 4 global measures (Work Productivity Scale – Arthritis (WPS-A), Work Productivity and Activity Impairment Questionnaire (WPAI), Work Ability Index (WAI), and both the Quality and Quantity scales of the QQ questionnaire) (see table legend for descriptions individual scales). Spearman correlations were applied to test the correlation between individual presenteeism scales and to test construct validity with the 11-item Workplace Activity Limitation presenteeism Scale (WALS) and several health related patient reported outcome measures. Interpretation of correlation coefficients: (very) weak (rrange=0.0–0.39), moderate (rrange=0.40–0.59) to strong (rrange=0.60–1.0). Results 468 patients with a median disease duration of 10 [IQR 5–18] yrs were included; 62% were female. Median [IQR] presenteeism scores were, respectively: 2 [0–5] for WPS-A, 3 [1–5] for WPAI, 8 [6–9] for WAI, 81 [49–100] QQ-total, with WAI and QQ having reversed scales (Legend table). Correlations between the 4 global measures were moderate to strong, ranging from -0.49 for the correlation between WPS-RA and QQ-Quality to 0.83 between WPAI and WPS-RA. The multi-item presenteeism scale WALS, measuring difficulty at work, strongly correlated with both WPAI (r=0.65, p Conclusions Global measures of presenteeism show good to moderate construct validity, with the WPAI and WPS-IA/OA showing slightly better construct validity compared to the WAI and QQ. The information obtained in this study will further inform research on instrument use for a standardized approach to estimate presenteeism in future clinical studies. Acknowledgements Funding: EULAR, AbbVie, BMS Disclosure of Interest None declared