Eyeball Test Research Articles

WTP2.2 Subjective Assessment of Frailty Compared to Validated Frailty Assessment in Adults with Chronic Renal Failure presenting for Dialysis-Access/Transplant workup has Poor Estimation of Agreement

Abstract Purpose Frailty assessment often rely on subjective frailty assessment, such as ‘the end-of-the-bed’ or ‘eyeball’ test. These assessments have traditionally been accurate in 40% of cases only. Frailty assessment is a part of our institutional clinical workup. We examined the association between subjective frailty and formal validated score aided frailty estimation in the adult renal failure population. Methods A cohort of all renal failure patients presenting for dialysis access/transplant assessment at a satellite unit over one year (December 2020-2021) was analyzed. Adult patients aged ≥18 years in the outpatient dialysis access/transplant assessment surgical clinic were rated with eyeball test in routine clinical assessment as either: frail, pre-frail, or non-frail, which was then compared to a formal frailty assessment using a modified version of the Frailty Phenotype. The association between clinician-estimated frailty and formal frailty assessment was examined. Results A total of 113 patients were approached, producing 109 paired frailty assessments. The median age of the patients was 62 years. The Composite Proportions of Agreement of clinician-estimated frailty to formal frailty was poor (0.57). The sensitivity of the Eyeball test was 0.30 & specificity was 0.43. The sensitivity of the Frailty Score was 0.70 & specificity was 0.57. The validated tool has more than twice the odds of estimating frailty OR 2.86 (1.49- 5.46). p=0.002 (2-tailed). Conclusion Subjective frailty assessment is not a reliable replacement for formal frailty assessment in adults with renal failure. The validated Frailty Tool provides a uniform frailty estimation.

Eyeball Test for the Assessment of Frailty in Elderly Patients With Cardiovascular Disease: A Prospective Study

Frailty has been associated with poor outcomes in patients with cardiovascular diseases (CVDs). We aimed to assess the accuracy of the Eyeball test for frailty assessment in elderly patients with CVD. This is a prospective study including stable patients ≥75 years old who were followed-up in a cardiology clinic. Frailty assessment was performed separately through the Eyeball test and the Fried test in a blinded way. Cardiologists were asked to rate the frailty status of participants based on their routine clinical assessment and grade frailty on a Fried-type scale (1 to 5, with frailty defined as a score≥3). Each patient then underwent formal frailty assessment using the Fried test. Included were 300 consecutive patients with a mean age of 81±6years. Frailty was diagnosed in 109 (36%) and 125 patients (41%) according to the Fried and Eyeball tests, respectively. The Eyeball test demonstrated 86% sensitivity and 82% specificity for the diagnosis of frailty. A receiver operating characteristics curve analysis demonstrated an area under the curve of 0.82 for the diagnosis of frailty. The Eyeball test demonstrated a very high negative predictive value of 90% and a modest positive predictive value of 73% for frailty assessment. Similar results were observed after subgroup analysis according to age and gender. In conclusion, the Eyeball test is an accurate method to rule out frailty in elderly patients with CVD. However, when frailty is suspected based on the Eyeball test, a formal tool such as the Fried test should be used to confirm the diagnosis.

Correlation Between Visual Factors During Patient Transfer and Objective Measures of Operative Risk in Preoperative Risk Assessment

<h3>Introduction and Objectives</h3> Frailty, an important consideration for determining a patient's surgical risk, is usually assessed informally based on clinical gestalt—the "eye-ball test." Surgeons are usually skilled at identifying high-risk patients, however, the factors underlying their unstructured assessments are unknown. The objective of our study was to explore the visual factors that may be used in an "eye-ball test" and understand how they compare to objective measures of frailty, multiple comorbidities, and operative risk. <h3>Methods</h3> A convergent mixed methods design was utilized to compare factors present in video recordings of patients transferring from a chair to exam table during vascular clinic visits to objective measures of surgical risk, including grip strength, modified frailty index-5 (mFI-5), and Fried Frailty Score. The videos were qualitatively evaluated by three independent coders. Patient transfer began in seated position in chair, followed by ambulation and transfer to the exam table, and ended in seated position on the exam table (Figure 1). Transfer length of time was measured in seconds based on time stamps. T-tests were used to compare length of transfer and Fisher's exact test was used to examine associations between visual factors and the objective measures of operative risk.Figure 1Components of a patient transfer from chair to exam table in the clinic setting. This segmentation was utilized for analysis of the video-recorded patient transfers.Figure 1 <h3>Results</h3> 30 patients and their video-taped transfers from two centers were analyzed. Mean age of participants was 71.9±9.45 years, 43.3% were female, and 18% identified with non-white race. Approximately half were categorized as frail by mFI-5 score and 50% were weak by grip strength measurement (65% convergence; P=.37). Frail patients had a longer transfer time (mean 11.6 vs 9.9 seconds; P=.19). A median of 45 coded factors based on visually present patient appearance and movement were coded. Patients who were considered frail more often used their arms to push up from sitting position (69.2% vs 25.0%; P=.04), have a medical device visible (e.g., portable oxygen, orthotic shoe, insulin pump) (38.5% vs 0%; P=.04), have a walking assistive device present (e.g., wheelchair, cane) (23.1% vs 0%; P=.22), and displayed postural instability during transfer from chair to exam table (50% vs 8.3%; P=.07). There appeared to be no difference in the presence of no-lace shoes (46.2% vs 41.7%; P=.82). <h3>Conclusions</h3> This pilot study reveals patient appearance and movement correlate with objective measures of operative risk. These visual factors may underlie unstructured frameworks utilized by vascular surgeons during preoperative risk assessment. Future work will build on this work by exploring surgeon's assessment in comparison to the visually coded factors in this study through case simulations.

Visual Factors From Patient Transfer During Clinic Visits Are Associated With Objective Measures of Operative Risk

Frailty, an important consideration for high-risk procedures, is usually assessed informally based on clinical gestalt—the “eye-ball test.” Although experienced surgeons are skilled at identifying high-risk patients, factors underlying their unstructured assessments are unknown. The objective of our study was to explore the visual factors that may be used in an “eye-ball test” and understand how these factors compare to objective measures of frailty, comorbidity, and risk.

Frailty is associated with chronic inflammation and pro-inflammatory monocyte subpopulations.

Frail patients with high grade aortic valve stenosis (AS) undergoing Transcatheter Aortic Valve Implantation (TAVI) have an increased mortality. A connection between frailty and inflammation has been suggested. Monocyte subpopulations are associated with both cardiovascular diseases and chronic inflammatory diseases. This study investigates the association of frailty with monocyte subpopulations and systemic inflammatory parameters in elderly patients undergoing TAVI. A total of 120 patients with symptomatic AS was examined. Before TAVI implantation, frailty was assessed by a bedside evaluation (eyeball test). In all patients a flow cytometry analysis has been performed. Monocyte subpopulations were defined as follows: classical (CD14++CD16-), intermediate (CD14++CD16+) and non-classical (CD14+CD16++). Expression of CD11b was measured as a marker for monocyte activation. Pro-inflammatory cytokines such as interleukin IL-8, as well as CRP were measured with Cytometric Bead Array or standard laboratory methods. 28 out of 120 patients were frail. These patients showed both, signs of elevated chronic systemic inflammation reflected by elevated CRP (3.7 (1.4-5.4) vs. 5.9 (3.7-29.1), p=0.001) and an elevated level of intermediate monocytes (37 (24-54) vs. 53 (47-63), p=0.001). At 6months after TAVI, 19 of 120 patients died, primarily without relevant dysfunction of the implanted aortic valve. Mortality was significantly higher in the frail as compared with non-frail patients (9 of 28 frail patients vs. 10 of 92 non frail patients, p<0.001). A binary logistic regression analysis validated frailty and intermediate monocytes as independent predictors for early mortality after TAVI. Chronic systemic inflammation and increased levels of intermediate monocytes are associated with frailty in old patients with severe aortic valve stenosis. Both the syndrome of frailty and elevated intermediate monocytes showed an association with early mortality after TAVI.

Assessment of the Frail Patient With End-Stage Liver Disease: A Practical Overview of Sarcopenia, Physical Function, and Disability.

Frailty has emerged as a powerful predictor of clinical outcomes (e.g., decompensation, hospitalization, mortality) in patients with end‐stage liver disease (ESLD). It is therefore of paramount importance that all patients with ESLD undergo an assessment of frailty, to support life and death decision making (i.e., candidacy for critical care, transplantation) and aid with prioritization of evolving prehabilitation services (i.e., nutrition, physiotherapy, psychotherapy). This article aims to provide a practical overview of the recent advances in the clinical, radiological, and remote assessment tools of the frail patient with ESLD. Historically, clinicians have incorporated an assessment of frailty using the “end‐of‐the‐bed test” or “eyeball test” into their clinical decision making. However, over the last decade, numerous nonspecific and specific tools have emerged. The current evidence supports the use of a combination of simple, user‐friendly, objective measures to first identify frailty in ESLD (notably Clinical Frailty Scale, Liver Frailty Index), followed by a combination of serial tools to assess specifically sarcopenia (i.e., muscle ultrasound), physical function (i.e., chair stands, hand grip strength), functional capacity (i.e., 6‐minute walk test), and physical disability (i.e., activities of daily living).

Looking beyond the eyeball test: A novel vitality index to predict recovery after esophagectomy

ObjectivesTo (1) measure 4 physiologic metrics before esophagectomy, (2) use these in an index to predict composite postoperative outcome after esophagectomy, and (3) compare predictive accuracy of this index to that of the Fried Frailty Index and Modified Frailty Index. MethodsGrip strength (kilograms), 30-second chair sit-stands (number), 6-minute walk distance (meters), and normalized psoas muscle area (cm2/m) were measured for 77 consenting patients from January 1, 2018, to April 1, 2019. Imbalanced random forest classification estimated probability of a composite postoperative outcome, which included mortality, respiratory complications, anastomotic leak, delirium, length of stay ≥14 days, discharge to nursing facility, and readmission. G-mean error was used to compare predictive accuracy among indexes. ResultsMedian grip strength was 38 kg (25th-75th percentiles, 31-44), number of sit-stands 11 (10-14), psoas muscle area to height ratio 6.9 cm2/m (6.0-8.2), and 6-minute walk distance 407 m (368-451). There was generally weak correlation between these metrics, with the highest between 30-second sit-stands and 6-minute walk distance (r = 0.57). Age, degree of patient-reported exhaustion, and the 4 objective metrics comprised the Esophageal Vitality Index, which had a lower G-mean error of 32% (31-33) than the Fried Frailty Index, 37% (37-38), and the Modified Frailty Index, 48% (47-48). ConclusionsThe Esophageal Vitality Index, an objective, simple assessment consisting of grip strength, 30-second chair sit-stands, 6-minute walk, and psoas muscle area to height ratio outperformed commonly used frailty indexes in predicting postesophagectomy mortality and morbidity. The index provides a robust picture of patients' fitness for surgery beyond the qualitative “eyeball” test.

Researchers explore new prognostic, predictive tools for cancer: Easily attainable markers and measurements may help to better inform treatment decision making.

Researchers explore new prognostic, predictive tools for cancer: Easily attainable markers and measurements may help to better inform treatment decision making.

Comparison of Surgeon Assessment to Frailty Measurement in Abdominal Aortic Aneurysm Repair

BackgroundEndovascular abdominal aortic aneurysm repair (EVAR) allows us to intervene on patients otherwise considered poor candidates for open repair. Despite its importance in determining operative approach, no comparison has been made between the subjective “eyeball test” and an objective measurement of preoperative frailty for EVAR patients. Materials and methodsPatients undergoing elective EVAR were identified in the Vascular Quality Initiative (VQI) database (2003-2017). Patients were classified “unfit” based on a surgeon-reported variable. Frailty was defined using the VQI-derived Risk Analysis Index, which includes sex, age, BMI, renal failure, congestive heart failure, dyspnea, preoperative ambulation, and functional status. The association between fitness and/or frailty and adverse outcomes was determined by logistic regression. ResultsA total of 11,694 patients undergoing elective EVAR were included of which only 18.1% were “unfit,” whereas 34.6% were “frail” and overall 43.6% “unfit or frail.” Patients deemed “unfit” or “frail” had significantly increased odds of mortality, complications, and nonhome discharge (P < 0.001), and both frailty and unfitness generated negative predictive values for these outcomes greater than 93%. In adjusted logistic regression, the addition of objective frailty significantly improved model performance in predicting nonhome discharge (C-statistic 0.65 versus 0.71, P < 0.001) and complications (0.59 versus 0.61, P = 0.01), but similarly predicted mortality (0.74 versus 0.73, P = 0.99). ConclusionsPreoperative frailty assessment provides a useful objective measure of risk stratification as an adjunct to a physician's clinical intuition. The addition of frailty expands the pool of high-risk patients who are more likely to experience adverse postoperative events after elective EVAR and may benefit from uniquely tailored perioperative interventions.

Personalizing the Kidney Transplant Decision: Who Doesn't Benefit from a Kidney Transplant?

The transplant community has succeeded in clearly communicating the survival benefit generally associated with kidney transplantation in comparison to maintenance dialysis. However, although kidney transplantation is associated with survival gains on a population level, this is not universally true

A teoria republicana da justiça

A teoria republicana da justiça representa a compreensão que os indivíduos, para não serem dominados na vida social e pública, necessitam da estrutura organizacional do Estado democrático de direito para realizarem os seus projetos de vida. A questão da justiça está centrada na implementação social do ideal de liberdade como não-dominação. Ela se refere às relações sociais fundadas sob o princípio da igualdade de tratamento e oportunidades. A teoria política de Philip Pettit propõe a aplicação do teste do globo ocular como sendo a ferramenta de reconhecimento das formas de subjugação e submissão nas sociedades contemporâneas. Essa regra de teste conscientizará os indivíduos sobre as injustiças sociais e os marginalizados pela extrema pobreza e ausentes de oportunidades. Pettit estabelece dois critérios para a dedução das liberdades básicas que devem ser asseguradas pelo Estado republicano. Os critérios são a co-exercibilidade e a co-satisfação das escolhas dos indivíduos. O Estado estaria obrigado somente a garantir as liberdades básicas que passassem sob esse crivo. Os cidadãos republicanos desfrutam da condição de independentes socialmente e atuam com o objetivo de construir a sociedade democrática e inclusiva.

The “Eyeball Test” for Risk Assessment in Aortic Stenosis: Characterizing Subjective Frailty Using Objective Measures

ABSTRACT Background: Subjective frailty assessment is widely employed in risk stratification of patients with severe aortic stenosis (AS), but the association with objective frailty parameters is poorly characterized. Methods: Frailty was subjectively assessed (dichotomously as frail or not frail) in high-risk patients with AS referred to a Heart Valve Clinic. An objectively derived composite frailty score was derived by summing quartiles of the following frailty measures: 15-foot walk time, grip strength, independence in activities of daily living (ADL), and serum albumin. The objective measures and composite score were compared between those considered frail and not frail by subjective assessment. The relationship between frailty status and outcomes was analyzed. Results: Of 100 subjects, 31 were frail by subjective assessment. When compared to those considered not frail, there were no differences in age, sex, and BMI. However, frail subjects had higher STS scores and had significantly greater dependence in ADL, slower gait speed, weaker grip strength, and lower albumin than non-frail subjects. The composite frailty score was highly correlated with frailty designation by subjective assessment. Subjective and objective frailty were both highly predictive of treatment assignment to either medical therapy or aortic valve replacement, and of mortality. Conclusion: Among patients with AS evaluated in a Heart Valve Clinic, those considered frail by subjective assessment were slower, weaker, more malnourished, and had greater ADL impairment. Subjective assessment of frailty and objective frailty measures were similarly predictive of treatment assignment and mortality.

Surgical Intuition.

Surgical Intuition.

Preoperative Testing and Planning for Safer Surgery

Consensus statements and regulatory guidelines endorse the process of identifying patients at increased risk for surgical morbidity and mortality. This is termed prognostic testing, and it identifies patients who are deemed to be too sick to benefit from the anticipated gain of surgery. However, much more valuable than prognostic testing is predictive, or directive, testing. A predictive test pinpoints the patient’s problem that will benefit from a specific available intervention. This review covers what is risk?, changing paradigms of surgical success, building a case for moderation, so, does anyone disagree?, timing, frailty and age (and the eyeball test), is the heart the only organ that counts?, changing paradigms, the enhanced importance of functional capacity, resting electrocardiogram, exercise stress testing, ventricular function testing, stair climbing: putting it all together, pulmonary function tests, obstructive airway disease, perioperative nutrition, how can we make surgery safer?, enhanced recovery after surgery, putting it all together, extended enhanced recovery after surgery, tight glucose control, smoking cessation, and timing of collaboration with anesthesia. Figures show routine preoperative tests for elective surgery (adapted from the National Institute for Health and Care Excellence clinical guideline 3, preoperative assessment strategies and recommended risk-reducing therapy relative to American Society of Anesthesiologists (ASA) classification performed by the surgeon and age, ASA Class I and II patients may be safely be evaluated by an anesthesiologist on the day of their scheduled surgery for a full preoperative history and physical examination, flow volume loop. Tables list ASA physical status classification, effect of abnormal screening results on physician behavior, and minimum preoperative test requirements at the Mayo Clinic (in 1997). This review contains 4 highly rendered figures, 3 tables, and 111 references

Evaluating the efficiency of chlorine removal from potable tap water using off-gassing, boiling, and filtration treatment methods

&#x0D; Background: One of the most frequent complaints to water distribution systems is the taste and odor of chlorine in consumer tap water. Chlorine is a common disinfectant used to inactivate and breakdown microbes and other contaminants. However, excess chlorine can result in an unpalatable chlorinous taste and odor. When water taste becomes too objectionable, consumers may search for alternative water sources, such as raw, untreated water that does not contain chemical additives. Raw, untreated water contains various contaminants, including disease-causing pathogens. To encourage consumers to drink treated tap water, and prevent disease, this study evaluated and compared the effectiveness of off-gassing, boiling and filtration as dechlorination methods for consumers to perform on their tap water. Method: Hach Method 8021 was performed to collect and analyse water samples following treatment with Off-gassing, Boiling and Filtration. Water samples were collected from BCIT SW1-1230. The Hach Pocket Colorimeter ™ II determined the free chlorine concentration of the water samples, and compared to a sample of untreated chlorinated tap water to see which method reduced chlorine concentrations the most. Results: Mean concentration of chlorine following off-gassing was determined to be 0.51 ppm, 0.24 ppm following boiling, and 0.55 ppm following filtration. It was determined that the boiling method was statistically significantly different from the mean values of chlorine concentration from the other two methods, as shown by the Kruskal-wallis test (P=0.000), and therefore was the most effective in dechlorinating tap water samples. This was further confirmed by the Scheffe’s Mutliple-Comparison Test and eyeball test. Conclusion: Based on the results, boiling water is the most effective method to dechlorinate potable tap water for consumer acceptability. The free chlorine levels found post-boiling were also found to be below the WHO’s threshold for tasting and smelling chlorine in drinking water (0.3 ppm), and above WHO’s minimum required 0.2 ppm chlorine residual. Therefore, drinking water following boiling will be safe for consumption, as well as free of chlorinous taste and smell. Public Health professionals can safely advise consumers of an effective method to encourage treated tap water consumption, and to discourage finding alternative water sources.&#x0D;

Estimating Quality of Life Among Advanced Heart Failure Patients: What Could Formal Screening Add to Clinical Assessments

Background: Assessing patient outcomes beyond survival assists health resource planning and shared decision-making. However, patient-reported quality of life (pr-QoL) is still rarely measured in the clinical setting. Proxy assessments of QoL and the ‘eyeball test’ of frailty are vulnerable to clinician bias, but in the absence of formal screening will occur by default. This study compared clinician estimates with measured frailty and pr-QoL.

"Eyeball test" of thermographic patterns for predicting a successful lateral infraclavicular block.

Increased distal skin temperature can be used to predict the success of lateral infraclavicular (LIC) block. We hypothesized that an "eyeball test" of specific infrared thermographic patterns after LIC block could be used to determine block success. In this observational study, five observers trained in four distinct thermographic patterns independently evaluated thermographic images of the hands of 40 patients at baseline and at one-minute intervals for 30 min after a LIC block. Sensitivity, specificity, and predictive values of a positive and a negative test were estimated to evaluate the validity of specific thermographic patterns for predicting a successful block. Sensory and motor block of the musculocutaneous, radial, ulnar, and median nerves defined block success. Fleiss' kappa statistics of multiple interobserver agreements were used to evaluate reliability. As a diagnostic test, the defined specific thermographic patterns of the hand predicted a successful block with increasing accuracy over the 30-min observation period. Block success was predicted with a sensitivity of 92.4% (95% confidence interval [CI], 86.8 to 96.2) and with a specificity of 84.0% (95% CI, 70.3 to 92.4) at min 30. The Fleiss' kappa for the five observers was 0.87 (95% CI, 0.77 to 0.96). We conclude that visual evaluation by an eyeball test of specific thermographic patterns of the blocked hands may be useful as a valid and reliable diagnostic test for predicting a successful LIC block.

Content and Construct Validity, Reliability, and Responsiveness of the Rheumatoid Arthritis Flare Questionnaire: OMERACT 2016 Workshop Report.

The Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis (RA) Flare Group was established to develop a reliable way to identify and measure RA flares in randomized controlled trials (RCT). Here, we summarized the development and field testing of the RA Flare Questionnaire (RA-FQ), and the voting results at OMERACT 2016. Classic and modern psychometric methods were used to assess reliability, validity, sensitivity, factor structure, scoring, and thresholds. Interviews with patients and clinicians also assessed content validity, utility, and meaningfulness of RA-FQ scores. People with RA in observational trials in Canada (n = 896) and France (n = 138), and an RCT in the Netherlands (n = 178) completed 5 items (11-point numerical rating scale) representing RA Flare core domains. There was moderate to high evidence of reliability, content and construct validity, and responsiveness. Factor analysis supported unidimensionality. Rasch analysis showed acceptable fit to the Rasch model, with items and people covering a broad measurement continuum and evidence of appropriate targeting of items to people, ordered thresholds, minimal differential item functioning by language, sex, or age. A summative score across items is defensible, yielding an interval score (0-50) where higher scores reflect worsening flare. The RA-FQ received endorsement from 88% of attendees that it passed the OMERACT Filter 2.0 "Eyeball Test" for instrument selection. The RA-FQ has been developed to identify and measure RA flares. Its review through OMERACT Filter 2.0 shows evidence of reliability, content and construct validity, and responsiveness. These properties merit its further validation as an outcome for clinical trials.

Pixel-Level Deep Segmentation: Artificial Intelligence Quantifies Muscle on Computed Tomography for Body Morphometric Analysis

Pretreatment risk stratification is key for personalized medicine. While many physicians rely on an “eyeball test” to assess whether patients will tolerate major surgery or chemotherapy, “eyeballing” is inherently subjective and difficult to quantify. The concept of morphometric age derived from cross-sectional imaging has been found to correlate well with outcomes such as length of stay, morbidity, and mortality. However, the determination of the morphometric age is time intensive and requires highly trained experts. In this study, we propose a fully automated deep learning system for the segmentation of skeletal muscle cross-sectional area (CSA) on an axial computed tomography image taken at the third lumbar vertebra. We utilized a fully automated deep segmentation model derived from an extended implementation of a fully convolutional network with weight initialization of an ImageNet pre-trained model, followed by post processing to eliminate intramuscular fat for a more accurate analysis. This experiment was conducted by varying window level (WL), window width (WW), and bit resolutions in order to better understand the effects of the parameters on the model performance. Our best model, fine-tuned on 250 training images and ground truth labels, achieves 0.93 ± 0.02 Dice similarity coefficient (DSC) and 3.68 ± 2.29% difference between predicted and ground truth muscle CSA on 150 held-out test cases. Ultimately, the fully automated segmentation system can be embedded into the clinical environment to accelerate the quantification of muscle and expanded to volume analysis of 3D datasets.

OMERACT Quality-adjusted Life-years (QALY) Working Group: Do Current QALY Measures Capture What Matters to Patients?

To understand the limitations with current patient-reported outcome measures (PROM) used to generate quality-adjusted life-years (QALY) in rheumatology, and set a research agenda. Two activities were undertaken. The first was a scoping review of published studies that have used PROM to generate QALY in rheumatology between 2011 and 2016. The second was an interactive "eyeball test" exercise at Outcome Measures in Rheumatology 13 that compared subdomains of widely used generic PROM, as identified through the scoping review, to subdomains of the Assessment of SpondyloArthritis Health Index (ASAS-HI) condition-specific PROM for ankylosing spondylitis. The scoping review included 39 studies. Five different PROM have been used to generate QALY in rheumatology; however, the EQ-5D and Short Form 6 Dimensions (SF-6D) were used most frequently (in 32 and 9 of included studies, respectively). Special interest group participants identified energy/drive and sleep as 2 key subdomains of the ASAS-HI instrument that may be missed by the EQ-5D, and sexual function as potentially missed by the SF-6D. Participants also expressed concerns that aspects of the process of care and non-health outcomes may be missed. Three ways of incorporating additional subdomains were discussed, including using an alternative generic PROM, modifying an existing generic PROM with "bolt-on" subdomain(s), and generating societal weights for a condition-specific PROM. Three priorities for future research were identified: understanding whether the EQ-5D and SF-6D identify what matters to patients with different rheumatic conditions, analyzing how much patients value process or non-health outcomes, and identifying which approaches to incorporating a greater number of subdomains into the QALY are being undertaken in other disease areas.