Patient Activity Scale Research Articles

Defining Minimum Clinically Important Changes for the Patient Activity Scale II.

To define the minimum clinically important improvement (MCII) and minimum clinically important worsening (MCIW) for the Patient Activity Scale II (PAS-II; range 0-10), a recommended patient-reported outcome measuring rheumatoid arthritis disease activity. Data were taken from Forward, The National Databank for Rheumatic Diseases, from four 6-month data collection periods. Both anchor-based and distribution-based methods were used to estimate the MCII and MCIW. Anchor-based analyses used comparisons of pain and general health to the previous 6 months. Distribution-based analyses used 0.5 and 0.35 SDs. We stratified analyses based on the PAS-II score (above/below 3.7), hypothesizing that the MCII and MCIW would depend on the baseline score. To assess construct validity, we evaluated the odds of achieving the MCII in patients receiving new therapies. In the overall sample, for pain and general health anchor questions, the MCIW was 0.50 and 0.55, respectively. The MCII was defined as 0.39 and 0.45, respectively, for pain and general health. The MCIW for anchor-based methods among participants with low disease activity was 1.10 (1.09/1.11 [pain/general health]), while the MCII for those with moderate-to-high disease activity was 1.09 (1.15/1.02 [pain/general health]). Distribution-based methods for 0.5 and 0.35 SD were 1.08 and 0.76, respectively, for pain and general health. There was fair-to-excellent agreement with clinically important differences in assessments of pain and disability. Patients receiving new treatments had 30% greater odds of achieving the MCII. The minimum important change in PAS-II score was approximately 0.5. Among participants with a moderate-to-high PAS-II score , the MCII was 1.1, and among participants with low disease activity, the MCIW was 1.1.

Evaluation of a non-face to face multidisciplinary health care model in a population with rheumatoid arthritis vulnerable to covid-19 in a health emergency situation

Objectives: The COVID-19 pandemic has impacted everyday practice pattern of health care in rheumatoid arthritis (RA) patients. The objective was to evaluate the implementation of a tele-consultation program in an adult population with RA Methods: Analytical observational study longitudinal cohort (Clinical trials NCT04768413) that evaluated the effectiveness of a tele consultation model compared with a face-to-face consultation model in adult RA patients. Patients were followed 12 weeks (Jul-Oct 2020) at an RA center of excellence in Colombia. Simple random sampling was done. Two groups were included: Group A, patients who were cared for by tele-consultation care and Group B, thosewho wished to continue with the usual face-to-face consultation. Data regarding activity of disease (Week 0,6,12) [Patient Activity Scale (PAS) in both groups and DAS28 in group B], and Quality of life [EQ-5D-3L], disability [Health Assessment Questionnaire (HAQ)], therapeutic adherence [Morisky-Green Adherence Scale (MGLS)] and self-care capacity [Appraisal of Self-care Agency Scale -Revised (ASA-R)] were evaluated (weeks 0-12). Outcomes regarding COVID-19 were evaluated. Bivariate analysis was done (StataV-13;P-value remote>presential (p = 0,0001);the same result was documented in the group presential>remote>presential, with an increase in adherence (p = 0,033). 7 patients developed COVID-19 (one patient hospitalized/group A and one patient died/mixed model) Conclusion: In the tele consultation model patients remained adherent to their RA treatment, without major differences compared to the face-to-face model. It is important to know these results due to the impact they have, given the changes that will follow in the care of RA patients due the current pandemic. Studies with a longer follow-up period are required to corroborate these results.

Probiotic Use and Psoriatic Arthritis Disease Activity

ObjectiveProbiotics have been hypothesized to mediate inflammation through gut microbiome modulation. Spondyloarthropathies have subclinical gut inflammation associated with inflammatory disease that may benefit from probiotic use. We aimed to evaluate associations between probiotic use and patient‐reported outcomes in patients with psoriatic arthritis (PsA).MethodsUsing FORWARD, The National Databank for Rheumatic Diseases, we examined probiotic use among patients with PsA and rheumatoid arthritis (RA), a comparator in which gut inflammation is less clearly related to pathogenesis. Patient‐reported outcome measures such as pain and physical function were compared for probiotic users and nonusers among patients with PsA and RA. Patients were propensity score–matched for taking a probiotic by demographics and nonmedication supplements.ResultsMore patients have reported probiotic use over the past decade, with less than 1% reporting use in 2008 and approximately 7% in 2018. Probiotic users are more likely to be white women with higher education, income, and supplement use. Following propensity score matching, probiotic users with PsA had significantly lower Short Form 36 Physical Component Summary (SF‐36 PCS) scores and higher pain scores than nonusers with PsA (33.11 ± 11.50 vs. 40.82 ± 11.03; P = 0.04 and 4.78 ± 3.09 vs. 3.00 ± 2.58; P = 0.03). There were no significant differences in Patient Activity Scale II, Health Assessment Questionnaire II, SF‐36 PCS, and Short Form 36 Mental Component Summary scores or pain among users with PsA before and after probiotic initiation.ConclusionWe found increasing probiotic use in patients with PsA and important differences between users and nonusers. After accounting for these differences, we found no statistical difference in health outcomes after probiotic use.

ПРОДЛЕННАЯ ВНУТРИРАНЕВАЯ АНАЛЬГЕЗИЯ ПОСЛЕ РЕКОНСТРУКТИВНЫХ ОПЕРАЦИЙ НА ПОЗВОНОЧНИКЕ У БОЛЬНЫХ ТУБЕРКУЛЕЗНЫМ СПОНДИЛИТОМ

Objective. To assess the efficacy of postoperative continuous intralesional analgesia in patients with tuberculous spondylitis. Material and Methods. Patients (n = 56) with tuberculous spondylitis undergoing radical reconstructive spinal surgery were randomized into two groups depending on the type of post-operative analgesia: standard parenteral analgesia in Group I, and continuous intralesional infusion with local anesthetic in Group II. The amount of administered narcotic and non-narcotic analgesics was evaluated with formalized Analgesic Assessment Scale, postoperative activity - with the Patient Activity Scale, and pain intensity - with the VAS. Side effects of analgesic therapy were registered. Results. Statistical analysis revealed reliable differences in terms of the assessed analgesic amounts, VAS indexes and frequency of side effects between groups. Results in Group I were reliably higher than in Group II. Conclusion. The study showed efficacy and safety of continuous wound analgesia with infusion of ropivacaine 0.2 % through a special catheter in the early postoperative period. Hir. Pozvonoc. 2014;(2): 74-78.

SAT0035 Variability in the Classification of Remission among Disease Activity Indices and Their Correlation: An Analysis From a Prospective, Observational Registry

BackgroundIn recent years, disease remission in rheumatoid arthritis (RA) has been assessed using various disease activity indices such as the DAS28, SDAI, CDAI, ACR/EULAR-recommended Boolean definition and the Patient Activity...

FRI0158 The correlation of acr recommended clinical disease activity measures with grading of histological synovitis in rheumatoid arthritis

BackgroundSynovitis is the key pathological change in rheumatoid arthritis (RA). 2012 updated ACR recommended RA disease activity measures for use in clinical practice included Disease Activity Score with 28-joint counts...

Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice

Although the systematic measurement of disease activity facilitates clinical decision making in rheumatoid arthritis (RA), no recommendations currently exist on which measures should be applied in clinical practice in the US. The American College of Rheumatology (ACR) convened a Working Group (WG) to comprehensively evaluate the validity, feasibility, and acceptability of available RA disease activity measures and derive recommendations for their use in clinical practice. The Rheumatoid Arthritis Clinical Disease Activity Measures Working Group conducted a systematic review of the literature to identify RA disease activity measures. Using exclusion criteria, input from an Expert Advisory Panel (EAP), and psychometric analysis, a list of potential measures was created. A survey was administered to rheumatologists soliciting input. The WG used these survey results in conjunction with the psychometric analyses to derive final recommendations. Systematic review of the literature resulted in identification of 63 RA disease activity measures. Application of exclusion criteria and ratings by the EAP narrowed the list to 14 measures for further evaluation. Practicing rheumatologists rated 9 of these 14 measures as most useful and feasible. From these 9 measures, the WG selected 6 with the best psychometric properties for inclusion in the final set of ACR-recommended RA disease activity measures. We recommend the Clinical Disease Activity Index, Disease Activity Score with 28-joint counts (erythrocyte sedimentation rate or C-reactive protein), Patient Activity Scale (PAS), PAS-II, Routine Assessment of Patient Index Data with 3 measures, and Simplified Disease Activity Index because they are accurate reflections of disease activity; are sensitive to change; discriminate well between low, moderate, and high disease activity states; have remission criteria; and are feasible to perform in clinical settings.

Rheumatoid Arthritis Disease Severity Indices in Administrative Databases: A Systematic Review

We aimed to systematically review rheumatoid arthritis (RA) disease severity indices for use in administrative healthcare databases. We also provide an overview of alternative methods to control for RA disease severity in administrative database research. We conducted a systematic review of studies that developed/validated an index for RA disease severity using variables in administrative databases, and compared the convergent validity/reliability of the index with a standard measure of RA severity. After reviewing 539 articles, 2 studies were included. The claims-based index for RA severity (CIRAS) was developed in one study. Components of the CIRAS included tests for inflammatory markers, number of chemistry panels/platelet counts ordered, rheumatoid factor test, number of rehabilitation and rheumatology visits, and Felty's syndrome. The CIRAS correlated moderately well with a previously validated RA medical records-based index of severity. The second study assessed whether current and lifetime treatment with disease-modifying antirheumatic drugs and/or biologics accurately predicted RA severity, as measured by the patient-reported Patient Activity Scale (PAS). Treatment variables did not fully distinguish patients in the highest and lowest quartiles of PAS scores (67.2% correctly classified). Two claims-based indices of RA severity were identified but have some limitations for routine use. A concerted effort from experts in the field is needed to define, develop, and validate a widely applicable measure of RA disease severity for administrative database research.

Identification of disease activity and health status cut-off points for the symptom state acceptable to patients with rheumatoid arthritis

Background:Established thresholds for low levels of disease activity need to be examined from a patients’ perspective.Objective:To identify new cut-off points for patients’ perception of satisfactory condition (patient acceptable symptom state...

Minimal disease activity, remission, and the long‐term outcomes of rheumatoid arthritis

To determine the prevalence of minimal disease activity (MDA) and remission in patients with rheumatoid arthritis (RA), to assess the effect of anti-tumor necrosis factor (anti-TNF) therapy on MDA, and to determine the extent to which MDA status improves long-term outcomes. Using the Patient Activity Scale (PAS) as a surrogate, we assessed the prevalence of MDA and remission in 18,062 patients with RA using the newly developed Outcome Measures in Rheumatology Clinical Trials (OMERACT) criteria for MDA. MDA was noted in 20.2% of 18,062 patients and persistent MDA, operationally defined as having MDA during >or=2 consecutive 6-month observation periods, occurred in 13.5% of 7,433 patients followed longitudinally. Disease activity at remission levels was noted in 7%. Among patients with MDA, 82% received disease-modifying antirheumatic drugs or biologic agents. Following anti-TNF initiation, the cumulative probability of achieving MDA at 2 and 6 years was 4.1% and 7.6%, respectively, and persistent MDA probabilities were 2.7% and 4.5%, respectively. Regardless of RA duration, patients with MDA had substantially better outcomes, including a 10-fold reduction in work disability and an approximately 2-fold reduction in total joint replacement and mortality. Remission remains uncommon in RA, and the prevalence of new remission in community practice is substantially lower than noted in published trials of biologic therapy. On average, persons with MDA appear to have persistently mild RA. This might be the effect of milder RA and/or more effective treatment in early RA. The PAS had satisfactory levels of agreement with the full MDA criteria and appears suitable for use in clinical and epidemiologic research.

Validation of functional activity index in patients with rheumatoid arthritis (RAS)

Objective. To evaluate psychometric properties of Patient Activity Scale (PAS) index and possibility of its application for assessment of pt functional activity (PFA) and therapy efficacy in pts with rheumatoid arthritis (RA). Materia l and methods . Validity assessment was performed on 454 pts with definite RA,mainly female (85,2%) with mean age 51,3±11,3 years, mean disease duration was 9,1±8,5 years, 59,7% of pts were seropositive on rheumatoid factor, most pts had moderate or high inflammatory activity of the disease (95,6%), II or III radiological stage ( 44,7% and 27,8% respectively, II (53,5%) or III (31,8%) functional class. Constructive validity of the index was assessed by calculation of coefficients of correlation with “external criteria”. Sensitivity was assessed with ACR criteria in 285 pts after 6 months of standard therapy. Reliability (reproducibility and internal constancy) were assessed in 92 pts in 3 days after admission. Results. Assessment of PAS reliability with test-retest analysis did not reveal differences between first and repeat examination of pts whose state had not change after 3 days (mean scores 5,07±1,27 and 5,17±1,34 respectively, p=0,45). Intra-class Cronbach alpha coefficient was 0,95 (p<0,000001). Constructive validity assessment revealed moderate relationship of PFA with disease inflammatory activity measures: morning stiffness duration (r= 0,33, p<0,0000001), DAS 28 value (r=46, p<0,001), tender joint count (r=0,39, p<0,0000001), swollen joint count (r=0,28, p<0,0002) and weak relationship with ESR and radiological stage of the disease (r=0,17, p<0,00001). PAS correlation relationships with quality of life measures assessed on all SF-36 scales varied from -0,37 to -0,58. Index sensitivity to changes assessment showed that PAS change exceeding 0,22 corresponded to at least 20% health improvement according to ACR criteria. Conclusion . PAS is a reliable, valid and sensitive instrument of pt functional state self assessment and can be used for dynamic evaluation of pts state and treatment efficacy in outpatient practice