Patient Global Estimate Research Articles

The association of baseline sarcoidosis measurements with 6-month outcomes that are of interest to patients: Results from the On-line Sarcoidosis Assessment Platform Study (OSAP)

IntroductionThe impact of common measures to assess sarcoidosis have not been compared longitudinally to outcomes that are meaningful to patients. We prospectively examined the relationship of baseline measurements of sarcoidosis status to outcomes of interest to patients longitudinally over 6 months. MethodsSarcoidosis patients cared for at 6 US medical centers were “phenotyped” at baseline with measurements of pulmonary function, organ involvement, health related quality of life (HRQoL) instruments, and their anti-sarcoidosis treatment history. These patients were followed for 6 months by monitoring outcomes of interest to patients (OIPs) including steps walked, calories expended, sleep, HRQoL measures, workdays missed and health care utilization. For each baseline phenotypic measurement, patients were dichotomized into two groups above and below a specified cutoff value. The area under the OIP versus time curve was compared between these two groups. ResultsThe cutoff values for many baseline phenotypic measures distinguished the patients into groups with significantly different 6-month OIPs. The chosen cutoff for the patient global estimate of health status distinguished the most OIPs (13/15). The 6-min walk distance cutoff was associated with more OIPs than spirometric measures. All of the HRQOL measure cutoffs were associated with many OIPs, although most of them were other HRQOL measures. InterpretationCutoffs for most of the phenotypic measures used to assess sarcoidosis distinguished groups of sarcoidosis patients with differing OIPs over the subsequent 6 months. The patients’ global assessment of their disease was the most accurate of these measures. Clinical trial registration numberNCT04342403.

An observational study on the effect of individualised homoeopathic medicine administered based on totality of symptoms vis-à-vis personality in cases of osteoarthritis knee

Background: Individualisation is the process of arriving at the image of the patient for the selection of remedy. The customary way of individualisation of the patient is through the construction of totality of symptoms. The little explored area in Homoeopathy is individualisation solely based on personality characteristics. Objective: The objective of this study was to compare the effect of individualised homoeopathic medicine administered based on totality of symptoms vis-à-vis personality in patients suffering from knee osteoarthritis. Methods: The observational study includes 60 clinically diagnosed cases of osteoarthritis knee, of which 30 cases were administered the homoeopathic medicine selected on the basis of totality of symptoms and thirty cases based on personality. Randomisation was done using computer-generated numbers. The personality of the patients was assessed through the 44-item Big-Five Inventory. A self-made tool, transcribing trait items to rubrics of the homoeopathic repertory, was prepared. The knee osteoarthritis scores on physical function, pain and patient global estimate in Routine Assessment of Patient Index Data 3 (RAPID3) sheet, before and after treatment, were compared. Results: The paired difference mean of RAPID3 in totality of symptom-based administration was 4.06 and for personality-based administration was 1.92 with a standard deviation of 3.91 and 3.29, respectively. The test result is statistically significant at 0.05 level (P < 0.05). Conclusion: Administration of individualised Homoeopathy medicine based on totality of symptoms is found to be more effective as compared to individualised Homoeopathy medicine based on personality amongst patients suffering from osteoarthritis knee.

Pragmatic assessment of exercise in routine care using an MDHAQ: associations with changes in RAPID3 and other clinical variables

BackgroundExercise is associated with major benefits in patients with rheumatic diseases for both cardiovascular and rheumatic status. However, information about exercise generally is not collected systematically in routine rheumatology care. A multidimensional health assessment questionnaire (MDHAQ), which was designed for busy clinical settings, includes a query about exercise status. We analyzed possible associations between change in MDHAQ exercise scores and other MDHAQ measures in patients with various rheumatic diseases over one year.MethodsIn one rheumatology clinical setting, all patients, regardless of diagnosis, complete an MDHAQ before seeing a rheumatologist. The MDHAQ includes scores for physical function, pain, and patient global estimate, compiled into an index, routine assessment of patient index data (RAPID3), as well as a self-report joint count and a query about exercise. Patients were classified into four groups according to their exercise status at baseline and one year later as: EXER-Yes (regular exercise), EXER-Yes; EXER-No (no regular exercise), EXER-Yes; EXER-Yes, EXER-No; and EXER-No, EXER-No. These groups were compared using the chi square and Kruskal-Wallis tests and analysis of variance (ANOVA).ResultsPatients who reported regular exercise at baseline were younger, had higher formal education, and better clinical status than other patients. The EXER-No, EXER-Yes group had greater improvement in other MDHAQ variables than patients in the other three groups. By contrast, the EXER-Yes, EXER-No group was the only group with poorer status one year later.ConclusionsThe MDHAQ exercise query indicates that regular exercise is associated with better clinical status. Patients in the EXER-No, EXER-Yes group reported the best clinical improvement, although it is not known whether exercise preceded or followed the improved clinical status.

Responsiveness of a simple RAPID-3-like index compared to disease-specific BASDAI and ASDAS indices in patients with axial spondyloarthritis

ObjectiveTo evaluate the responsiveness of a simple routine assessment of patient index data (RAPID3)-like index that includes only 3 patient self-report measures (physical function, pain and patient global estimate) compared...

Prediction of Remission in a French Early Arthritis Cohort by RAPID3 and other Core Data Set Measures, but Not by the Absence of Rheumatoid Factor, Anticitrullinated Protein Antibodies, or Radiographic Erosions.

To identify baseline variables that predict remission according to different criteria in rheumatoid arthritis (RA) in a comprehensive French ESPOIR early arthritis database. Individual variables and indices at baseline were analyzed in 664 patients for capacity to predict remission either 6 or 12 months later according to 4 criteria that require a formal joint count: the American College of Rheumatology/European League Against Rheumatism Boolean criteria, the Simplified Disease Activity Index, the Clinical Disease Activity Index, and the 28-joint Disease Activity Score; and 2 remission criteria that do not require a formal joint count: the Routine Assessment of Patient Index Data 3 (RAPID3) and the RAPID3 ≤ 3 + swollen joint, using univariate and multivariate logistic regressions. Remission was predicted significantly 6 and/or 12 months later in 26.8%-51.4% of patients, according to all 6 criteria by younger age, low index scores, and better status for the 6/7 clinical RA core dataset measures: tender joint count, swollen joint count (SJC), physician's global estimate, patient self-report Health Assessment Questionnaire (HAQ) physical function, pain, and patient's global estimate. Remission was not predicted by the absence of "poor prognosis RA" indicators, rheumatoid factor (RF), anticitrullinated protein antibodies (ACPA), or radiographic erosions. In multivariate regressions that included only 3 variables, low HAQ function predicted remission by all criteria as effectively as SJC, erythrocyte sedimentation rate, or C-reactive protein. Younger age and 6 core dataset clinical measures, but not the absence of traditional "poor prognosis RA" indicators, RF, ACPA, or radiographic erosions, predicted remission according to 6 criteria, including 2 without a formal joint count.

Effect of Formal Education Level on Measurement of Rheumatoid Arthritis Disease Activity

Objective. The aim of this study is to analyze the capacity of three demographic variables - age, sex, and formal education level - as well as disease duration to explain variation in 7 Core Data Set variables and 4 indices used to assess rheumatoid arthritis (RA), in a cohort of Korean patients seen in usual care. Methods. All RA Core Data Set measures were collected in usual care of 397 RA patients, including tender/swollen joint counts (TJC, SJC) 28, physician global estimate of status, erythrocyte sed- imentation rate, C-reactive protein, and a multidimensional health assessment questionnaire to assess physical function, pain, and patient global estimate of status (PATGL). Four indices were computed: disease activity score with 28 joint count (DAS28), simplified disease activity index (SDAI), clinical disease activity index (CDAI), and routine assessment of patient index data 3 (RAPID3). Descriptive statistics and multivariate generalized linear models were used in data analysis. Results. Patients with lower education had higher scores, indicating greater severity, for all 7 Core Data Set measures and 4 indices (significant for TJC, function, pain, PATGL, DAS28, SDAI, CDAI, RAPID3). In a series of regressions that included age, sex, disease duration, and education, formal education level was the only significant variable to explain variation in TJC, pain, PATGL, physician global estimate of status (DOCGL), DAS28, SDAI, CDAI, and RAPID3. Conclusion. Significant associations with education were found in Korean RA patients according to most RA Core Data Set measures and 4 indices. Education was more likely than age, sex, or disease duration to explain variation in most measures and indices. (J Rheum Dis 2015;22:231-237)

Are patient self-report questionnaires as "scientific" as biomarkers in "treat-to-target" and prognosis in rheumatoid arthritis?

Information from patients traditionally is regarded as "subjective," in contrast to "objective," "scientific" laboratory data. However, patient questionnaire scores for physical function are more significant to predict severe outcomes of rheumatoid arthritis (RA), such as work disability and mortality, than radiographs or laboratory tests. Furthermore, the 3 RA Core Data Set patient self-report measures of physical function, pain, and patient global estimate are as effective as radiographs or laboratory tests to distinguish active from control treatments in clinical trials. A multidimensional health assessment questionnaire (MDHAQ) has been developed in routine clinical care, to be completed by patients in 5-10 minutes and contribute to clinical decisions, in contrast to research questionnaires which may provide extensive information, but often are lengthy, unfeasible for routine care, and not designed to add to clinical care. RAPID3 (routine assessment of patient index data) is an index included on the MDHAQ which is calculated in 5 seconds, compared with almost 2 minutes for RA indices that require a formal joint count, such as DAS28 (disease activity score with 28-joint count) or CDAI (clinical disease activity index). MDHAQ with included RAPID3 scores appears as "scientific" as laboratory tests, formal joint counts, and indices such as DAS28 and CDAI, to assess patient status using standard, protocolized, quantitative measurement. MDHAQ/RAPID3 helps the patient prepare for the visit, enhances doctor-patient communication, and saves time for the physician. MDHAQ/RAPID3 is useful in all rheumatic diseases, and can be incorporated into routine clinical care with minimal extra work for physicians and staff. MDHAQ in no way prevents collection of formal joint counts, radiographs and other imaging studies, laboratory tests, or any other information regarded as important by a rheumatologist. MDHAQ provides quantitative, "scientific" data, rather than gestalt impressions, regarding patient status, change in status, prognosis, and outcomes of RA and all rheumatic diseases.

AB0289 The Degree of Discordance between Global Estimates by Patients and their Physicians in Various Rheumatic Diseases

BackgroundIn rheumatic diseases, quantitative assessment including estimates of global status by physicians (DOCGL) and patients (PATGL) is required since there is no any single gold standard biomarker measure for optimal...

FRI0189 Assessment of Exercise Status in Routine Care Using Mdhaq: Evidence That Initiating Exercise is Associated with Substantially Better Outcomes than NO Exercise

BackgroundExtensive evidence indicates major benefits of exercise in rheumatoid arthritis1 and many rheumatic diseases,2 not only for cardiovascular and general fitness, but also for better rheumatologic clinical status. Most reported...

FRI0204 Patient Global Estimates of Status Vary More than Physician Global Estimates, and Estimates Become Increasingly Discordant from ONE Another at Both High and Low Extremes of Disease Activity

BackgroundGlobal estimates by both patient (PATGL) and physician (DOCGL) are concordant within 2 units on a 0-10 visual analog scale (VAS) in about 40-65% of encounters, while discordance of PATGL>DOCGL...

FRI0141 Rapid3 in 90 Korean Patients with Ankylosing Spondylitis Yields Similar Information to BASDAI and Asdas, with Greater Feasibility for Busy Clinical Settings

BackgroundThe BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) is a self-report index to assess disease activity in patients with ankylosing spondylitis (AS). The ASDAS (AS disease activity score) is recorded...

Is a Patient Questionnaire Without a Joint Examination as Undesirable as a Joint Examination Without a Patient Questionnaire?

Patient questionnaires have gained increasing prominence in the treatment of rheumatic diseases over the last few decades. Three patient self-report scores for physical function, pain, and patient global estimate are included in the rheumatoid arthritis (RA) core dataset1. These 3 scores distinguish active from control treatments in RA clinical trials involving leflunomide2, methotrexate2, anakinra3, adalimumab4, abatacept5, and certolizumab6, at levels of significance similar to formal joint counts or laboratory tests. Patient physical function scores generally are more significant than radiographic scores or laboratory test results in the prognosis of severe longterm RA outcomes such as work disability and premature mortality7,8,9,10. Routine Assessment of Patient Index Data (RAPID3), an index of only the 3 patient-reported RA Core Data Set measures, is correlated significantly with standard indices that require a formal joint count, such as DAS28 (28-joint Disease Activity Score) and CDAI (Clinical Disease Activity Index)11,12. A RAPID3 score of ≤ 3/30 with 1 or 0 swollen joints, RAPID3≤3+≤SJ1, provides remission criteria comparable to Boolean13, SDAI (Simplified Disease Activity Index), CDAI, and DAS2814 criteria in far less time than a formal joint count, in studies of the French ESPOIR early arthritis cohort15 … Address correspondence to Dr. Pincus, Division of Rheumatology, NYU Hospital for Joint Diseases, 301 East 17th St., Room 1608, New York, New York 10003, USA. E-mail: tedpincus{at}gmail.com

GUEPARD treat-to-target strategy is significantly more efficacious than ESPOIR routine care in early rheumatoid arthritis according to patient-reported outcomes and physician global estimate

Objective. To analyse seven RA Core Data Set measures and three indices for their capacity to distinguish treatment results in early RA in the GUEPARD treat-to-target clinical trial vs ESPOIR routine care.Methods. Post hoc analyses compared 65 GUEPARD and 130 matched control ESPOIR patients over 6 and 12 months for mean changes in measures, relative efficiencies and standardized response means (SRM). Three indices—28-joint disease activity score (DAS28), clinical disease activity index (CDAI) and routine assessment of patient index data (RAPID3)—were compared for mean changes and numbers of patients with high, moderate or low activity or remission using κ values.Results. Greater improvement was seen for GUEPARD vs ESPOIR, statistically significant for physician and patient global estimates and pain and health assessment questionnaire physical function (HAQ-FN), but not joint counts and laboratory tests. Relative efficiencies with tender joint count as the referent measure indicated that pain (2.57) and global estimates by patient (3.13) and physician (2.31) were most efficient in distinguishing GUEPARD from ESPOIR. Mean improvements in GUEPARD vs ESPOIR were −3.4 vs −2.6 for DAS28 (0–10) (24%), −29.8 vs −23.1 for CDAI (0–76) (23%) and −13.0 vs −7.8 for RAPID3 (0–30) (40%) (all P < 0.01); agreement was moderate between CDAI vs DAS28 (κ = 0.56) and vs RAPID3 (κ = 0.48), and fair between DAS28 vs RAPID3 (κ = 0.26).Conclusion. Patient and global measures indicate greater efficacy than joint counts or laboratory measures in detecting difference between GUEPARD treat-to-target and ESPOIR routine care. A RAPID3 of only patient measures may help guide treat-to-target in busy clinical settings.

FRI0077 Relative efficiencies of joint counts and laboratory tests are no higher than patient-reported measures to document superior results in the guepard tight-control versus espoir routine care cohorts

BackgroundA single “gold standard” measure such as blood pressure or serum glucose is not available in rheumatoid arthritis (RA) for diagnosis and monitoring of all individual patients. A Core Data...

THU0517 Patient and Physician Global Estimates in the Danish Nationwide Danbio Registry: Male and Female Physicians are More Likely to Underestimate Severity in Female Than Male Patients

BackgroundAbout one third of physician global estimates (DOCGL) of rheumatoid arthritis (RA) disease activity are >20mm lower than patient global estimates (PATGL) on a 100 mm visual analog scale (VAS)[1]....

SAT0316 Routine Assessment of Patient Index Data 3 (Rapid3) is a Valid Index for Routine Care in Patients with Osteoarthritis

BackgroundRAPID3 (routine assessment of patient index data) is an arithmetic composite index of three Core Data Set, patient self-report, measures: physical function (0-3 converted to 0-10), pain (0-10), and patient...

MDHAQ/RAPID3 to Recognize Improvement Over 2 Months in Usual Care of Patients With Osteoarthritis, Systemic Lupus Erythematosus, Spondyloarthropathy, and Gout, as Well as Rheumatoid Arthritis

To analyze whether MDHAQ (Multidimensional Health Assessment Questionnaire) scores for physical function (FN), pain, Patient Global Estimate (PATGL), and RAPID3 (Routine Assessment of Patient Index Data, a composite of these 3 measures) document improvement in patients with osteoarthritis, systemic lupus erythematosus, spondyloarthropathy, and gout, similarly to rheumatoid arthritis. In a solo rheumatology practice, every patient completes an MDHAQ/RAPID3 and is assigned a Physician Global Estimate (DOCGL) at every visit. Mean and median FN (0-10 scale), pain (0-10), PATGL (0-10), RAPID3 (0-30), and DOCGL (0-10) were computed at first visit and 2 months later in 141 new patients with 5 diagnoses. Proportions with RAPID3 high (>12), moderate (6.1-12), and low (3.1-6) severity and remission (≤3) were computed. Differences between baseline and 2-month follow-up for each diagnosis were analyzed using paired t tests. Mean changes over 2 months across 5 diagnoses were compared using analysis of variance. Mean baseline scores for all measures were in narrow ranges for all 5 diagnoses: FN 1.5 to 2.5, pain 4.2 to 5.9, PATGL 4.3 to 5.6, RAPID3 10.1 to 13.7, and DOCGL 2.4 to 4.0. Improvement for FN was 9.4% to 26.8% in all diagnoses but osteoarthritis, for pain 20.2% to 35.3% in all diagnoses, PATGL 11.3% to 30.4%, RAPID3 16.8% to 27.5%, and for DOCGL 23.8% to 36.4%, similar in 5 diagnostic groups. MDHAQ, RAPID3, and DOCGL document similar baseline and improvement scores in patients with 5 diagnoses. These quantitative data may supplement traditional narrative, "gestalt" descriptions in usual care of patients with any rheumatic disease.

OP0150 Formal Education Level is More Explanatory of Variation in Patient Global Estimate than Age, Duration of Disease or Gender in Patients with Rheumatoid Arthritis, Osteoarthritis, Systemic Lupus Erythematosus and Gout

BackgroundAge, duration of disease, and gender are included in all clinical research reports as potential modifiers of patient status and treatment responses. Formal education level (EDUC), which has been interpreted...

AB0604 Association of knee symptoms with self-reported physical function in knee osteoarthritis patients

ObjectivesTo examine associations of knee symptoms with self-reported physical function of individuals with knee osteoarthritis (OA).MethodsWe examined differences in pain, pain sensitivity, function, psychosocial variables, and physical activity between women...

OP0133 Analysis of Potential Predictors for Remission in Early Rheumatoid Arthritis According to ACR/EULAR Boolean, DAS28 and RAPID3RJ1 Criteria: Results from the Espoir Cohort

BackgroundRemission in rheumatoid arthritis (RA) is increasingly possible in recent years with a treat-to-target strategy. It would be of value to recognize baseline variables that are potential predictors of remission.ObjectivesTo...