Quality Of Life In Arthritis Research Articles

Adaptation and validation of the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire for use in Bulgaria.

Rheumatoid arthritis (RA) is a chronic disease with an enormous impact on patients' quality of life. The Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire is a disease-specific measure of QoL for individuals with rheumatoid arthritis. Our aim was to adapt and validate the RAQoL for use in Bulgaria. The development of a new language version of the RAQoL consisted of three stages: translation, field testing and psychometric evaluation. The dual-panel methodology, requiring two independent panels of Bulgarian speakers, was applied to translate the UK English version of the RAQoL into Bulgarian. Face and content validity of the translated questionnaire were assessed through cognitive debriefing interviews. Lastly, the RAQoL was administered on two occasions to a random sample of RA patients to evaluate reliability and validity. At the first occasion, the SF-36 was also administered for use as a comparator scale. The RAQoL was successfully adapted into Bulgarian and considered easy to understand, acceptable and comprehensive by RA patients. A psychometric study demonstrated that the new language version has excellent internal consistency (Cronbach's alpha coefficients = 0.93 and 0.94) and test-retest reliability (a Spearman's rank correlation coefficient = 0.97). Convergent validity was established by correlating scores on the RAQoL with a comparator measure, the SF-36. A strong correlation between RAQoL scores and the physical functioning section of the SF-36 was observed. Known group validity was established by the ability of the measure to distinguish between subgroups of patients, who differed according to their perceived general health, disease severity (p < 0.001) and whether they were experiencing a flare-up (p < 0.01). The new language version is recommended for use in future research studies, clinical trials and routine practice with Bulgarian RA patients.

Adaptation and validation of the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire for use in Serbia.

Rheumatoid arthritis (RA) is one of the most prevalent inflammatory rheumatic diseases. As it is a chronic and a lifelong destructive disease, the aim of the treatment is to reduce disability and improve quality of life. The Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire is a patient-reported outcome measure, specific to RA. To adapt and validate the RAQoL for use in Serbia, two translation panels were involved to produce the Serbian RAQoL. After successful translation, face and content validity was determined via cognitive debriefing interviews. The psychometric properties of the questionnaire were examined, including reliability and construct validity, by using the Nottingham Health Profile (NHP) as a comparator scale. The RAQoL was translated successfully and rated as applicable, relevant and comprehensive by respondents. The questionnaire had high internal consistency (alpha=0.94 at both time points) and test-retest reliability (r=0.92). Moderately high correlations were found between the RAQoL and physical mobility, pain and energy level sections of the NHP, providing evidence of convergent validity. The RAQoL was able to distinguish between patients grouped by perceived general health, incidence of flare-up and disease severity. The Serbian language version of the RAQoL showed strong evidence of reliability and validity and is recommended for use in clinical trials and routine general practice in RA.

Further international adaptation and validation of the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire.

The Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire was developed directly from rheumatoid arthritis (RA) patients in the United Kingdom and the Netherlands to measure quality of life (QoL). Since then, it has become widely used in clinical studies and trials and has been adapted for use in 24 languages. The objective was to develop and validate 11 additional language versions of the RAQoL in US English, Mexican Spanish, Argentinean Spanish, Belgian French, Belgian Flemish, French, Romanian, Czech, Slovakian, Polish and Russian. The language adaptation and validation required three stages: translation, cognitive debriefing interviews and validation survey. The translation process involved a dual-panel methodology (bilingual panel followed by a lay panel). The validation survey tested the psychometric properties of the new scales and included either the Nottingham Health Profile (NHP) or the Health Assessment Questionnaire (HAQ) as comparators. Internal consistency of the new language versions ranged from 0.90 to 0.97 and test-retest reliability from 0.85 to 0.99. RAQoL scores correlated as expected with the HAQ. Correlations with NHP sections were as expected: highest with energy level, pain and physical mobility and lowest with emotional reactions, sleep disturbance, and social isolation. The adaptations exhibited construct validity in their ability to distinguish subgroups of RA patients varying by perceived disease severity and general health. The new language versions of the RAQoL meet the high psychometric standards of the original UK English version. The new adaptations represent valid and reliable tools for measuring QoL in international clinical trials involving RA patients.

Distinguishing Between-Person and Within-Person Relationships in Longitudinal Health Research: Arthritis and Quality of Life

Many health measures (e.g., blood pressure, quality of life) have meaningful fluctuation over time around a relatively stable mean level for each person. This didactic paper describes two closely related statistical models for examining between-person and within-person relationships between two or more sets of measures collected over time: the latent intercept model with correlated residuals (LI) in structural equation modeling framework and the multivariate multilevel model (MVML) in multilevel modeling framework. We illustrated that the basic LI model and the MVML model are equivalent. We presented an illustrative example using a national arthritis data resource to examine between-person and within-person relationships of symptom status, functional health, and quality of life in arthritis patients. Additional design and modeling issues for the treatment of missing data are considered. We discuss contexts in which one of the two models may be preferred. Mplus and SAS syntax are available.

Extraarticular manifestations in Turkish patients with rheumatoid arthritis: impact of EAMs on the health-related quality of life in terms of disease activity, functional status, severity of pain, and social and emotional functioning

The aim of our study was to investigate extraarticular manifestations (EAMs) in Turkish patients with rheumatoid arthritis (RA) and also assess the impact of EAMs on various health-related quality of life (HRQoL) domains, including physical, social, emotional, mental functioning, and bodily pain. A total of 150 patients were included in the study. EAMs were identified clinically. Pulmonary involvement was confirmed by using pulmonary function tests (PFT) and high-resolution computed tomography (HRCT), atlantoaxial subluxation by cervical spine X-rays. Peripheral neuropathy, rheumatoid nodules, and Sicca symptoms were picked up on clinical examination. Peripheral neuropathy was also confirmed by electroneurophysiologic studies. Patients were evaluated by Rheumatoid Arthritis Quality of Life (RAQoL), and Short form-36 (SF36). The quadrivariate Disease Activity Score- 28 (DAS28) was used for measuring disease activity. Functional status was evaluated by using the Stanford Health Assessment Questionnaire (HAQ). The severity of pain was documented by using 10-cm Visual Analog Scale-Pain (VAS-pain). EAMs were observed in 50 patients (33.3%). These were pulmonary involvement (28.7%), rheumatoid nodules (14.7%), Sicca Syndrome (8%), peripheral neuropathy (2.7%), and atlantoaxial subluxation (0.7%), respectively. It was not recorded any statistically significant difference in HAQ, DAS28, VAS-pain, and RAQoL scores between the patient groups with and without EAMs. Patients with EAMs scored significantly lower in physical functioning, role-physical, and role-emotional subgroups of SF36 (P<0.01). Presence of EAMs is not directly associated with disease activity and functional status, but influences negatively HRQoL including physical and emotional functioning.

Adaptation of the Psoriatic Arthritis Quality of Life (PsAQoL) instrument for Sweden

Objective: The Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire is the first disease-specific patient-derived instrument for assessing QoL in patients with PsA and has been extensively validated in this population. The aim of the adaptation process reported here was to develop a Swedish version of the PsAQoL that was equivalent to, and met the same psychometric and acceptability standards as, the original instrument, which was developed in the UK.Method:Translation of the original questionnaire into Swedish was performed by a professional and a lay panel. Field testing for face and content validity was performed by interviewing 13 patients. Finally, 123 patients with PsA were included in a test–retest postal survey designed to test reproducibility and construct validity. The PsAQoL was administered on two occasions approximately 2 weeks apart. The Nottingham Health Profile (NHP) was used as a comparator instrument.Results: The Swedish version of the PsAQoL questionnaire showed good reliability at both time points and, as expected, correlated with the NHP. The scale was able to distinguish between groups based on self-reported general health and flare-up. Patients with active symptoms of both arthritis and psoriasis had worse QoL. The results also indicated that duration of disease has a progressive impact on PsAQoL scores.Conclusions: This study provides evidence that the adapted PsAQoL can be used for clinical studies in Swedish patients. The instrument provides valuable information on the long-term effects of PsA on QoL.

Psychological factors and quality of life in arthritis: a population-based study

Previous studies using clinic or convenience samples have indicated that not only patients with arthritis are at increased risk of depression, but there may also be a link between depression and disability in people with arthritis. We examined the prevalence of psychological distress in a population sample with and without arthritis and the association with health-related quality of life. The WANTS Health and Well-being Survey was a population household telephone interview survey of adults (age > or =18 years) in three states of Australia. Data obtained were weighted to provide population-representative estimates. The survey included questions regarding arthritis, SF-12, the Kessler 10 index of psychological distress and presence of mental health conditions. A total of 7,473 interviews providing information on arthritis were completed, with 1,364 (18.3%) reporting arthritis. Self-reported mental health conditions were more frequent in those with arthritis (14.9 vs 12.0%, p = 0.004), and a higher proportion were at a medium or high risk for anxiety or depression (39.0 vs 31.0%, p < 0.001). People with arthritis had significantly lower scores on the SF-12 physical component summaries compared to those without arthritis. Among those with arthritis, those with coexisting psychological distress had significantly lower scores on the SF-12 physical component summary than those without psychological distress. Psychological distress is common among people with arthritis in the community. In arthritis, psychological distress makes a significant additional negative impact on the physical well-being. Physicians need to recognize and address this additional impact on physical functioning in patients with arthritis.

Assessment of health-related quality of life in arthritis: conceptualization and development of five item banks using item response theory.

BackgroundModern psychometric methods based on item response theory (IRT) can be used to develop adaptive measures of health-related quality of life (HRQL). Adaptive assessment requires an item bank for each domain of HRQL. The purpose of this study was to develop item banks for five domains of HRQL relevant to arthritis.MethodsAbout 1,400 items were drawn from published questionnaires or developed from focus groups and individual interviews and classified into 19 domains of HRQL. We selected the following 5 domains relevant to arthritis and related conditions: Daily Activities, Walking, Handling Objects, Pain or Discomfort, and Feelings. Based on conceptual criteria and pilot testing, 219 items were selected for further testing. A questionnaire was mailed to patients from two hospital-based clinics and a stratified random community sample. Dimensionality of the domains was assessed through factor analysis. Items were analyzed with the Generalized Partial Credit Model as implemented in Parscale. We used graphical methods and a chi-square test to assess item fit. Differential item functioning was investigated using logistic regression.ResultsData were obtained from 888 individuals with arthritis. The five domains were sufficiently unidimensional for an IRT-based analysis. Thirty-one items were deleted due to lack of fit or differential item functioning. Daily Activities had the narrowest range for the item location parameter (-2.24 to 0.55) and Handling Objects had the widest range (-1.70 to 2.27). The mean (median) slope parameter for the items ranged from 1.15 (1.07) in Feelings to 1.73 (1.75) in Walking. The final item banks are comprised of 31–45 items each.ConclusionWe have developed IRT-based item banks to measure HRQL in 5 domains relevant to arthritis. The items in the final item banks provide adequate psychometric information for a wide range of functional levels in each domain.

The effects of reflexology on foot pain and quality of life in a patient with rheumatoid arthritis: A case report

The purpose of this work was to identify what effect reflexology has on foot pain and quality of life (QoL) in a patient with rheumatoid arthritis (RA). Using an observational case report, a 6-week course of reflexology treatments were given to a patient who has RA. Perceived pain and QoL were assessed using two validated outcome measures: the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire and the Foot Pain Disability Questionnaire (FPDQ). The RAQoL scores demonstrated no significant change throughout the duration of the investigation, suggesting that the patient's QoL did not change during or at the end of the 6-week course of reflexology. Scores from the FPDQ indicated reflexology was associated with a reduction in foot pain described by the subject. The clinical implications are that reflexology may be a valuable addition in the management of foot pain for participants with RA. However, it is impossible to generalize from a observational case report and further work is recommended.

The Rheumatoid Arthritis Quality of Life (RAQoL) for Sweden: adaptation and validation

Objective: To produce and evaluate the official Swedish language version of the Rheumatoid Arthritis Quality of Life instrument (RAQoL).Methods: The UK RAQoL was translated into Swedish by a bilingual translation panel. A separate lay panel was conducted to consider the appropriateness and comprehensibility of the items in Swedish. Interviews were conducted with 15 Swedish RA patients to assess face and content validity. Responses to a postal survey were used to calculate reproducibility and construct validity.Results: Few difficulties arose in the translation process and the new language version was well received by the lay panel and field‐test participants. One hundred and sixty‐five RA patients participated in the postal survey (69% female; mean age 62.7 years, SD 11.3, RA duration range 1–62 years). Cronbach’s α for the Swedish RAQoL was 0.91 and test–retest reliability was 0.95, indicating that the instrument has adequate inter‐relatedness of items and very low inherent random measurement error. A high correlation with the Health Assessment Questionnaire (HAQ) was observed; this was expected because RA has significant physical manifestations that are in turn a significant determinant of QoL. The Swedish RAQoL was able to distinguish between patients who differed according to their self‐perceived RA severity, general health, and rating of their RA today, in addition to whether or not the patient was experiencing a flare of RA.Conclusions: The official Swedish RAQoL was well received by RA patients. The psychometric quality of the adapted questionnaire means that it is suitable for inclusion in clinical trials involving patients with RA.

Depression and health-related quality of life in patients with rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory musculoskeletal disease with a prevalence rate of 1–3% in Western countries. In addition to limited physical function, rheumatoid arthritis patients also suffer from psychologic comorbidities. Depression in rheumatoid arthritis patients has been linked to disease outcomes such as increased healthcare service utilization and poor adherence to medication. This review focuses on the impact of depression on rheumatoid arthritis patient’s quality of life and how quality of life can be improved through the management of depression. Both generic and disease-specific instruments have been used to assess health-related quality of life in rheumatoid arthritis research. Commonly used instruments include the generic Short Form-36, the Nottingham Health Profile, the disease-specific Arthritis Impact Measurement Scale and the Rheumatoid Arthritis Quality of Life. Studies have shown that depression in rheumatoid arthritis patients may exert an important impact on multiple domains of health-related quality of life. Currently, depression in rheumatoid arthritis has been managed by both psychoeducation and antidepressant treatment. They are generally effective in improving clinical outcomes. However, future studies are needed to clarify whether they can improve patient reported quality of life. As depression is a prevalent comorbidity in rheumatoid arthritis, clinicians should pay more attention to the rheumatoid arthritis patient’s psychologic wellbeing. Screening for depression and other psychologic distress should be recognized as an important process in the routine clinical care of patients with rheumatoid arthritis.

Measuring utilities by the time trade-off method in Tunisian rheumatoid arthritis patients

The objective of this study was to determine the feasibility, reliability and validity of the time trade-off (TTO) in Tunisian rheumatoid arthritis (RA) patients. The TTO was used to measure the utility in 122 RA patients with increasing difficulty in performing activities of daily living. The 1-week test-retest reproducibility was studied in 57 patients using the intraclass correlation coefficient (ICC). Validity was evaluated by comparison with other outcome measures: utility rating scale (RS), quality of life (QOL) [arthritis impact measurement scale 2 (AIMS2), rheumatoid arthritis quality of life (RAQOL)], functional status [health assessment questionnaire (HAQ), Lee index] and disease activity score (DAS). Eight patients (6.6%) did not complete the TTO. The median value of the TTO score was 0.655 (0.019-1.000). The ICC for reliability of the TTO was 0.89 (p<0.001). The TTO showed poor to moderate correlation (Spearman's correlation coefficients between 0.2 and 0.409, p<0.01) with AIMS2, RAQOL, HAQ and Lee index. We did not find any correlation between TTO and DAS. Multiple regression analysis showed that only 32% of TTO scores could be explained. The TTO method appeared to be reliable in a group of Tunisian RA patients, but TTO values were poorly to moderately related to measures of QOL, functional ability, and disease activity. We think that TTO and RS are not feasible for use in RA patients.

Drug-Related Problems and Quality of Life in Arthritis and Low Back Pain Sufferers

Objective The objective of this study was to determine the relationship between drug-related problems (DRPs) and health-related quality-of-life (HRQoL) in ambulatory, community-dwelling patients with musculoskeletal disorders. Methods A 12-month, prospective, observational study was conducted in 12 independent community pharmacies in eastern Iowa. Ambulatory patients with self-reported diagnoses of osteoarthritis, rheumatoid arthritis, or low back pain were invited to participate. During quarterly visits to the pharmacy, patients used touch-screen computers to fill out the Short Form-36 (SF-36) general health survey. Using the results of these point-of-service health status assessments, community pharmacists interviewed patients to assess for DRPs. To examine the influences of different DRP characteristics on HRQoL and controlling for potential confounders, both univariate and multivariate analyses were performed using the change in physical component summary (PCS) score and mental component summary (MCS) score of the SF-36 from baseline to 12 months as the dependent variables. In each regression, the independent variables were those significant variables from the univariate analyses, as well as the types of DRPs and their outcomes. Results A total of 461 patients were enrolled in the study. Through 12 months, 926 cumulative DRPs were identified. Overall regression models were significant for the PCS and MCS scores, respectively. Two types of DRPs showed significant negative associations with change in PCS: wrong drug and needs additional drug therapy. One type of DRP showed significant negative association with change in MCS: needs additional drug therapy. Resolution or improvement in DRPs showed a significant positive correlation with change in MCS but not PCS. Conclusions Two DRPs, needs additional drug therapy and wrong drug, are associated with reduced self-reported physical health in arthritis and low back pain, while the DRP needs additional drug therapy is also associated with reduced self-reported mental health. Resolution of DRPs is associated with improvement in mental health in this cohort.

Measuring health related quality of life in patients with rheumatoid arthritis - reliability, validity, and responsiveness of a Swedish version of RAQoL

Objective: To adapt the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire for Swedish patients and evaluate psychometric properties in a prospective study. Methods: Reliability was assessed in 61 patients filling in RAQoL two times with one week's interval. 114 patients completed RAQoL and Nottingham Health Profile (NHP) on 2-3 occasions 6 months apart. Validity was evaluated comparing RAQoL-scores to disease-related variables and NHP subscales. Standardized response mean was applied to calculate responsiveness with the RA-related variables as external indicators of change. Results: Test-retest reliability was high and internal consistency sufficient. RAQoL correlated as expected to NHP section scores. In a multivariate model the Stanford Health Assessment Questionnaire disability index (HAQ) and general health could explain 40% and disease activity measures 13% of the variance of RAQoL. Correlations between change scores of clinical variables and RAQoL and NHP were weak but positive. Standardized response means regarding change of disease activity, HAQ, and general health were small but in the same range for both RAQoL and NHP. Conclusion: The Swedish RAQoL had similar measurement properties as the original version. However, responsiveness regarding condition specific measures was not better than for the generic instrument NHP.