Combining nurse-led care with patient self-assessment could enhance tight control of rheumatoid arthritis and management of comorbidities

Implications for practice and researchPatient self-monitoring of disease activity can improve tight control of rheumatoid arthritis (RA).Nurse-led care can be used in the monitoring and management of comorbidities associated with RA.Further research should assess wider acceptability, as well as the clinical and cost-effectiveness of a patient self-monitoring approach

Specialist nursing in rheumatology: The state of play

Rheumatology nurse specialist-led care is effective and safe, and leads to higher patient satisfaction rates than in comparable services. Rheumatology nurse specialists are at the forefront of patient care; in addition to their clinical work, they provide emotional support, promote self-management, and lead advice lines. They play an integral role in helping patients address the impact of theircondition on their family and work life. Their value is not only apparent in patient’s clinical outcomes, but is also demonstrable in cost savings. The RCN calculated that outpatient work by rheumatology nurse specialists saves the NHS up to £175,168 per nurse each year in freeing up consultant appointments

Developing a rheumatology team to meet a growing need in Africa: Let’s not forget to feed the cow

In many African countries the burden of preventable communicable diseases such as HIV/AIDS, lower respiratory infections, malaria and diarrhoeal diseases is overwhelming

Online interventions for addressing psychological distress in people with rheumatoid arthritis and other long-term conditions: A systematic review

Psychological distress in rheumatoid arthritis (RA) is significantly higher than the general population and impacts disease activity and treatment outcomes. Online interventions have the potential to reach large numbers of patients. This study aimed to identify online interventions for psychological distress and determine their effectiveness in people with RA and other long-term conditions.https://academic.oup.com/rheumatology/article/57/suppl_3/key075.501/4971403?searchresult=

Assessing glucocorticoid toxicity: Are the measures sensitive enough?

The Glucocorticoid Toxicity Index (GTI) is a composite instrument designed to capture change in glucocorticoid-related morbidity over time.1 It was developed through consensus methods and multi-criteria decisions among 19 medical specialists, with relative domain weights decided via clinician consensus.2 The GTI has now been used in more than 45 studies, including 12 phase 3 clinical trials.1The GTI comprises eight domains: body mass index, blood pressure, glucose tolerance, lipid metabolism, glucocorticoid myopathy, skin toxicity, neuropsychiatric effects and infections. Two overall scores are calculated: the cumulative worsening score (CWS), which includes transient and permanent GC toxicity from baseline to specific time points, and the Aggregate Improvement Score (AIS), which accounts for improvement as well as worsening GC-toxicity.1 In The Lancet Rheumatology, Naomi Patel and colleagues3 present an analysis of domain scores of the GTI using data from the phase 3 ADVOCATE trial.4 In a clinical trial context where the GTI is used to produce repeated measures to demonstrate differences between (and within) groups of patients taking different dosages of glucocorticoids, and to measure the impact of steroid sparing agents, it is expected to have a high level of measurement validity and reliability

PSYCHOMETRIC CHARACTERISTICS OF A SPANISH TRANSLATION OF THE MANCHESTER FOOT PAIN AND DISABILITY INDEX: VALIDATION AND RASCH ANALYSIS

Background: The Manchester Foot Pain and Disability Index (MFPDI) is a self-assessment questionnaire developed in the UK to measure foot pain and disability in the general population1. It has been translated and validated in several languages 2,3 Objectives: The aim of this study was to conduct cross-cultural adaptation and validation of the MFPDI into Spanish Methods: The cross-cultural adaptation process was undertaken using International Society for Pharmacoeconomics and Outcomes Research (ISPOR)4 recommendations. This involved 8 stages: i) Forward translation, ii) Reconciliation, iii) Back translation, iv) Back translation review, v) Harmonisation, vi) Pilot, vii) Pilot review, and viii) Proofreading. In the validation phase, the MFPDI datasets from the UK (original) and Spain (adapted) were pooled and subjected to Rasch analysis. Fit to the Rasch model, unidimensionality, reliability and cross-cultural invariance is reported Results: The pooled dataset comprised 1015 patients (Spain n=333 and UK n=682) with characteristics summarised in Table 1. Rasch analysis confirmed three subscales for both the Spanish and UK datasets and fit to the Rasch model X2 (df) = 15.945 (12), p = 0.194 and 31.024 (21), p = 0.073, for Spain and UK . The reliability (Person Separation Index - PSI) was .85 and .82 for Spain and UK respectively. Significant cross-cultural non-invariance was present on the Functional and Personal appearance subscales. Adjustment for the bias was achieved by ‘splitting’ the affected subscales and creation of cultural-specific subscales for each country and cultural-general subscale. Fit to the Rasch model was satisfied following cross-cultural adjustment (Table 1). The MFPDI was calibrated into interval-level scales for Spain and UK to enable future data pooling or comparisons. Sampl e size Gender Age Item Fit Residual Person Fit Residual Chi Square Interaction PSI Analysis N Female (%) Mean (SD) Mean SD Mean SD Value (df) p Spain 333 248 (74.4) 51.6 (15.2) -0.164 3.07 - 0.364 0.93 15.95 (12) 0.19 0.85 UK 682 416 (61.0) 55.2 (16.7) -0.366 2.80 - 0.429 0.99 31.02 (21) 0.07 0.82 Pooled 1015 663 (65.4) 52.8 (15.8) -0.766 4.40 - 0.441 1.06 49.17 (27) 0.01 0.84 DIFAdjusted -0.420 2.98 - 0.415 0.98 57.94 (45) 0.09 0.84 Table 1: P = Χ2 interaction probability, (non-significant P = Fit to the model), PSI = Person separation index Conclusions: A gold standard translation process (ISPOR) has been used to develop a Spanish (for Spain) version of the MFPDI, a widely used foot-specific patient-reported outcome measure. Rasch analysis has confirmed that the MFPDI is a robust 3-subscale measure of foot pain, function and appearance in both its English and Spanish versions. Future work can make cross-cultural comparisons using the calibrated scale

Rehabilitation provided to patients with rheumatoid arthritis: A comparison of three different rheumatology clinics in Austria, Sweden and the UK from the perspectives of patients and health professionals

© 2015 The Authors. © 2015 Foundation of Rehabilitation Information. Objective: To explore patients' and health professionals' views of outpatient rehabilitation services for patients with rheumatoid arthritis in 3 different rheumatology sites across Europe. Methods: A qualitative multi-method study was conducted with patients and health professionals in Vienna (Austria), Gothenburg (Sweden) and Leeds (UK). Data collection was carried out during focus groups with patients and health professionals. Patients' hospital records were integrated into the analysis. Data were analysed for site and findings were compared across sites. Results: A total of 20 patients and 20 health professionals participated in 12 focus groups. Although the 3 sites were all publicly funded university clinics, there were differences between sites regarding the structure and content of rehabilitation services. The themes that emerged in the focus groups were: referrals; continuity in rehabilitation; information provided to patients; patients' organizations; documentation and communication amongst health professionals; interface between primary and specialist care; and prescription practices. Most themes were addressed at all 3 sites, but there were variations in the specifics within themes. Conclusion: Integration of patients' and health professionals' views on how rehabilitation services are coordinated and how (parts of) processes are set up elsewhere provide valuable information for the further optimization of rehabilitation services

Factors associated with patient activation in inflammatory arthritis: A multisite cross-sectional study

Objectives Patient activation covers the skills, abilities and behaviour that impact how able and willing someone is to take an active role in self-managing their health. This study explored clinical and psychosocial factors associated with patient activation in rheumatology patients. Methods This was a cross-sectional study using postal survey methods. Participants with inflammatory rheumatic conditions were from six rheumatology centres in England. Patient activation was captured using the Patient Activation Measure (PAM). Twenty-nine explanatory factors were tested for potential association with patient activation in univariable and multivariable analyses. In preliminary multivariable analyses, factors found to have an association with patient activation at a P < 0.1 level were entered into the final multivariable model. Those that remained significant at a P < 0.05 level were considered associated with patient activation. Results The sample comprised 251 participants (74% female) with a mean age of 59.31 years (S.D. 12.69), disease duration of 14.48 years (S.D. 12.52) and a PAM score of 58.3 (S.D. 11.46). Of the 29 candidate factors, 25 were entered into a preliminary multivariable analysis. In the final multivariable analysis, four factors (self-efficacy, the illness belief that treatment will control participants' condition and two dimensions of health literacy) were significantly associated with patient activation. This final model accounted for 40.4% of the variance in PAM scores [F(4, 246)= 41.66, P < 0.001]. Conclusions Patient activation is important in managing rheumatic conditions. Our data confirm that self-efficacy and health literacy are particular targets for patient activation interventions

Developing the Korean Educational Needs Assessment Tool (Korean ENAT) in rheumatoid arthritis: Cross-cultural validation using Rasch analysis

Background/aims: This study was performed to undertake cross-cultural adaptation and validation of the Educational Needs Assessment Tool (ENAT) in rheumatoid arthritis (RA) for use in Korea.Methods: The study involved two main phases: cross-cultural adaptation of the ENAT from English into Korean, and validation of the Korean ENAT. The first phase followed the established process of cross-cultural adaptation of self-report measures, and in the second phase, the Korean ENAT data were analyzed using the Rasch measurement model. Fit to the model was determined using the observed data infit and outfit statistics. Additional tests of validity included unidimensionality and internal consistency.Results: Adequate conceptual equivalence was achieved following the adaptation process. A total of 123 patients completed the Korean ENAT. The mean age was 46.7 ± 12.3 years and the majority of patients (81.3%) were female. Thirty-five of the 39 items gave good fit to the model. The four items deviating from the model had infit and outfit > 1.50. The item separation index (5.26) and item reliability index (0.97) provided evidence for good reliability of items. All seven domains of the Korean ENAT fit the Rasch model. The internal consistency of the Korean ENAT was high, and unidimensionality was confirmed (person separation index, 3.41; reliability index, 0.92; item separation index, 16.82; reliability index, 1.00).Conclusions: Using the standard procedure for cross-cultural adaptation, the ENAT has been adapted into Korean, and Rasch analysis has confirmed the construct validity, reliability, and unidimensionality of the Korean ENAT