Elizabeth M Badley

University of Toronto, Toronto, Ontario, Canada

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Publications (196)684.83 Total impact

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    ABSTRACT: Purpose:To determine the impact of lack of government insured routine eye examinations on the incidence of self-reported glaucoma, cataracts and vision loss. Methods:We analyzed data from the Canadian longitudinal National Population Health Survey (1994-2011). White respondents aged 65+ in 1994/1995 were included (n=2618). Three cohorts were established at baseline: those free of glaucoma, cataracts and vision loss (i.e. unable to see close or distance when wearing glasses or contact lenses). Incident cases were identified through self-reporting of these conditions during the follow-up period. Results:The incidence (per 1000 person-years) of glaucoma was lower in uninsured provinces (8.1, 95% confidence interval [CI] 5.5-10.7) than in insured provinces (12.8, 95% CI 10.5-15.1). The incidence of cataracts was also lower in the uninsured (67.2, 95% CI 55.7-78.6) versus insured provinces (75.7, 95% CI 69.2-82.2). The incidence of vision loss was higher in the uninsured (26.6, 95% CI 20.2-33.0) versus insured provinces (22.5, 95% CI 20.0-25.5). Adjusting for confounders, seniors in insured provinces had a 59% increased risk of glaucoma (incidence rate ratio [IRR] 1.59; 95% CI 1.07-2.37), a 13% greater risk of cataracts (IRR 1.13, 95% CI 0.93-1.37) and a 12% reduced risk of vision loss (IRR 0.88, 95% CI 0.67-1.16). Conclusions:Lack of government-funded routine eye examinations is associated with a reduced incidence of self-reported glaucoma and cataracts, likely due to reduced detection. Lack of insurance is also associated with a higher incidence of self-reported vision loss, likely due to poorer access to eye care and late treatment. Copyright © 2014 by Association for Research in Vision and Ophthalmology.
    Investigative Ophthalmology &amp Visual Science 12/2014; · 3.66 Impact Factor
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    ABSTRACT: To explore the perceived consequences of knee symptoms on the lives of people aged 35-65 years who had diagnosed osteoarthritis (OA) or OA-like symptoms.
    BMJ Open 10/2014; 4(10):e006006. · 2.06 Impact Factor
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    ABSTRACT: To examine perceived independence, overprotection, and support, and their association with the employment participation of young adults with rheumatic disease.
    The Journal of Rheumatology 10/2014; · 3.17 Impact Factor
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    ABSTRACT: Background: This multilevel study examines access to rheumatologists for all arthritis and inflammatory arthritis taking into account geographic availability of rheumatologists, access to primary care physicians (PCPs), and population characteristics (e.g. SES).Methods: Analysis of data of the population (18+ years) living in the 105 health planning areas in Ontario, Canada on visits to physicians for arthritis and musculoskeletal disorders. Using data from a survey of rheumatologists and GIS analysis, an index of geographic availability for rheumatologists was calculated incorporating distance between the population and rheumatologist locations and the number of hours per week of rheumatologist’s care. Multilevel Poisson regression was used to examine factors associated with the rates of rheumatology visits for inflammatory arthritis and all arthritis.Results: Controlling for age and sex, the rheumatologist availability index was associated with visit rates for all arthritis but not inflammatory arthritis. Patients living in areas with low access to PCPs or low SES were less likely to have office visits to rheumatologists for all arthritis and inflammatory arthritis.Discussion: Besides potential deficiencies in rheumatology provision, there may be access barriers to rheumatology services particularly for populations with low access to PCPs or low SES. This is of special concern for patients with inflammatory arthritis for whom rheumatologist care is necessary. In developing models of care for arthritis, this study points to the need to pay attention to areas with low PCPs resources and areas of low SES, as well as the location and amount of rheumatology services available. © 2014 American College of Rheumatology.
    Arthritis Care & Research. 07/2014;
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    Mayilee Canizares, Aileen M Davis, Elizabeth M Badley
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    ABSTRACT: To examine the impact of access to primary care physicians (PCPs), geographic availability of orthopaedic surgeons, socioeconomic status (SES), proportion of older population (≥65 years) and proportion of rural population on orthopaedic surgeon office visits and orthopaedic surgery.
    BMJ Open 07/2014; 4(7):e004472. · 2.06 Impact Factor
  • Osteoarthritis and Cartilage 04/2014; 22:S205. · 4.66 Impact Factor
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    ABSTRACT: To estimate systemic autoimmune rheumatic disease (SARD) prevalence across 7 Canadian provinces using population-based administrative data evaluating both regional variations and the effects of age and sex. Using provincial physician billing and hospitalization data, cases of SARD (systemic lupus erythematosus, scleroderma, primary Sjögren syndrome, polymyositis/dermatomyositis) were ascertained. Three case definitions (rheumatology billing, 2-code physician billing, and hospital diagnosis) were combined to derive a SARD prevalence estimate for each province, categorized by age, sex, and rural/urban status. A hierarchical Bayesian latent class regression model was fit to account for the imperfect sensitivity and specificity of each case definition. The model also provided sensitivity estimates of different case definition approaches. Prevalence estimates for overall SARD ranged between 2 and 5 cases per 1000 residents across provinces. Similar demographic trends were evident across provinces, with greater prevalence in women and in persons over 45 years old. SARD prevalence in women over 45 was close to 1%. Overall sensitivity was poor, but estimates for each of the 3 case definitions improved within older populations and were slightly higher for men compared to women. Our results are consistent with previous estimates and other North American findings, and provide results from coast to coast, as well as useful information about the degree of regional and demographic variations that can be seen within a single country. Our work demonstrates the usefulness of using multiple data sources, adjusting for the error in each, and providing estimates of the sensitivity of different case definition approaches.
    The Journal of Rheumatology 03/2014; 41(4). · 3.17 Impact Factor
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    ABSTRACT: The purpose of this study was to profile characteristics of people with traumatic brain injury (TBI) who self-reported arthritis 7 to 24 yr. post-injury. Pre- and post-injury socio-demographic factors, injury-related factors, and postinjury standardized assessments measuring health, activity, and participation outcomes were assessed in a retrospective cohort study of 274 participants. The group self-reporting arthritis had significantly more sleep disturbances, poorer overall health, lower mental health and physical function, and decreased productivity. Also, they were older and reported a shorter length of loss of consciousness from TBI. These resulted suggest that musculoskeletal complaints from long-term survivors of TBI sholud be addressed in post-acute care and could guide future research on arthritis in the TBI population.
    Perceptual and Motor Skills 02/2014; 118(1):274-92. · 0.49 Impact Factor
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    ABSTRACT: Objective: While the prevalence of osteoarthritis (OA) increases with age, the first signs begin in the fourth or fifth decade. Little is known about how younger adults respond to OA. This paper explores how people age 35-65 years manage knee symptoms. Methods: Six focus groups were conducted with 41 participants (mean age 50.9 years; 63% female) who self-reported a diagnosis of OA or reported knee symptoms (i.e. pain, aching or stiffness) on most days of the past month. Purposive sampling was used, seeking variation in age and sex. The principles of constructivist grounded theory guided data collection and analysis. Data were analyzed using a constant comparative method. Results: Participants engaged in a process of proactively trying to find ways to control knee symptoms and disease progression. Their approach to management was not linear, but rather, a process that moved back and forth between searching for "solutions" and active management (ongoing use of strategies). During the process, participants consulted health care providers but often perceived that medical care offered limited options and guidance. Management was constructed as a "never-ending" process that entailed effort and personal resources. Conclusion: Participants were proactive in seeking ways to manage knee OA symptoms. There is a mismatch between participants' proactive approach and the reactive approach of the health care system that has focused on late stage disease. Programs and supports within the formal and informal health care system are required to enable people to successfully manage knee symptoms across the lifespan. © 2013 American College of Rheumatology.
    Arthritis care & research. 01/2014;
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    ABSTRACT: Purpose To examine men and women's perceptions of inter-role balance/imbalance in work, arthritis, and personal roles and its association with demographic, health and employment factors, including job stress, career satisfaction, job disruptions, absenteeism and perceived productivity losses. Methods Participants were employed, aged ≥40 years and diagnosed with osteoarthritis or inflammatory arthritis. They were recruited through community advertising and rheumatology clinics in two Canadian provinces. Respondents completed a 35-45 min telephone interview and a 20-min self-administered questionnaire assessing role perceptions [(arthritis negatively impacts work (A → W); work/personal life negatively impact arthritis (W/P → A); work as a positive role (W +))], demographic, health and work context information. Analyses included exploratory factor analysis and multivariate regressions. Results Findings revealed similarities between men (n = 104) and women (n = 248) in health, work and role perceptions, although women reported more benefits of working with arthritis (W+) than men. Some gender differences were found in factors associated with inter-role perceptions highlighting the importance of children, fatigue, unpredictable work hours, job control, and workplace activity limitations. Role perceptions were associated with work outcomes but only one perception, W/P → A, interacted with gender. Among men, greater perceptions that work and personal demands interfered with managing arthritis were associated with more job disruptions. Conclusions This study revealed negative and positive inter-role perceptions related to working with a chronic illness and associations with work outcomes. It highlights potentially modifiable factors that could assess risk and inform interventions to improve role balance and working experiences.
    Journal of Occupational Rehabilitation 12/2013; 24(3). · 2.80 Impact Factor
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    ABSTRACT: Objectives: To describe the exercise/physical activity and weight management efforts of Canadians with self-reported arthritis; to examine factors associated with their engagement in these strategies to help manage their arthritis; and to explore reasons for lack of engagement. Methods: Data were from the arthritis component of the 2009 Survey on Living with Chronic Diseases in Canada. The responses (78% response rate; n=4,565) were weighted to be representative of Canadians (20+ years) with arthritis. Logistic regression analyses were used to examine factors associated with engaging in exercise/physical activity and weight control/loss (among those overweight/obese) for arthritis management purposes. Results: Individuals with arthritis were mostly female(63%), aged >45 years(89%), overweight/obese(67%), married(68%), white (87%) with post-secondary education(69%). Sixty-three percent were exercising and of those who were overweight or obese, 68% were trying to control/lose weight; only 46% were engaged in both. Having received a clinical recommendation was the factor associated most strongly with engaging in exercise/physical activity and/or controlling/losing weight. The most common reason for not exercising was a co-existing health condition/problem(22%), while the most common reason for not controlling/losing weight among those who were overweight/obese was that it was felt not to be necessary(51%). Conclusions: The provision of clinical recommendations from a health professional, providing advice on safe and suitable exercises/physical activities as well as addressing misperceptions of need to lose weight among the overweight and obese may facilitate engagement in these health behaviours and ultimately, reduce the consequences of arthritis. © 2013 American College of Rheumatology.
    Arthritis care & research. 07/2013;
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    ABSTRACT: OBJECTIVE: Total hip (THR) and knee (TKR) replacements increasingly are performed on younger people making return to work a salient outcome. This research evaluates characteristics of individuals with early and later return to work following THR and TKR. Additionally, at work limitations pre-surgery and upon returning to work, and factors associated with work limitations were evaluated. METHODS: 190 THR and 170 TKR of a total 931 cohort participants were eligible (i.e., working or on short-term disability pre-surgery).They completed questionnaires pre-surgery and one, three, six and twelve months post-surgery that included demographics, type of occupation, and the Workplace Activity Limitations Scale (WALS). RESULTS: 166 (87%) and 144 (85%) returned to work by twelve months following THR and TKR, respectively. Early (one month) return to work was associated with, male gender, university education, working in business, finance or administration, and low physical demand work. People with THR returned to work earlier than those with TKR. For both groups, less pain and everyday functional limitations were associated with less workplace activity limitations at the time return to work. CONCLUSIONS: The majority of individuals working prior to surgery return to work following hip or knee replacement for OA and experience fewer limitations at work than pre-surgery. The changing workforce dynamics and trends toward surgery at younger ages mean that these are important outcomes for clinicians to assess. Additionally, this is important information for employers in understanding continued participation in employment for people with OA.
    Osteoarthritis and Cartilage 06/2013; · 4.26 Impact Factor
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    ABSTRACT: This population-based cohort study has the objective to understand the sociodemographic characteristics and health conditions of patients who do not receive surgery within 18 months following an ambulatory visit to an orthopaedic surgeon. Administrative healthcare databases in Ontario, Canada were linked to identify all patients making an initial ambulatory visit to orthopaedic surgeons between October 1(st), 2004 and September 30(th), 2005. Logistic regression was used to examine predictors of not receiving surgery within 18 months. Of the 477,945 patients in the cohort 49% visited orthopaedic surgeons for injury, and 24% for arthritis. Overall, 79.3% did not receive surgery within 18 months of the initial visit, which varied somewhat by diagnosis at first visit (84.5% for injury and 73.0% for arthritis) with highest proportions in the 0-24 and 25-44 age groups. The distribution by income quintile of patients visiting was skewed towards higher incomes. Regression analysis for each diagnostic group showed that younger patients were significantly more likely to be non-surgical than those aged 65+ years (age 0-24: OR 3.45 95%CI 3.33-3.57; age 25-44: OR 1.30 95%CI 1.27-1.33). The odds of not getting surgery were significantly higher for women than men for injury and other conditions; the opposite was true for arthritis and bone conditions. A substantial proportion of referrals were for expert diagnosis or advice on management and treatment. The findings also suggest socioeconomic inequalities in access to orthopaedic care. Further research is needed to investigate whether the high caseload of non-surgical cases affects waiting times to see a surgeon. This paper contributes to the development of evidence-based strategies to streamline access to surgery, and to develop models of care for non-surgical patients to optimize the use of scarce orthopaedic surgeon resources and to enhance the management of musculoskeletal disorders across the care continuum.
    PLoS ONE 06/2013; 8(6):e65560. · 3.53 Impact Factor
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    ABSTRACT: Objective To compare the incidence and progression of radiographic osteoarthritis (OA) in the knee and hip among African Americans and whites. Methods Using the joint as the unit of analysis, we analyzed data from the Johnston County Osteoarthritis Project, a population-based prospective cohort study in rural North Carolina. Baseline and followup assessments were 3–13 years apart. Assessments included standard knee and hip radiographs read for Kellgren/Lawrence (K/L) radiographic grade. Weighted analyses controlled for age, sex, body mass index, level of education, and baseline K/L grade; bootstrap methods adjusted for lack of independence between left and right joints. Time-to-event analysis was used to analyze the data. ResultsFor radiographic knee OA, being African American had no association with incidence (adjusted hazard ratio [HRadj] 0.80, 95% confidence interval [95% CI] 0.53–1.22), but had a positive association with progression (HRadj 1.67, 95% CI 1.05–2.67). For radiographic hip OA, African Americans had a significantly lower incidence (HRadj 0.44, 95% CI 0.27–0.71), whereas the association with progression was positive but nonsignificant (HRadj 1.46, 95% CI 0.53–4.01). In sensitivity analyses, the association with hip OA incidence was robust to a wide range of assumptions. Conclusion African Americans are protected against incident hip OA, but may be more susceptible to progressive knee OA.
    Arthritis Care & Research. 06/2013; 65(6).
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    ABSTRACT: OBJECTIVES: To develop a paper-and-pencil semi-adaptive test for 5 domains of health-related quality of life (PAT-5D-QOL) based on item response theory (IRT). METHODS: The questionnaire uses items from previously developed item banks for 5 domains: (1) walking, (2) handling objects, (3) daily activities, (4) pain or discomfort, and (5) feelings. For each domain, respondents are initially classified into 4 functional levels. Depending on the level, they are instructed to respond to a different set of 5 additional questions. IRT scores for each domain and overall health utility scores are obtained using a simple spreadsheet. The questions were selected using psychometric and conceptual criteria. The format of the questionnaire was developed through focus groups and cognitive interviews. Feasibility was tested in two population surveys. A simulation study was conducted to compare PAT-5D-QOL with a computerized adaptive test (CAT-5D-QOL) and a fixed questionnaire, developed from the same item banks, in terms of accuracy, bias, precision, and ceiling and floor effects. RESULTS: Close to 90 % of the participants in feasibility studies followed the skip instructions properly. In a simulation study, scores on PAT-5D-QOL for all domains tended to be more accurate, more precise, less biased, and less affected by a ceiling effect than scores on a fixed IRT-based questionnaire of the same length. PAT-5D-QOL was slightly inferior to a fully adaptive instrument. CONCLUSIONS: PAT-5D-QOL is a novel, semi-adaptive, IRT-based measure of health-related quality of life with a broad range of potential applications.
    Quality of Life Research 05/2013; · 2.86 Impact Factor
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    Lauren Churcher, Christina H Chan, Elizabeth M Badley
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    ABSTRACT: BACKGROUND: Back problems and arthritis are common chronic conditions, while having back problems is a frequent reason for lost work time. The objective of this study was to investigate employment status amongst individuals who report having both back problems and arthritis, compared to having either condition alone. METHODS: We analyzed data from the 2007/2008 Canadian Community Health Survey (ages 25--64, n = 79,719). Respondents who reported neither having worked in the past 12 months nor the past week were coded as not currently employed. Those reported being permanently unable to work were considered to be out of the labor force. Log-Poisson regressions, adjusting for socio-demographic and lifestyle factors, were used to estimate risks for being not currently employed or being out of the labor force for 5 mutually exclusive groups of chronic conditions: arthritis and back problems, back problems, arthritis, any other chronic conditions, and no chronic conditions. RESULTS: 12.7% of respondents reported being not currently employed and 2.9% being out of the labor force. 5.8% of respondents reported both arthritis and back problems, while 16.1% reported back problems and 7.3% arthritis. The back problems and arthritis group had the highest risk of not being currently employed. The risk was higher for men (PR = 1.90; 95% CI = 1.58, 2.29) than for women (PR = 1.31; 95% CI = 1.18, 1.46). Risks of being permanently unable to work were also the greatest for those with comorbid back problems and arthritis. CONCLUSIONS: There is a need for a reappraisal of back problems as a cause of work disability to account for the possibility of co-occurring arthritis.
    BMC Public Health 04/2013; 13(1):326. · 2.32 Impact Factor
  • Osteoarthritis and Cartilage 04/2013; 21:S159-S160. · 4.66 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate patient predictors of 'good outcome' following total joint arthroplasty (TJA). METHODS: A population cohort with hip/knee arthritis (osteoarthritis, OA; inflammatory arthritis, IA) aged 55+ years was recruited (1996-98; baseline) and assessed annually (demographics, troublesome joints, health status and overall hip/knee arthritis severity [WOMAC]). Survey data were linked with administrative databases to identify primary TJAs. Good outcome was defined as a WOMAC summary score improvement ≥ the Minimal Important Difference (MID = 0.5 SD mean change). Logistic regression and Akaike's Information Criterion determined the optimal number of predictors and the best model of that size. Log Poisson regression determined relative risk for good outcome. RESULTS: 202 individuals received a primary TJA (mean age 71.0 years; 79.7% female; 82.7% > 1 troublesome hip/knee; 65.8% knee replacement). Mean WOMAC summary score improvement was 10.2 points (SD 18.05 = MID 9 points). 53.5% experienced a good outcome. Four predictors were optimal; the best four-variable model included pre-TJA WOMAC, comorbidity, number of joints, and arthritis type (c-statistic 0.80). The probability of a good outcome was greater with worse (higher) pre-TJA WOMAC summary scores (adjusted RR 1.32 per 10-point increase, p<0.0001), fewer troublesome hips/knees (adjusted RR 0.82 per joint, p=0.002), OA (adjusted RR for RA 0.33, p=0.009), and fewer comorbidities (adjusted RR per condition 0.88, p=0.01). CONCLUSIONS: In an OA cohort with high prevalence of multiple troublesome joints and comorbidity, only half achieved a good TJA outcome, defined as improved pain and disability. A more comprehensive assessment of the benefits and risks of TJA is warranted. © 2013 American College of Rheumatology.
    Arthritis & Rheumatology 03/2013; 65(5). · 7.48 Impact Factor
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    ABSTRACT: OBJECTIVE: Research points to many potential benefits of physical activity (PA) for those with arthritis. However, PA has not typically been examined within the context of other life roles. This paper examines perceptions of PA among individuals managing arthritis in addition to employment and other role demands. METHODS: Eight focus groups were conducted with 24 women and 16 men (29-72 years) who were currently or recently employed (within 2 years) and had osteoarthritis or inflammatory arthritis. Participants were recruited from community newspaper advertisements, rheumatology clinics and arthritis groups. Discussions were audiotaped and transcribed. Transcripts were analyzed using qualitative content analysis. RESULTS: All groups discussed the impact of arthritis on a range of physical activities. Overall, participants discussed PA as positively influencing their health and well-being. Yet, several overarching themes highlighted the complexity of PA, including: 1) PA as a potential cause of arthritis; 2) the reciprocal impact of arthritis on PA and PA on arthritis; 3) physical and psychological benefits and harms of PA like difficulty making PA decisions when living in pain or when faced with episodic symptoms; (4) perceived choices about engagement in PA (e.g., role overload); and (5) social support. CONCLUSIONS: The relationships amongst work, health, and other roles were complex. Competing demands, pain, energy, episodic symptoms, support, and decisions to disclose one's illness at work influenced physical activity. Changes to PA not only affected physical health but also people's self-identity. PA interventions may be improved by taking into account the demands of multiple life roles.
    Arthritis care & research. 01/2013;
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    ABSTRACT: OBJECTIVE: Osteoarthritis is acknowledged as an enduring condition, however, in epidemiological studies, half the participants who report having osteoarthritis at one time may report not having it at a subsequent time. The aim of this study was to examine whether variations in reporting doctor-diagnosed osteoarthritis reflected concurrent fluctuations in indicators of disease severity in mid-age women. METHODS: Data were from 7,623 participants (aged 50-55 years in 2001) in the Australian Longitudinal Study on Women's Health. Based on self-report of doctor-diagnosed osteoarthritis at surveys in 2001, 2004, 2007 and 2010, the participants were classified according to pattern of osteoarthritis reporting (e.g. 0-0-0-0='no' on all surveys, 0-1-0-1='no-yes-no-yes'). Indicators of disease severity included frequency of joint pain/stiffness, use of anti-inflammatory medications, and physical functioning assessed with the SF-36. Bar graphs were used to show concurrent variations in osteoarthritis and markers, and associations were examined using log-linear models. RESULTS: In this sample, 46% reported having osteoarthritis on at least one survey, with half these cases reporting not having osteoarthritis at a later survey. Odds of reporting joint pain/stiffness often (odds ratio (OR) 7.26, 95% confidence interval (CI) 7.06-7.47) and using anti-inflammatory drugs (OR 4.44, CI 2.37-8.33) were higher, and physical functioning scores were lower (OR 3.75, CI 3.56-3.95) when participants reported having osteoarthritis. CONCLUSION: Variations in reporting osteoarthritis coincided with episodic fluctuations in symptoms and functioning. Inconsistent reporting of osteoarthritis could therefore reflect presence of symptoms rather than reporting error and should be considered in longitudinal studies. © 2012 by the American College of Rheumatology.
    Arthritis care & research. 12/2012; 65(6).

Publication Stats

4k Citations
684.83 Total Impact Points

Institutions

  • 1992–2014
    • University of Toronto
      • • Institute for Clinical Evaluative Sciences
      • • Institute of Health Policy, Management and Evaluation
      • • Faculty of Medicine
      • • Department of Family and Community Medicine
      • • Department of Medicine
      Toronto, Ontario, Canada
  • 2000–2013
    • University Health Network
      • • Division of Healthcare and Outcomes Research
      • • Arthritis and Immune Disorder Research Center
      Toronto, Ontario, Canada
  • 2011
    • The Arthritis Society
      Toronto, Ontario, Canada
  • 2007–2011
    • University of British Columbia - Vancouver
      • School of Population and Public Health
      Vancouver, British Columbia, Canada
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 2009
    • Women's College Hospital
      Toronto, Ontario, Canada
  • 2008
    • Federal University of Minas Gerais
      Cidade de Minas, Minas Gerais, Brazil
  • 2006
    • Leiden University Medical Centre
      • Department of Rheumatology
      Leiden, South Holland, Netherlands
  • 2004
    • SickKids
      • Department of Rehabilitation Services
      Toronto, Ontario, Canada
  • 2003
    • Sunnybrook Health Sciences Centre
      Toronto, Ontario, Canada
    • Toronto Rehabilitation Institute
      Toronto, Ontario, Canada
  • 2002
    • Population Health Research Institute
      Hamilton, Ontario, Canada
  • 2001
    • The Princess Margaret Hospital
      Toronto, Ontario, Canada
  • 1999
    • Mount Sinai Hospital, Toronto
      Toronto, Ontario, Canada
    • Arthritis Research Centre of Canada
      Richmond, British Columbia, Canada
  • 1996
    • University of Oxford
      • Department of Primary Care Health Sciences
      Oxford, ENG, United Kingdom
  • 1991–1993
    • Newton-Wellesley Hospital
      Boston, Massachusetts, United States
    • The University of Manchester
      Manchester, England, United Kingdom