[Show abstract][Hide abstract] ABSTRACT: Objective:
To assess the current state of reporting of pain outcomes in Cochrane reviews on chronic musculoskeletal painful conditions and to elicit opinions of patients, healthcare practitioners, and methodologists on presenting pain outcomes to patients, clinicians, and policymakers.
We identified all reviews in the Cochrane Library of chronic musculoskeletal pain conditions from Cochrane review groups (Back, Musculoskeletal, and Pain, Palliative, and Supportive Care) that contained a summary of findings (SoF) table. We extracted data on reported pain domains and instruments and conducted a survey and interviews on considerations for SoF tables (e.g., pain domains, presentation of results).
Fifty-seven SoF tables in 133 Cochrane reviews were eligible. SoF tables reported pain in 56/57, with all presenting results for pain intensity (20 different outcome instruments), pain interference in 8 SoF tables (5 different outcome instruments), and pain frequency in 1 multiple domain instrument. Other domains like pain quality or pain affect were not reported. From the survey and interviews [response rate 80% (36/45)], we derived 4 themes for a future research agenda: pain domains, considerations for assessing truth, discrimination, and feasibility; clinically important thresholds for responder analyses and presenting results; and establishing hierarchies of outcome instruments.
There is a lack of standardization in the domains of pain selected and the manner that pain outcomes are reported in SoF tables, hampering efforts to synthesize evidence. Future research should focus on the themes identified, building partnerships to achieve consensus and develop guidance on best practices for reporting pain outcomes.
The Journal of Rheumatology 10/2015; DOI:10.3899/jrheum.141423) · 3.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives:
This study sought to: (i) explore the impact of mood disorders (such as depression, bipolar disorder, mania, or dysthymia) and five age-related chronic physical conditions (arthritis, back pain, diabetes, heart disease, and hypertension) on presenteeism (as indicated by self-reported activity limitations at work), and (ii) examine how mood disorders interact with each physical condition to affect this work outcome.
Using Canadian Community Health Survey (CCHS) data, we modeled the relationships between self-reported restrictions at work and each health condition. We then calculated synergy indices (SI) for the interaction between mood disorders and each of the five physical conditions.
All six health conditions were associated with presenteeism. The strongest association was observed for back pain [prevalence ratio (PR) 2.70, 95% confidence interval (95% CI) 2.57-2.83] and the weakest for hypertension (PR 1.18, 95% CI 1.11-1.25). The unadjusted SI indicated no interactions between mood disorders and any of the physical conditions, while the adjusted SI indicated statistically significant interactions between mood disorders and each of the five physical conditions. The statistically significant adjusted interactions were in a negative direction, such that having a mood disorder concurrent with a chronic physical condition was associated with a lower burden of presenteeism than expected. Post-hoc analyses revealed that this unexpected finding was attributable to adjustment for other co-morbid health conditions, particularly arthritis and back pain.
Our results suggest that targeting chronic physical conditions or mood disorders may be productive in reducing presenteeism. The combined effect on presenteeism when the two types of conditions occur simultaneously is similar to the additive effect of these conditions when each occurs in isolation.
Scandinavian Journal of Work, Environment & Health 09/2015; DOI:10.5271/sjweh.3524 · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
Systematic reviews often struggle with how to combine information when more than 1 instrument is used across studies being synthesized. Different techniques have been suggested based on frequency of use in the literature, or on consensus. We explore an approach blending 2 initiatives: OMERACT (Outcome Measurement in Rheumatology) and COSMIN (Consensus On Selection of Measurement Instruments), and investigate the effects of an evidence-based measurement approach on selection of outcomes.
Readings were circulated to attendees registered for a preconference workshop on pain measurement. Three instruments were considered and exercises conducted to engage people in the content and measurement performance of these tools. Consensus was sought that an evidence-based approach could be created for selection of instruments for summary of findings (SoF) tables.
The blending of COSMIN and OMERACT approaches led to an evidence-based approach that depended both on a clear definition of target concept and a review of measurement performance of the instrument. Participants emphasized that conceptual clarity and practical considerations should come before measurement property results.
Evidence-based approaches can be adopted for selection of instruments for SoF tables. A research agenda was formulated.
The Journal of Rheumatology 09/2015; DOI:10.3899/jrheum.141446 · 3.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Indicators of work role functioning (being at work, and being productive while at work) are important outcomes for persons with arthritis. As the worker productivity working group at OMERACT (Outcome Measures in Rheumatology), we sought to provide an evidence base for consensus on standardized instruments to measure worker productivity [both absenteeism and at-work productivity (presenteeism) as well as critical contextual factors].
Literature reviews and primary studies were done and reported to the OMERACT 12 (2014) meeting to build the OMERACT Filter 2.0 evidence for worker productivity outcome measurement instruments. Contextual factor domains that could have an effect on scores on worker productivity instruments were identified by nominal group techniques, and strength of influence was further assessed by literature review.
At OMERACT 9 (2008), we identified 6 candidate measures of absenteeism, which received 94% endorsement at the plenary vote. At OMERACT 11 (2012) we received over the required minimum vote of 70% for endorsement of 2 at-work productivity loss measures. During OMERACT 12 (2014), out of 4 measures of at-work productivity loss, 3 (1 global; 2 multiitem) received support as having passed the OMERACT Filter with over 70% of the plenary vote. In addition, 3 contextual factor domains received a 95% vote to explore their validity as core contextual factors: nature of work, work accommodation, and workplace support.
Our current recommendations for at-work productivity loss measures are: WALS (Workplace Activity Limitations Scale), WLQ PDmod (Work Limitations Questionnaire with modified physical demands scale), WAI (Work Ability Index), WPS (Arthritis-specific Work Productivity Survey), and WPAI (Work Productivity and Activity Impairment Questionnaire). Our future research focus will shift to confirming core contextual factors to consider in the measurement of worker productivity.
The Journal of Rheumatology 09/2015; DOI:10.3899/jrheum.141077 · 3.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We examined fracture patients' understanding of "high" fracture risk after they were screened through a post-fracture secondary prevention program and educated about their risk verbally, numerically, and graphically. Our findings suggest that messages about fracture risk are confusing to patients and need to be modified to better suit patients' needs.
The aim of this study was to examine fracture patients' understanding of high risk for future fracture.
We conducted an in-depth qualitative study in patients who were high risk for future fracture. Patients were screened through the Osteoporosis Exemplary Care Program where they were educated about fracture risk: verbally told they were "high risk" for future fracture, given a numerical prompt that they had a >20 % chance of future fracture over the next 10 years, and given a visual graph highlighting the "high risk" segment. This information about fracture risk was also relayed to patients' primary care physicians (PCPs) and specialists. Participants were interviewed at baseline (within six months of fracture) and follow-up (after visit with a PCP and/or specialist) and asked to recall their understanding of risk and whether it applied to them.
We recruited 27 patients (20 females, 7 males) aged 51-87 years old. Fractures were sustained at the wrist (n = 7), hip (n = 7), vertebrae (n = 2), and multiple or other locations (n = 11). While most participants recalled they had been labeled as "high risk" (verbal cue), most were unable to correctly recall the other elements of risk (numerical, graphical). Further, approximately half of the patients who recalled they were high risk did not believe that high risk applied, or had meaning, to them. Participants also had difficulty explaining what they were at risk for.
Our results suggest that health care providers' messages about fracture risk are confusing to patients and that these messages need to be modified to better suit patients' needs.
Osteoporosis International 06/2015; DOI:10.1007/s00198-015-3214-y · 4.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Prior to the Outcome Measures in Rheumatology (OMERACT) 12 meeting in Budapest, Hungary, a workshop was held bringing together individuals from a number of international outcome measure organizations to assess how best to further develop consensus on how pain is conceptualized and measured in trials of musculoskeletal conditions, and how the trials should be reported in systematic reviews.
The Journal of Rheumatology 02/2015; DOI:10.3899/jrheum.141430 · 3.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Prior to the Outcome Measures in Rheumatology (OMERACT) 12 meeting in Budapest, Hungary, a workshop was held bringing together individuals from a number of international outcome measure organizations to assess how best to further develop consensus on how pain is conceptualized and measured in trials of musculoskeletal conditions, and how the trials should be reported in systematic reviews. (J Rheumatol First Release Feb 1 2015; doi:10.3899/jrheum.141430) Key Indexing Terms: PAIN MEASUREMENT CHRONIC PAIN OUTCOMES RESEARCH SYSTEMATIC REVIEW Prior to the Outcome Measures in Rheumatology (OMERACT) 12 meeting in Budapest, Hungary, in May 2014, a workshop of 42 individuals was held to assess how best to move toward developing consensus on how pain is conceptualized and measured in trials of musculoskeletal (MSK) conditions, and how the trials should be reported in systematic reviews. The workshop included clinicians, patients, and researchers from 9 countries in the Americas, Australasia, and Europe, from 7 organizations representing the Cochrane Collaboration (6 Cochrane subgroups/entities), COMET (Core Outcome Measures in Effec tiveness Trials), COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments), GRADE (Grading of Recommendations Assessment, Development, and Evalu -ation), IMMPACT/ACTTION (Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials/Anal -gesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks), OMERACT, and VAPAIN (Validation and Application of a core set of patient-relevant outcome domains to assess the effec-tiveness of multimodal pain therapy). David Tovey, editor-in-chief of The Cochrane Library, noted that Cochrane Systematic Reviews aim to provide trustworthy and interpretable estimates of what works in health and healthcare. Identifying the proper research question using a formulation based on the P (Population), I (Intervention), C (Comparator), and O (Outcomes) frame -work is a critical first step. The aim of a review focused on treatment is to determine whether, for a given comparison and outcome, there is any effect/difference, the direction of any effect, and the degree of certainty that the calculated
The Journal of Rheumatology 02/2015; 42. DOI:10.3899/jrheum.141430) · 3.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
To examine perceived independence, overprotection, and support, and their association with the employment participation of young adults with rheumatic disease.
One hundred and forty-three young adults, ages 18 to 30 years, with systemic lupus erythematosus (54.5%) and juvenile arthritis (45.5%) completed a 30-min online questionnaire of their work and education experiences. Information collected was demographic, health (e.g., pain, fatigue, disease activity), work context (e.g., career satisfaction, helpfulness of job accommodation/benefits, and workplace activity limitations), and psychosocial (e.g., independence, social support, and overprotection). Log-Poisson regression analysis examined factors associated with employment status.
Over half of respondents were employed (59%) and 26% were enrolled in school. Respondents reported moderate to high perceptions of independence and social support. However, 27% reported that "quite a bit" to "a great deal" of overprotection characterized their relationships with those closest to them. At the bivariate level, employed participants and those indicating greater perceived independence reported greater social support and less overprotection. Multivariable analysis revealed that being employed was associated with older age, more job accommodations/benefits perceived as being helpful, and greater perceived independence.
This is one of the first studies examining the employment of young adults with rheumatic diseases. Findings highlight the importance of psychosocial perceptions such as independence and overprotection, in addition to support related to working. Additional research is needed to better understand the role of those close to young adults with rheumatic diseases in supporting independence and encouraging employment.
The Journal of Rheumatology 10/2014; 41(12). DOI:10.3899/jrheum.140419 · 3.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Workforce health is capturing increased attention as a critical driver of the economy. An important demographic trend that will affect worker health and work disability is aging of the workforce. While the number of aging workers wanting or needing to return to work or stay at work after injury or chronic disease is increasing, knowledge on their specific needs and circumstances has not been summarized in a systematic way. The increasing aging working population will necessitate an understanding of efforts to prevent work disability among aging workers. Therefore, we have undertaken a review to synthesize the evidence on the effectiveness of interventions aimed at preventing poor outcome in aging workers and synthesize the literature on what determines risk of poor outcome in aging workers.
3rd WDPI Conference: Implementing Work Disability Prevention Knowledge, Hyatt Regency Hotel, Toronto Canada; 10/2014
[Show abstract][Hide abstract] ABSTRACT: Background Improved appreciation of recovery profiles of sensory and motor function as well as complex motor functions (prehension) after cervical spinal cord injury (SCI) will be essential to inform clinical studies to consider primary and secondary outcome measures for interventions and the optimization of dosing and timing of therapies in acute and chronic SCI. Objectives (1) To define the sensory, motor, and prehension recovery profiles of the upper limb and hand in acute cervical SCI and (2) to confirm the impact of AIS severity and conversion on upper limb sensorimotor recovery. Methods An observational longitudinal cohort study consisting of serial testing of 53 patients with acute cervical SCI was conducted. International Standards of Neurological Classification of Spinal Cord Injury, Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), Capabilities of Upper Extremity (CUE-Q) Questionnaire, and Spinal Cord Independence Measure III (SCIM-III) were administered at 0-10 days, 1, 3, 6, and 12 months. Analysis Change over time was plotted using mean and standard deviation of the total and subgroups of the sample. Results Individuals with traumatic tetraplegia show distinct patterns of recovery. Factors that distinguish homogeneous subgroups of the sample are: severity of injury (level of injury, completeness) at baseline and conversion from a complete to an incomplete injury. Conclusions In cervical SCI, clinical recovery can be assessed using standardized measures that distinguish levels of activity and impairment. Specific recovery profiles of the upper limb over the 1-year timecourse provide new insights and opportunity for combined analysis of recovery profiles for different clinical assessment tools of upper limb function which are meaningful to inform the design of study protocols.
The journal of spinal cord medicine 09/2014; 37(5):503-510. DOI:10.1179/2045772314Y.0000000252 · 1.33 Impact Factor