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F Wolfe

Publications and source records attributed to F Wolfe.

At least 55 records · Page 3Linked to original sources
PubMed2000

Measuring the epidemiology of distress: the rheumatology distress index.

OBJECTIVES: (1) To examine clinical and psychological variables to determine which are associated with psychologic and psychosocial severity or "distress"; (2) to investigate whether patients with the 2 major rheumatic disorders, rheumatoid arthritis (RA) and osteoarthritis (OA), differ in distress variables and distress; and (3) to develop and validate a simple, clinically acceptable index of distress suitable for routine care and research purposes. METHODS: A total of 2,403 patients were evaluated in 2 data sets (N = 1,399 and N = 1,490). The first data set was evaluated in the clinic by a routine clinical examination and administration of the Clinical Health Assessment Questionnaire (CLINHAQ). This instrument includes measures of pain, global severity, functional disability, anxiety, depression, sleep disturbance, fatigue, health satisfaction, and health status. The second data set was evaluated by a mailed questionnaire that included the CLINHAQ, but also coping scales, the Beliefs in Pain Control Questionnaire, the Self Performance Scale, and the Arthritis Helplessness Index. RESULTS: RA and OA groups had similar scores for the variables associated with distress: pain, global severity, functional disability, anxiety, depression, sleep disturbance, fatigue, health satisfaction, and health status. Patients with fibromyalgia (FM) had more abnormal scores for every variable, reflecting overall distress. Using patients with FM as a "gold standard" of distress, we developed an index in data set 2. the Rheumatology Distress Index (RDI), made up of 5 variables, anxiety, depression, global severity, fatigue, and sleep disturbance, that best identified patients with FM compared to other patients. We then validated the instrument on the distress severity clusters formed in data set 1. The correlation between RDI and distress severity cluster was 0.874 with all patients considered and 0.867 with FM patients excluded. In addition, RDI predicted 1,174 of 1,399 (83.9%) cluster memberships correctly. Compared with a battery of psychological and clinical tests that classified 74% of FM and non-FM patients correctly, the RDI and is only slightly less effective, classifying 70.3% correctly. CONCLUSION: Distress is a patient rather than a disease phenomenon. A simple, easy to administer self-report questionnaire can be used to classify patients according to their level of distress. The resulting index, the RDI. accurately identifies distressed and non-distressed patients. Such an index should be useful for patient care and research.

Aged↗
PubMed2000

Assessing radiographic status of rheumatoid arthritis: introduction of a short erosion scale.

OBJECTIVE: Although radiographs are an important marker of rheumatoid arthritis severity, no valid simple scoring method exists. Current scoring systems are cumbersome, difficult to learn, time consuming, and suitable only for experts. In addition, there is no "gold standard" for radiographic severity, so that it is impossible for the clinician, trialist, or researcher to place patients' scores along a continuum of radiographic severity. We investigated the scoring and scaling properties of radiographs read by the Larsen method, and we developed a shortened scale that can be placed in the perspective of a linear severity continuum. METHODS: A total of 3,538 paired hand radiographs obtained over a 24 year period were read by Larsen method and evaluated by Rasch analysis. By iterative methods the number of joints was reduced so that proper fitting, scaling, and dimensionality were obtained. The shortened scale was then tested against the full Larsen scale to determine its ability to detect radiographic progression. RESULTS: A scale consisting of 6 joints on each hand (3 wrist areas and 3 metacarpophalangeal joints) performed as well as the full 28 joint Larsen score, and had improved fit and scaling properties. This Short Erosion Scale (SES) also performed as well as the Larsen score in measuring radiographic progression as measured by comparative effect sizes. In addition, a nomogram was developed to translate SES scores into radiographic severity scores according to a Rasch logit scale. CONCLUSION: We developed a Short Erosion Scale by reducing the number of joints evaluated in the Larsen method from 28 to 12. The scale is at least as sensitive in detecting change as the full Larsen scale. SES fits the Rasch model and is hierarchical and generally well spaced. Graphs and nomograms are available so that intrinsic radiographic severity can be documented. This scale is suitable for use in clinical practice and observational studies, and may be appropriate for clinical trials as well.

Arthritis, Rheumatoid↗
PubMed1999

Toward a multidimensional Health Assessment Questionnaire (MDHAQ): assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format.

OBJECTIVE: To develop components of a multidimensional Health Assessment Questionnaire (MDHAQ) through the addition of new items in the "patient-friendly" HAQ format, including advanced activities of daily living (ADL), designed to overcome "floor effects" of the HAQ and modified HAQ (MHAQ) in which patients may report normal scores although they experience meaningful functional limitations, and psychological items, designed to screen efficiently for psychological distress in routine care. METHODS: The new MDHAQ items, as well as scales for pain, fatigue, helplessness, and global health status on a 2-page questionnaire, were completed by 688 consecutive patients with various rheumatic diseases, including 162 with rheumatoid arthritis (RA), 114 with fibromyalgia, 63 with osteoarthritis, 34 with systemic lupus erythematosus, 20 with vasculitis, 18 with psoriatic arthritis, 16 with scleroderma, and 261 with various other rheumatic diseases, over 2 years at a weekly academic rheumatology clinic. RESULTS: The new MDHAQ items have good test-retest reliability and face validity. MHAQ scores were highest in patients with RA, and scores for other scales were highest in patients with fibromyalgia. On the advanced ADL, 58% of patients reported difficulty with errands, 68% with climbing stairs, 79% with walking two miles, 87% with participating in sports and games, and 94% with running or jogging two miles. On the psychological items, 75% of patients reported difficulty with sleep, 63% with stress, 61% with anxiety, and 57% with depression. Normal MHAQ scores were reported by 23% of patients and normal HAQ scores by 16% of patients who completed these questionnaires, while fewer than 5% had normal scores on the MDHAQ. CONCLUSION: The MDHAQ items overcome in large part the "floor effects" seen on the HAQ and MHAQ, and are useful to screen for problems with sleep, stress, anxiety, and depression in the "patient-friendly" HAQ format. These data support the value of completion of a simple 2-page patient questionnaire by each patient at each visit to a rheumatologist.

Female↗
PubMed1999

Psychological distress and rheumatic disease.

Psychological factors influence the results of self-reports of pain, function and global severity in questionnaires such as the HAQ, SF-36 and the WOMAC. Persons with psychological distress use more resources, including medications, and have greater rates of work disability and joint surgery. Psychological status is influenced only very slightly by disease severity and tends to remain relatively constant over the course of the rheumatic disease. The psychological status of patients with differing rheumatic diseases is similar, and patients with rheumatoid arthritis do not have special psychological problems or psychological characteristics.

Arthritis↗
PubMed1999

Determinants of WOMAC function, pain and stiffness scores: evidence for the role of low back pain, symptom counts, fatigue and depression in osteoarthritis, rheumatoid arthritis and fibromyalgia.

OBJECTIVES: The Western Ontario MacMaster (WOMAC) is a validated instrument designed specifically for the assessment of lower extremity pain and function in osteoarthritis (OA) of the knee or hip. In the clinic, however, we have noted that OA patients frequently have other musculoskeletal and non-musculoskeletal problems that might contribute to the total level of pain and functional abnormality that is measured by the WOMAC. In this report, we investigated back pain and non-articular factors that might explain WOMAC scores in patients with OA, rheumatoid arthritis (RA) and fibromyalgia (FM) in order to understand the specificity of this instrument. METHODS: RA, OA and FM patients participating in long-term outcomes studies completed the WOMAC and were assessed for low back pain, fatigue, depression and rheumatic disease symptoms by mailed questionnaires. RESULTS: Regardless of diagnosis, WOMAC functional and pain scores were very much higher (abnormal) among those complaining of back pain. On average, WOMAC scores for back pain (+) patients exceeded those of back pain (-) patients by approximately 65%,, and 52% of OA patients reported back pain. In regression analyses, study symptom variables explained 42, 44 and 38% of the variance in WOMAC function, pain and stiffness scores, respectively. In the subset of OA patients, radiographic scores added little to the explained variance. The strongest predictor of WOMAC abnormality in bivariate and multivariate analyses was the fatigue score, with correlations of 0.58, 0.60 and 0.53 with WOMAC function, pain and stiffness, respectively. The WOMAC performed well in RA and FM, and correlated strongly with the Health Assessment Questionnaire (HAQ) disability scale and a visual analogue scale (VAS) pain scale. CONCLUSION: The WOMAC captures more than just knee or hip pain and dysfunction, and is clearly influenced by the presence of fatigue, symptom counts, depression and low back pain. WOMAC scores also appear to reflect psychological and constitutional status. These observations suggest the need for care in interpreting WOMAC scores as just a measure of function, pain or stiffness, and indicate the considerable importance of psychological factors in rheumatic disease and rheumatic disease assessments.

Adult↗
PubMed1999

Rasch analysis of the Western Ontario MacMaster questionnaire (WOMAC) in 2205 patients with osteoarthritis, rheumatoid arthritis, and fibromyalgia.

OBJECTIVE: Advances in health measurement have led to the application of Rasch Item Response Theory (IRT) analysis (Rasch analysis) to evaluate instruments measuring health status and quality of life of patients, including the Health Assessment Questionnaire and SF-36. This study investigated the extent to which the Western Ontario MacMaster osteoarthritis questionnaire (WOMAC) satisfies the Rasch model, particularly in respect to unidimensionality, item separation, and linearity. METHODS: The study included a total of 2205 patients, 1013 with rheumatoid arthritis (RA), 655 with osteoarthritis of the knee or hip (OA), and 537 with fibromyalgia. All patients completed the WOMAC as part of a longitudinal study of rheumatic disease outcomes. To examine whether the WOMAC pain and function scales each fits the Rasch model, the Winsteps program was used to assess item difficulty, scale unidimensionality, item separation, and linearity. RESULTS: Although the WOMAC worked best in OA, regardless of disorder, both the pain and function scales were unidimensional, had adequate item separation, and had a long range (25-150) of linearity in the function scale. Several functional items, however, had a high information weight fit (INFIT) statistic, indicating poor fit to the model. These items included "getting in and out of the bath" and "going down stairs." CONCLUSION: The WOMAC generally satisfies the requirements of Rasch item response theory across all disorders studied, and is an appropriate measure of lower body function in OA, RA and fibromyalgia. Although some individual items do not fit well, it is not likely that removing such items would result in more than overall minimal differences, and it will be difficult to remove traces of multidimensionality while keeping the central constructs of progressive lower body musculoskeletal abnormality intact. In addition, it is possible that a "purer", still more unidimensional instrument would be less useful in clinical trials and epidemiological studies by restricting the range of the scale.

Activities of Daily Living↗
PubMed1999

"Silicone related symptoms" are common in patients with fibromyalgia: no evidence for a new disease.

OBJECTIVE: To ascertain if the symptom content and rate of symptoms in patients with fibromyalgia (FM) are similar to those in what has been called silicone implant associated syndrome (SIAS), and to determine if SIAS is indeed a new disease or whether it is largely recognizable as FM. METHODS: Mailed survey to 901 patients in Wichita, KS, Portland, OR, Los Angeles, CA, Peoria, IL, Boston, MA, San Antonio, TX, and eastern Kansas who were participating in a longterm outcome study of FM. Laboratory data were available from Wichita patients. RESULTS: Content of symptoms was similar to that in SIAS, and rates were generally as high or higher in patients with FM than in SIAS. In patients with FM, 37.2% had all of the following 5 items: arthralgias, myalgias, sicca complex, atypical rash, and symptoms of a peripheral neuropathy; and 55.2% had 4 of the 5 items. CONCLUSION: These data do not suggest that SIAS is an unrecognized new disease, but suggest the opposite, that such symptoms are well known and previously recognized, and are common among those with musculoskeletal complaints and those seen in rheumatology clinics.

Breast Implants↗
PubMed1999

Silicone filled breast implants and the risk of fibromyalgia and rheumatoid arthritis.

OBJECTIVE: The symptoms of what has been called silicone implant associated syndrome (SIAS) and fibromyalgia (FM) are similar. It has been hypothesized that silicone (filled) breast implants (SBI) might be causally related to the development of FM. This hypothesis was investigated by comparing 508 patients with FM with 1228 control subjects. We also studied the relationship of SBI to the subsequent development of rheumatoid arthritis (RA). METHODS: Utilizing a longitudinal databank, implantation status was determined in 464 patients with RA, 508 with FM, 261 with osteoarthritis (OA) of the knee or hip, and in 503 randomly selected community controls. We obtained data on the type of implant and its temporal relationship to the onset of FM and RA. RESULTS: No association between SBI and RA was found (OR 1.66, 95% CI 0.33, 8.23, p = 0.538). No association between prior SBI and subsequent FM was found (OR 1.22, 95% CI 0.30, 4.89, p = 0.781). But one-third of the SBI in FM occurred after development of the syndrome. When all implants regardless of temporal relationship were considered, the overall relationship between any implant and the diagnosis of FM was significant at p = 0.095 (OR 2.45, 95% CI 0.86, 7.03). CONCLUSION: No relationship between prior SBI and the subsequent development of FM or RA was noted. But implants appear to be more common in patients with than in those without FM (p = 0.095). A common, predisposing set of psychosocial characteristics may be shared between those who have FM and those who undergo SBI.

Adult↗
PubMed1999

Effect of specific COX-2 inhibition in osteoarthritis of the knee: a 6 week double blind, placebo controlled pilot study of rofecoxib. Rofecoxib Osteoarthritis Pilot Study Group.

OBJECTIVE: To determine the efficacy and safety of the cyclooxygenase 2 (COX-2) specific inhibitor, rofecoxib in patients with osteoarthritis (OA) of the knee. METHODS: Rofecoxib, 25 mg or 125 mg once daily, was compared with placebo in a 6 week, double blind, parallel group, randomized, multicenter study of 219 patients with knee OA. RESULTS: Both doses of rofecoxib produced clinically significant improvement as assessed by primary (e.g., WOMAC Pain Subscale 0-100 mm, decrease from baseline: placebo: 7.1 mm; rofecoxib 25 mg: 28.1 mm, rofecoxib 125 mg: 28.0 mm; p < 0.001 rofecoxib vs placebo) and secondary efficacy (p < 0.05) criteria compared with placebo. Clinical improvement with the 25 mg dose was similar to that with the 125 mg dose. Both rofecoxib doses were generally well tolerated. CONCLUSION: Specific inhibition of COX-2 by 25 and 125 mg rofecoxib, administered once daily, resulted in clinically meaningful improvements in patients with OA. This study confirms that COX-2 derived prostanoids are important clinical mediators of pain and other symptoms of knee OA and that inhibition of COX-1 is not required to provide clinical benefit.

Adult↗
PubMed1999

Substantial superiority of semiflexed (MTP) views in knee osteoarthritis: a comparative radiographic study, without fluoroscopy, of standing extended, semiflexed (MTP), and schuss views.

OBJECTIVE: To improve the radiographic assessment of cartilage loss, as measured by joint space width (JSW) in patients with osteoarthritis (OA) of the knees required to detect the effect of structure modifying drugs in OA trials. This was achieved by determining which of 3 nonfluoroscopic radiographic views--standing extended, semiflexed, and schuss--produced the most accurate radioanatomic positioning of the joint and greater reproducibility in joint repositioning and JSW measurement. METHODS: Knees from 74 patients with OA of the knees who had medial tibiofemoral compartment JSW > or =2 mm in all views were studied. For all 3 radiographic views, accuracy in the radioanatomic positioning of the knee was determined for both joint rotation and flexion. Reproducibility in joint repositioning and JSW measurement were determined from the difference between repeat examinations taken within 2 h. RESULTS: About 86% of knees in the 3 views had accurate rotational position of the joint at each visit. Radioanatomically, knees in the semiflexed view were significantly more accurately positioned in regard to knee flexion (p<0.0005) than in the schuss view, which in turn was better (p<0.014) than in the extended knee view. Joint repositioning was significantly more reproducible in the semiflexed (p<0.0001) than in the extended knee, which was better (p<0.013) than in the schuss position. JSW measurement was significantly more reproducible in the semiflexed (p<0.014) than both schuss and extended knee positions, which were not significantly different from each other. CONCLUSION: Protocols defining the nonfluoroscopic radiographic procedures for the semiflexed view provide the most accurate radioanatomic joint positioning, and the most reproducible joint repositioning and JSW measurement. Using this method significantly fewer knees would be required to detect significant JSW changes in a structure modifying drug trial compared to the schuss and the extended knee positions.

Adult↗
PubMed1999

Critical issues in longitudinal and observational studies: purpose, short versus long term, selection of study instruments, methods, outcomes, and biases.

Longitudinal observational studies (LOS) provide key information about outcomes and treatment effectiveness that are not available from other types of investigations, including randomized controlled trials. Although LOS are easy to perform, they are difficult to perform correctly. Major problems include recruitment, retention, and relevance, but the central problems in LOS are bias, understanding the nature of the biases, and reporting the biases. To advance the quality and validity of LOS there must be a uniform requirement for reporting detailed data that includes details about the sampled population and the sampling methods, the rationale for the selection of control subjects, the probable biases, and estimates of the extent and consequences of the biases. Sufficient covariates should be collected so that where possible statistical adjustment for bias can be made.

Bias↗
PubMed1999

Preliminary core set of domains and reporting requirements for longitudinal observational studies in rheumatology.

Observational and longitudinal observational studies (LOS) provide essential information about the course and outcome of rheumatic disorders that cannot be provided by randomized controlled trials, and they constitute the major clinical scientific communication in rheumatology. There has been no consensus as to the full and appropriate content of LOS. This report defines a core set of domains and reporting requirements for LOS. At the 1998 OMERACT IV Conference a consensus process evaluated the literature of rheumatology in light of the constructs, variables, and outcomes of rheumatology by using introductory lectures, nominal groups, and plenary sessions. The result of this process was to identify 5 "core" domains that should be included in every LOS: Health Status, Disease Process, Damage, Mortality, and Toxicity/Adverse Reactions. Two additional domains, Work Disability and Costs, were recognized as important, but need not be used in all LOS. Eleven subdomains were identified that divided the domains into convenient clinical and conceptual units. A set of reporting requirements was also determined. The core recommendations, which follow on the WHO ICIDH-2 outline, are not disease-specific; the substitution of different "disease process" and "damage" measures make them suitable for many rheumatic disorders. The core set is intended to serve as a core for LOS in almost all rheumatic conditions.

Decision Making↗
PubMed1999

Randomized clinical trials and longitudinal observational studies in systemic lupus erythematosus: consensus on a preliminary core set of outcome domains.

The OMERACT module on systemic lupus erythematosus (SLE) dealt with the definition of preliminary core sets of outcome domains for randomized clinical trials (RCT) and longitudinal observational studies (LOS). After lectures introducing the problems and addressing the key issues, 6 discussion groups, 3 each for LOS and RCT, discussed and weighted more than a dozen possible items for use as outcome domains. The means of the respective 3 groups were calculated. For both RCT and LOS the same outcome domains received more than 10 of a total maximum of 100 points: disease activity, health related quality of life (HRQOL), damage, and toxicity/adverse events. However, the weights for HRQOL and damage were different for LOS and RCT. A final vote led to the acceptance of these 4 variables as a preliminary core set for outcome in SLE by more than 80% of the participants. This core set will allow for improved design, performance, and evaluation of future studies in SLE. However, a number of domains not included in the core set were regarded as important for further analysis and research.

Decision Making↗
PubMed1998

Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States.

OBJECTIVE: To provide a single source for the best available estimates of the national prevalence of arthritis in general and of selected musculoskeletal disorders (osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, the spondylarthropathies, systemic lupus erythematosus, scleroderma, polymyalgia rheumatica/giant cell arteritis, gout, fibromyalgia, and low back pain). METHODS: The National Arthritis Data Workgroup reviewed data from available surveys, such as the National Health and Nutrition Examination Survey series. For overall national estimates, we used surveys based on representative samples. Because data based on national population samples are unavailable for most specific musculoskeletal conditions, we derived data from various smaller survey samples from defined populations. Prevalence estimates from these surveys were linked to 1990 US Bureau of the Census population data to calculate national estimates. We also estimated the expected frequency of arthritis in the year 2020. RESULTS: Current national estimates are provided, with important caveats regarding their interpretation, for self-reported arthritis and selected conditions. An estimated 15% (40 million) of Americans had some form of arthritis in 1995. By the year 2020, an estimated 18.2% (59.4 million) will be affected. CONCLUSION: Given the limitations of the data on which they are based, this report provides the best available prevalence estimates for arthritis and other rheumatic conditions overall, and for selected musculoskeletal disorders, in the US population.

Adolescent↗