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R F Meenan

Publications and source records attributed to R F Meenan.

At least 55 records · Page 3Linked to original sources
PubMed1989

Effect sizes for interpreting changes in health status.

Health status measures are being used with increasing frequency in clinical research. Up to now the emphasis has been on the reliability and validity of these measures. Less attention has been given to the sensitivity of these measures for detecting clinical change. As health status measures are applied more frequently in the clinical setting, we need a useful way to estimate and communicate whether particular changes in health status are clinically relevant. This report considers effect sizes as a useful way to interpret changes in health status. Effect sizes are defined as the mean change found in a variable divided by the standard deviation of that variable. Effect sizes are used to translate "the before and after changes" in a "one group" situation into a standard unit of measurement that will provide a clearer understanding of health status results. The utility of effect sizes is demonstrated from four different perspectives using three health status data sets derived from arthritis populations administered the Arthritis Impact Measurement Scales (AIMS). The first perspective shows how general and instrument-specific benchmarks can be developed and how they can be used to translate the meaning of clinical change. The second perspective shows how effect sizes can be used to compare traditional clinical measures with health status measures in a standard clinical drug trial. The third application demonstrates the use of effect sizes when comparing two drugs tested in separate drug trials and shows how they can facilitate this type of comparison. Finally, our health status results show how effect sizes can supplement standard statistical testing to give a more complete and clinically relevant picture of health status change. We conclude that effect sizes are an important tool that will facilitate the use and interpretation of health status measures in clinical research in arthritis and other chronic diseases.

Activities of Daily Living↗
PubMed1989

Sensitivity of a health status measure to short-term clinical changes in arthritis.

To assess the sensitivity of the Arthritis Impact Measurement Scales (AIMS), we analyzed data from 3 clinical trials. One trial involving 255 patients with rheumatoid arthritis (RA) was a 12-week, randomized controlled trail of diclofenac, naproxen, and aspirin. Two trials were open-label studies of 24 weeks duration that included 165 RA and 355 osteoarthritis (OA) patients, all of whom were treated with diclofenac. In addition to the AIMS, tender joint count, morning stiffness, and erythrocyte sedimentation rate were used as outcome measures in the trials. The AIMS results showed substantial improvements in Physical Function, Psychological Status, and Pain, as well as in overall Arthritis Impact. These improvements were detected by the time of the initial outcome assessment at 4 weeks or 8 weeks, and were detected in patients with either OA or RA. These AIMS results closely parallel improvements shown by traditional clinical measures, and demonstrate that the AIMS health status measure is sensitive to improvements in OA as well as in RA. The AIMS also detects responses produced by therapy with nonsteroidal antiinflammatory drugs (NSAIDs), and these improvements can be demonstrated in as short a treatment time as 4 weeks. These findings confirm the utility of the AIMS for assessing outcome in rheumatic disease studies, and they have implications for the design of future clinical trials of NSAIDs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1989

The prevalence of chondrocalcinosis in the elderly and its association with knee osteoarthritis: the Framingham Study.

Chondrocalcinosis and osteoarthritis (OA) both increase in prevalence with age, yet previous studies assessing their association have often been too small to adjust for age and have had biased selection of subjects. We assessed the prevalence of chondrocalcinosis and its link with OA in the Framingham Knee Osteoarthritis Study, a large population based study of the elderly. After controlling for age, we found a modestly increased rate of radiographic OA in those with chondrocalcinosis (relative risk = 1.52 (95% CI 1.22, 1.90). There was a similar link between chondrocalcinosis and severe radiographic OA (relative risk = 1.52). Chondrocalcinosis was positively associated with both symptomatic and asymptomatic radiographic OA. The proportion of radiographic OA potentially attributable to chondrocalcinosis was only 4.4%. Our results confirm that chondrocalcinosis is significantly associated with OA after controlling for age, but they also suggest that chondrocalcinosis and OA increase independently with age.

Aged↗
PubMed1988

Obesity and knee osteoarthritis. The Framingham Study.

STUDY OBJECTIVE: To determine whether obesity preceded knee osteoarthritis and was thus a possible cause. DESIGN: Cohort study with weight and other important variables measured in 1948 to 1951 (mean age of subjects, 37 years) and knee arthritis evaluated in 1983 to 1985 (mean age of subjects, 73 years). SETTING: Population-based participants; a subset (n = 1420) of the Framingham Heart Study cohort. METHODS: For those subjects in the Framingham Study having knee radiographs taken as part of the 18th biennial examination (1983 to 1985), we examined Metropolitan Relative Weight, a measure of weight adjusted for height at the onset of the study (1948 to 1951). Relative risks were computed as the cumulative incidence rate of radiographic knee osteoarthritis in the heaviest weight groups at examination 1 divided by the cumulative rate in the lightest 60% weight groups at examination 1. Relative risks were adjusted for age, physical activity level, and uric acid level. RESULTS: In 1983 to 1985, 468 subjects (33%) had radiographic knee osteoarthritis. For men, the risk of knee osteoarthritis was increased in those in the heaviest quintile of weight at examination 1 compared with those in the lightest three quintiles (age-adjusted relative risk, 1.51; 95% confidence interval [CI], 1.14 to 1.98); risk was not increased for those in the second heaviest quintile (relative risk, 1.0). The association between weight and knee osteoarthritis was stronger in women than in men; for women in the most overweight quintile at examination 1, relative risk was 2.07 (95% CI, 1.67 to 2.55), and for those in the second heaviest group, relative risk was 1.44 (95% CI, 1.11 to 1.86). This link between obesity and subsequent osteoarthritis persisted after controlling for serum uric acid level and physical activity level, and was strongest for persons with severest radiographic disease. Obesity at examination 1 was associated with the risk of developing both symptomatic and asymptomatic osteoarthritis. CONCLUSIONS: These results and other corroborative cross-sectional data show that obesity or as yet unknown factors associated with obesity cause knee osteoarthritis.

Activities of Daily Living↗
PubMed1988

One-year experience in patients treated with auranofin following completion of a parallel, controlled trial comparing auranofin, gold sodium thiomalate, and placebo.

Following a 21-week double-blind trial that compared the effects of treatment with auranofin (AUR), gold sodium thiomalate, and placebo in 193 patients, 147 patients entered a 1-year, open-label study of treatment with AUR (6 mg/day). Results of this open-label study suggest that AUR has a long-term use profile similar to that of other slow-acting antirheumatic drugs. AUR appears to be capable of sustaining an initial response to gold sodium thiomalate. The withdrawal rate remains relatively high: Nearly half of the study patients had discontinued AUR by the end of 1 year.

Adolescent↗
PubMed1988

A model of health status for rheumatoid arthritis. A factor analysis of the Arthritis Impact Measurement Scales.

Health status is a key aspect of quality of life that may be addressed and affected by health care. The measurement of this construct requires the identification of unique and relevant components of health status that can be operationally defined by specific scales or scale groupings. We explored the components of health status that are operationalized by the Arthritis Impact Measurement Scales (AIMS). Prior testing has shown that the AIMS measures delineate at least 3 components of health status: Physical Function, Psychological Status, and Pain. This 3-component model, however, can be theoretically and empirically restrictive. Using AIMS responses from a rheumatoid arthritis (RA) patient population, our investigation, through factor analyses, identifies 5 components of health status in this chronic disease: Lower Extremity Function, Upper Extremity Function, Affect, Symptom, and Social Interaction. It is proposed that these intuitively reasonable and measurable components constitute the core of the health status construct for individuals with RA. These 5 components could also prove central to the assessment of health status in other rheumatic diseases. Future studies of health status in RA should include tested measures to assess these 5 components.

Arthritis, Rheumatoid↗
PubMed1988

The stability of health status in rheumatoid arthritis: a five-year study of patients with established disease.

We employed a health status measure to describe the outcomes of rheumatoid arthritis patients over five years. Of the 410 rheumatoid arthritis patients who were originally administered the Arthritis Impact Measurement Scales (AIMS), 299 completed a follow-up five years later. Data were analyzed using nine health status scales, three components of health status, and an overall arthritis impact item. Results for survivors indicated that there were no clinically important deteriorations in any of these measures. In fact, small improvements on most measures were found. The health status changes were similar for patients originally in a clinical trial and for those receiving routine specialty care. Age was found to positively relate to improvements in psychological status and overall arthritis impact, but we were unable to demonstrate any consistent effects of sex, marital status, education, or disease duration. Our results contrast with other studies that have noted major declines over time in the health status of patients with rheumatoid arthritis. Furthermore, level of education was not a major determinant of morbidity in this group. These results suggest that health status in certain patients with rheumatoid arthritis is more stable than previously thought. This has implications for both clinical practice and clinical research in rheumatology.

Arthritis, Rheumatoid↗
PubMed1988

The rheumatology knowledge and skills of trainees in internal medicine and family practice.

Our study examines the rheumatology knowledge and skills of trainees in internal medicine and family practice residency programs. Site visits were made to 15 programs in the eastern half of the United States. Eighty-one trainees participated in the study, 53 in internal medicine and 28 in family practice. Each completed a 50-item rheumatology quiz and performed a clinical assessment of a trained patient evaluator. Trainees in internal medicine had quiz and clinical assessment scores of 52.4% and 72.9%, respectively, while scores for family practice trainees were 43.4% and 61.6% (p less than 0.004 for both). Regression analysis showed that having had a rheumatology elective had a significant effect on knowledge and skills. Trainees in family practice programs were 3 times less likely than internal medicine trainees to have taken a rheumatology elective. Family practice trainee scores in our study were comparable to scores previously documented in 4th year medical students. These results confirm the importance of a specific rheumatology experience for the development of rheumatology knowledge and skills in internal medicine and family practice trainees, and suggest that the rheumatology content of these training programs needs to be enhanced.

Clinical Competence↗
PubMed1988

Health status information in clinical practice: the development and testing of patient profile reports.

As an initial step in a project to apply health status measures in routine clinical practice, we developed and tested patient profiles based on the Arthritis Impact Measurement Scales (AIMS) instrument. The health status profiles are single page summary reports of patient scores on the AIMS instrument whose reliability and validity were tested on a group of 123 rheumatologists and arthritis health professionals in clinical practice. Results demonstrated that the profile summary reports were reliable and valid when used by clinicians. These findings are important evidence for their eventual introduction into routine clinical practice.

Arthritis↗
PubMed1987

The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study.

To investigate the prevalence of osteoarthritis (OA) of the knee in elderly subjects, we studied the Framingham Heart Study cohort, a population-based group. During the eighteenth biennial examination, we evaluated the cohort members for OA of the knee by use of medical history, physical examination, and anteroposterior (standing) radiograph of the knees. Radiographs were obtained on 1,424 of the 1,805 subjects (79%). Their ages ranged from 63-94 years (mean 73). Radiographs were read by a radiologist who specializes in bone and joint radiology, and were graded 0-4 according to the scale described by Kellgren and Lawrence. OA was defined as grade 2 changes (definite osteophytes), or higher, in either knee. Radiographic evidence of OA increased with age, from 27% in subjects younger than age 70, to 44% in subjects age 80 or older. There was a slightly higher prevalence of radiographic changes of OA in women than in men (34% versus 31%); however, there was a significantly higher proportion of women with symptomatic disease (11% of all women versus 7% of all men; P = 0.003). The age-associated increase in OA was almost entirely the result of the marked age-associated increase in the incidence of OA in the women studied. This study extends current knowledge about OA of the knee to include elderly subjects, and shows that the prevalence of knee OA increases with age throughout the elderly years.

Age Factors↗
PubMed1987

Health status assessment in pediatric rheumatology.

Major issues in the conceptualization and measurement of health status in pediatric rheumatology are considered. Recent work on the Arthritis Impact Measurement Scales (AIMS) questionnaire for adults provides a framework for the discussion.

Activities of Daily Living↗
PubMed1985

The clinical features of elderly-onset rheumatoid arthritis. A comparison with younger-onset disease of similar duration.

Patients with elderly-onset rheumatoid arthritis (EORA) may represent a clinical subset of individuals who differ prognostically and therapeutically from patients with younger-onset disease (YORA). In order to test this hypothesis, we reviewed the records of 212 patients with rheumatoid arthritis and grouped them according to age at onset above or below 60 years old. Seventy-eight EORA patients and 134 YORA patients with disease duration of less than or equal to 10 years were used for a comparison of presenting features and disease outcome. Abrupt onset occurred somewhat more frequently in EORA, but was not associated with a significantly different clinical course than was an insidious presentation in this older group. There were no differences between the EORA and YORA groups in terms of mean initial joint score, although the scores for the YORA group had wider variation. An initial clinical presentation resembling polymyalgia rheumatica (PMR) was 4 times as frequent in EORA. Elderly patients were less likely to have subcutaneous nodules or rheumatoid factor at disease onset. At the final examination, the EORA patients had lower joint scores and higher health assessments despite similar courses of treatment. These outcome differences persisted when patients with PMR-like presentations were excluded. Multivariate analyses indicated that joint scores and disease duration made important contributions to a better outcome of EORA, whereas PMR presentation and abrupt onset did not. After an adjustment was made for these 4 features, age at onset was an important contribution to joint score outcome. These results confirm the existence of important differences in onset, clinical features, and prognosis between patients with EORA and those with YORA.

Adrenal Cortex Hormones↗
PubMed1985

Referral of musculoskeletal disease patients by family and general practitioners.

We surveyed general and family practitioners to evaluate their patterns of referring musculoskeletal disease patients to rheumatologists and orthopedists. Patients who had rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis were most often referred to rheumatologists, whereas patients with osteoarthritis, persistent low back pain, and post-traumatic knee pain were most often referred to orthopedists. As conditions worsened in severity, referrals were more frequent. Patients with conditions that were difficult to diagnose, such as possible shoulder tendinitis that was unresponsive to initial nonsteroidal therapy, undiagnosed polyarthritis, and intermittent knee swelling with pain, were most often treated without referral and, when referred, were most often sent to orthopedists. Belief in the effectiveness of rheumatologists or orthopedists correlated strongly with reported referral behavior, yet most respondents considered themselves capable of managing the majority of patients with musculoskeletal diseases. Neither practice arrangement, board certification, nor educational background affected referral behavior. However, younger physicians were more likely (P = 0.002) to refer patients to rheumatologists. Multivariate analysis showed that the significant predictors of global referral behavior were belief in the effectiveness of subspecialists and a small number of musculoskeletal problems seen by the generalist. The predictors of referral to rheumatologists were belief in rheumatologist efficacy and young physician age.

Adult↗
PubMed1984

Misuse of statistical methods in Arthritis and Rheumatism. 1982 versus 1967-68.

Articles published in Arthritis and Rheumatism in 1982 were compared with those from 1967-68 to evaluate trends in statistical methods and in the quantity and character of statistical misuse. Results show that among articles in 1982 using statistics, 66% contained methodologic errors. The percentage was similar in 1967-68, although fewer articles used statistics. In 1967-68 the most common error was failure to identify the statistical method used, whereas in 1982 multiple testing errors predominated, specifically, use of the t-test to compare 3 or more groups and comparison of 2 groups on multiple variables. The availability of calculators and computers which readily perform complex data analysis may underly the emergence of multiple testing errors. To compare multiple groups, we suggest using analysis of variance instead of the t-test. To avoid multiple testing errors, we recommend limiting the number of tests performed, lowering the alpha (significance) level, or using multivariate techniques.

Arthritis↗