Rheumatoid Arthritis: Badley EM

Badley EM. · No affiliation provided · J Rheumatol. · Pubmed #11669146 links to  free full text

This publication has no abstract.

Li LC, Badley EM, MacKay C, Mosher D, Jamal SW, Jones A, Bombardier C. · University of British Columbia and Arthritis Research Centre of Canada, 895 West 10th Avenue, Vancouver, BC, Canada. · Arthritis Rheum. · Pubmed #18668611 No free full text.

This publication has no abstract.

Badley EM. · Arthritis Community Research and Evaluation Unit, Division of Outcomes and Population Health, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada. · J Rheumatol Suppl. · Pubmed #15660465 No free full text.

Abstract: Doctors' visits for inflammatory arthritis reportedly represent only 6% of the overall visit rates for all arthritis and related conditions (163 per 1000), with about 40% of these patients seeing a specialist. Data from provincial drug plan databases show that although the proportion of the population aged 65 years and older with prescriptions for disease modifying antirheumatic drugs increased to 1% in 2000, this is only half the expected prevalence of rheumatoid arthritis in this age group. There are large provincial variations. Despite data on the efficacy and importance of treatment of early inflammatory arthritis, research is lacking on: the experience of arthritis, decision-making about seeking medical care, and factors affecting access to, and payment for, treatment, including drugs and rehabilitation; primary care decision-making about referral and treatment; organizational aspects of specialist care and access to drugs; and new ways of delivering services to reach patients in underserviced or remote areas. Monitoring the population impact of arthritis, including economic costs, is a priority for research, as are epidemiological studies on risk factors.

Lineker SC, Bell MJ, Wilkins AL, Badley EM. · Arthritis Community Research and Evaluation Unit, The Arthritis and Immune Disorder Research Centre, Health Research Division, University Health Network, Toronto, Ontario, Canada. · J Rheumatol. · Pubmed #11196519 No free full text.

Abstract: OBJECTIVE: We previously demonstrated the efficacy of a 6 week home based physical therapy (PT) intervention for people with moderate to severe rheumatoid arthritis (RA). This followup study determined if short term improvements were maintained to one year. METHODS: Participants in the short term study were randomly assigned to receive a PT intervention (education, exercise, and pain relief modalities) delivered by physiotherapists with advanced rheumatology training (Weeks 0 to 6) or to a wait list control group. The control group received the intervention between Weeks 6 to 12. Outcome measures included the Stanford Arthritis Self-Efficacy Scale (SES), the Arthritis Community Research and Evaluation Unit Rheumatoid Arthritis Knowledge Questionnaire (KQ), and a visual analog scale for pain. Disease activity measures (tender joints, grip strength, and morning stiffness) were also included. MANOVA was used to compare within-subject scores at baseline and at 12 and 52 weeks. Paired t tests were used to determine if 12 week changes were maintained at 52 weeks. RESULTS: Of the 127 protocol completers, 117 (92.1%) were available for the one year followup. For those measures that showed significant improvement in the randomized controlled trial (SES, KQ, morning stiffness), improvements at 12 weeks were maintained at 52 weeks (p > 0.010). CONCLUSION: Subjects who participated in a short term home based PT intervention delivered by specially trained therapists reported improved outcomes following treatment, and these improvements were maintained at one year followup. Future studies need to explore the relative contributions of education, exercise, home based care, therapist training, and reinforcement strategies in improving longterm outcomes in RA.

Power JD, Badley EM, French MR, Wall AJ, Hawker GA. · Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada. · BMC Musculoskelet Disord. · Pubmed #18452607 links to  free full text

Abstract: BACKGROUND: Fatigue is recognized as a disabling symptom in many chronic conditions including rheumatic disorders such as rheumatoid arthritis (RA) and lupus. Fatigue in osteoarthritis (OA) is not routinely evaluated and has only been considered in a very limited number of studies. To date, these studies have focused primarily on patients with OA under rheumatological care, which represent the minority of people living with OA. The purpose of this study was to increase our understanding of the fatigue experience in community dwelling people with OA. METHODS: In 2004, 8 focus groups were conducted with 28 men and 18 women (mean age 72.3) with symptomatic hip or knee OA recruited from a population-based cohort. Participants completed a self-administered questionnaire, which included demographics, measures of OA severity (WOMAC), depression (CES-D) and fatigue (FACIT). Sessions were audio taped and transcribed verbatim. Two researchers independently reviewed the transcripts to identify themes. Findings were compared and consensus reached. RESULTS: Mean pain, disability, depression and fatigue scores were 8.7/20, 27.8/68, 15.4/60, and 30.9/52, respectively. Participants described their fatigue as exhaustion, being tired and "coming up against a brick wall". Participants generally perceived fatigue as different from sleepiness and distinguished physical from mental fatigue. Factors believed to increase fatigue included OA pain and pain medications, aging, various types of weather and poor sleep. Mental health was identified as both affecting fatigue and being affected by fatigue. Participants described fatigue as impacting physical function, and their ability to participate in social activities and to do household chores. Rest, exercise, and avoiding or getting assistance with activities were cited as ways of coping. Participants generally did not discuss their fatigue with anyone except their spouses. CONCLUSION: Participants with OA described experiencing notable amounts of fatigue and indicated that it had a substantial impact on their lives. Further research is required to better understand the role of fatigue in OA in order to identify strategies to reduce its impact.

Gignac MA, Sutton D, Badley EM. · Arthritis Community Research and Evaluation Institute, Toronto Western Research Unit at the University Health Network, University of Toronto, Toronto, Ontario, Canada. · Arthritis Rheum. · Pubmed #17530672 links to  free full text

Abstract: OBJECTIVE: To develop a measure of job strain related to differing aspects of working with arthritis and to examine the demographic, illness, work context, and psychosocial variables associated with it. METHODS: Study participants were 292 employed individuals with osteoarthritis or inflammatory arthritis. Participants were from wave 3 of a 4-wave longitudinal study examining coping and adaptation efforts used to remain employed. Participants completed an interview-administered structured questionnaire, including a Chronic Illness Job Strain Scale (CIJSS) and questions on demographic (e.g., age, sex), illness and disability (e.g., disease type, pain, activity limitations), work context (e.g., job type, job control), and psychosocial variables (e.g., arthritis-work spillover, coworker/managerial support, job perceptions). Principal component analysis and multiple linear regression were used to analyze the data. RESULTS: A single factor solution emerged for the CIJSS. The scale had an internal reliability of 0.95. Greater job strain was reported for future uncertainty, balancing multiple roles, and difficulties accepting the disease than for current workplace conditions. Participants with inflammatory arthritis, more frequent severe pain, greater workplace activity limitations, fewer hours of work, less coworker support, and greater arthritis-work spillover reported greater job strain. CONCLUSION: The findings underscore the diverse areas that contribute to perceptions of job strain and suggest that existing models of job strain do not adequately capture the stress experienced by individuals working with chronic illnesses or the factors associated with job strain. Measures similar to the CIJSS can enhance the tools researchers and clinicians have available to examine the impact of arthritis in individuals' lives.

Vliet Vlieland TP, Li LC, MacKay C, Badley EM. · Leiden University Medical Center, Department of Rheumatology, Leiden, The Netherlands. · J Rheumatol. · Pubmed #16960951 No free full text.

Abstract: Multidisciplinary team care, defined as care provided by a group of health professionals from various disciplines, has been widely used in arthritis management since the 1950s. Its effectiveness in comparison with regular outpatient care has mainly been established in patients with rheumatoid arthritis (RA). Recent studies have shown that similar outcomes can be achieved in patients with RA at lower costs using care provided by a clinical nurse specialist. These latter findings suggest that the active components of the multidisciplinary team care model may not be related to the number or professional backgrounds of the health professionals involved, nor with their physical proximity, but rather to the provider's skills in rheumatology and the coordination of services. Because many patients with arthritis have healthcare needs that are not met through treatment by the rheumatologist alone and since traditional multidisciplinary team care in many countries is unavailable or may be undesirable in specific situations, the development and evaluation of alternative, comprehensive models of care delivery is recommended.

Gignac MA, Badley EM, Lacaille D, Cott CC, Adam P, Anis AH. · The Toronto Western Research Institute and The University of Toronto, Toronto, Ontario, Canada. · Arthritis Rheum. · Pubmed #15593110 links to  free full text

Abstract: OBJECTIVE: To understand arthritis-related workplace changes, including occasional work loss and changes to the type and hours of work, and the factors associated with them using theories of adaptation and behavior change as a framework. METHODS: Participants were 492 employed individuals with rheumatoid arthritis or osteoarthritis. They completed an interview-administered, structured questionnaire assessing demographic, workplace, and psychosocial variables, as well as such work transitions as changes to the hours, type, and nature of work. Hypotheses were examined using multiple linear regression. RESULTS: Seventy percent of respondents made at least 1 work change. Younger participants and those with greater workplace activity limitations reported more changes. Work changes were associated with greater depression. A hypothesized 3-way interaction among people's perceptions of their capacity, their future job expectations, and whether they had told their employer about their arthritis was significant. CONCLUSION: This study extends arthritis employment research by examining a range of work changes. It highlights the dynamic interplay among arthritis, workplace, and psychosocial variables to understand adaptation to arthritis disability.

Zangger P, Kachura JR, Bombardier C, Redelmeier DA, Badley EM, Bogoch ER. · Hôpital Orthopédique de la Suisse Romande and Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland. · Joint Bone Spine. · Pubmed #15474390 No free full text.

Abstract: OBJECTIVES: To evaluate observer agreement using the Larsen system (LS) and a Modified Larsen system (ML) when assessing individual joints of the hands and wrists in rheumatoid arthritis, and to compare the two systems. To determine the minimally important difference (MID) for the ML. METHODS: Thirty radiographs of hands and wrists from 10 patients who presented with RA were graded by two blinded observers, using the LS and then the ML. Patients were followed for a mean of 7.2 years (range: 4-10 years). Inter- and intra-observer agreement were calculated using the kappa statistic with linear incremental weights. Inter-observer agreement was also computed for the summed score, using an intraclass correlation coefficient. Inter-observer error was estimated by calculating the mean and standard deviation of the grading differences between the two observers. Prevalence of damage was calculated as a ratio of damage: no damage and expressed as a percentage. Pairs of radiographs were comparatively graded using a seven-point Likert scale. RESULTS: The kappa statistic for inter-observer agreement was 0.38 (marginal reproducibility) for the LS and 0.52 (good reproducibility) for the ML (P = 0.004). Using a difference of one grade as perfect agreement, it was 0.56 (good reproducibility) for the LS and 0.87 (excellent reproducibility) for the ML (P = 0.001). Intra-observer agreement was high in both systems. The distribution of ML-grade differences varied according to the level of the Likert scale: for "a little bit worse", representing the smallest amount of detectable damage progression, the distribution differences peaked around two grades. This value represented a MID 87% of the time. CONCLUSIONS: The LS lacks precision for individual joints. The ML, it is proposed, has more detailed definitions of grades, and is more reliable. When pairs of radiographs were compared, a two-grade difference on the ML was the MID.

Shipton D, Glazier RH, Guan J, Badley EM. · Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, University of Toronto, Toronto, Canada. · Med Care. · Pubmed #15319617 No free full text.

Abstract: BACKGROUND: In community settings, disease-modifying antirheumatic drug (DMARD) use for rheumatoid arthritis (RA) falls short of treatment recommendations. This population-based study investigates the relationship between the use of DMARDs and specialty care in an insured population. METHOD: A cohort of individuals aged 65 or older with RA was identified from a population-based physician billing database in Ontario, Canada, together with information on visit rates to general and specialist physicians and visit-specific diagnoses. DMARD prescription data were obtained from the Ontario Drug Benefits Plan database. The proportions of individuals with RA using DMARDs and specialist care were calculated for the 43 counties in Ontario, and the relationship between the 2 was determined using logistic multilevel modeling, controlling for possible confounders. RESULTS: A total of 13,698 RA individuals aged 65 or older were identified, representing 1% of the 65-or-older population. Within this cohort, 58% received DMARDs and 68% made 1 or more RA-related visits to a specialist in 3 years. There was considerable variation by county in both the proportion of those with RA making visits to specialists (39-82 per 100 RA population) and receiving DMARDs (36-81%). The use of DMARDs was significantly associated with the use of specialist services by individuals with RA (odds ratio 1.9 [95% confidence interval 1.87, 1.88] for counties with highest versus lowest proportional use of specialists) independent of effects of age, sex, income, and comorbidities. CONCLUSION: Even in a universally funded setting, suboptimal treatment of RA is associated with lack of access to specialist services. These findings are likely applicable to many jurisdictions worldwide.

Lineker SC, Badley EM, Hawker G, Wilkins A. · School of Rehabilitation Science, University of Toronto, Ontario, Canada. · Arthritis Care Res. · Pubmed #11094927 No free full text.

This publication has no abstract.