A comparison of directly elicited and pre-scored preference-based measures of quality of life: the case of adhesive capsulitis.

PURPOSE: To assess the convergent validity and comparative responsiveness in measuring the health-related quality of life associated with adhesive capsulitis of a disease-specific measure (Shoulder Pain and Disability Index), a generic quality of life measure (SF-36), a preference-based multi-attribute utility scale (assessment of quality of life), and two direct patient preference elicitation methods (willingness to pay and time trade-off). METHOD: Instruments administered to all 156 participants in both arms of a randomized placebo-controlled trial of physiotherapy following arthrographic joint distension at baseline were reported at 6, 12, and 26 weeks. Convergent validity was measured using both pooled correlation between instruments and within subjects over time. Responsiveness was measured using the effect size for those with no improvement, moderate improvement, and marked improvement. RESULTS: With the exception of the monetary measure, all of the instruments showed a low quality of life at baseline with adhesive capsulitis (66- 87 % of perfect health) and a substantial improvement in quality of life to week 26 on recovery. The time trade-off and willingness to pay measures of patient preferences were not responsive to changes in health, but all of the other instruments were at least moderately sensitive to change and moderately correlated with one another. CONCLUSIONS: These findings verify the significant adverse impact of adhesive capsulitis upon quality of life found in larger studies. There was a fair degree of convergence, as measured by the correlation between the instruments but while the time trade-off mean values were quite plausible, at a mean of 87 % of full health before treatment, there was a low correlation with health profile and disease-specific measures. It may be that the time trade-off measured wider aspects of quality of life and that individuals were not prepared to trade survival for potential gains in a self-limiting condition.

Efficacy and cost-effectiveness of physiotherapy following glenohumeral joint distension for adhesive capsulitis: a randomized trial.

OBJECTIVE: To determine whether an active physiotherapy program following arthrographic joint distension for adhesive capsulitis provides additional benefits. METHODS: We performed a randomized, placebo-controlled, participant and single assessor blinded trial. A total of 156 participants with pain and stiffness in predominantly 1 shoulder for >or=3 months and restriction of passive motion >30 degrees in >or=2 planes of movement entered the study, and 144 completed the study. Following joint distension, participants were randomly assigned to either manual therapy and directed exercise or placebo (sham ultrasound), both administered twice weekly for 2 weeks then once weekly for 4 weeks. Pain, function, active shoulder movements, participant-perceived success, and quality of life were assessed at baseline, 6, 12, and 26 weeks. Costs were also collected. RESULTS: Both groups improved over time with no significant differences in improvement between groups for pain, function, or quality of life at any time point. Significant differences favored the physiotherapy group for all active shoulder movements (e.g., pooled difference in mean change between groups across all time points for total shoulder abduction was 10.6 degrees , 95% confidence interval [95% CI] 3.1, 18.1) and participant-perceived success (pooled relative risk 1.4, 95% CI 1.1, 1.65; number needed to treat = 5). Net cost of physiotherapy was $136.8 Australian (95% CI -177.5, 223.1) over the 6 months. CONCLUSION: Physiotherapy following joint distension provided no additional benefits in terms of pain, function, or quality of life but resulted in sustained greater active range of shoulder movement and participant-perceived improvement up to 6 months.

Systematic review of the efficacy and safety of shock wave therapy for lateral elbow pain.

OBJECTIVE: To determine the efficacy and safety of extracorporeal shock wave therapy (ESWT) for lateral elbow pain. METHODS: Systematic review of randomized controlled trials using Cochrane Collaboration methodology. RESULTS: Nine placebo-controlled trials (1006 participants) and one trial of ESWT versus steroid injection (93 participants) were included. The 9 placebo-controlled trials reported conflicting results, although 11 of 13 pooled analyses found no significant benefit of ESWT over placebo, e.g., weighted mean difference for improvement in pain (on a 100-point scale) from baseline to 4-6 weeks (pooled analysis of 3 trials, 446 participants) was -9.42 (95% CI -20.70 to 1.86). Two pooled results favored ESWT, e.g., relative risk of treatment success (at least 50% improvement in pain with resisted wrist extension at 12 weeks) for ESWT in comparison to placebo (pooled analysis of 2 trials, 192 participants) was 2.2 (95% CI 1.55 to 3.12). However, this finding was not supported by the results of 4 other trials that were unable to be pooled. Steroid injection was more effective than ESWT at 3 months after the end of treatment assessed by a reduction of pain of 50% from baseline [21/25 (84%) vs 29/48 (60%); p < 0.05]. Minimal adverse effects of ESWT were reported. CONCLUSION: Based upon systematic review of 9 placebo-controlled trials, there is "platinum" level evidence that ESWT provides little or no benefit in terms of pain and function in lateral elbow pain. There is "silver" level evidence based upon one trial that steroid injection may be more effective than ESWT.

Functional health literacy of patients with rheumatoid arthritis attending a community-based rheumatology practice.

OBJECTIVE: To determine the health literacy of patients with rheumatoid arthritis (RA) attending community-based rheumatology practice. METHODS: Eighty patients were administered the Test of Functional Health Literacy in Adults (TOFHLA), a 50-item reading comprehension and 17-item numerical ability test (score 0-100); the Rapid Estimate of Adult Literacy in Medicine (REALM), which asks participants to read aloud 66 words of varying difficulty (score 0-66); and the Test of Reading Comprehension (TORCH), which asks participants to read a short text and then fill in the gaps of another version by using one or more of their own words (score 1-9). RESULTS: The study group included 60 women (75%), mean age (SD) 60.29 (15.02) years, median duration of RA 8 years (range 0.3-39). Nineteen of 80 (24%) had completed or= 11 years. TOFHLA and REALM scores ranged from 39-100 and 41-66 respectively. Scores for 8 patients (10%) indicated they would have difficulty reading and interpreting health texts and struggle with most currently available patient education materials. Of those who attempted the TORCH, 8/65 (12%) scored low or below average and 23/65 (35%) scored average compared with students completing 9th grade. All 3 literacy tests were significantly correlated with education level, but use of educational level alone as a measure of literacy would have misclassified more than 10% as health literate/illiterate. CONCLUSION: A significant number of patients with RA have limited health literacy and may not understand even simple written instructions or prescription labels.