ObjectiveTo analyse how non-adherence to prescribed treatments might be prevented, screened, assessed and managed in people with rheumatic and musculoskeletal diseases (RMDs).MethodsAn overview of systematic reviews (SR) was performed in four bibliographic databases. Research questions focused on: (1) effective interventions or strategies, (2) associated factors, (3) impact of shared decision making and effective communication, (4) practical things to prevent non-adherence, (5) effect of non-adherence on outcome, (6) screening and assessment tools and (7) responsible healthcare providers. The methodological quality of the reviews was assessed using AMSTAR-2. The qualitative synthesis focused on results and on the level of evidence attained from the studies included in the reviews.ResultsAfter reviewing 9908 titles, the overview included 38 SR on medication, 29 on non-pharmacological interventions and 28 on assessment. Content and quality of the included SR was very heterogeneous. The number of factors that may influence adherence exceed 700. Among 53 intervention studies, 54.7% showed a small statistically significant effect on adherence, and all three multicomponent interventions, including different modes of patient education and delivered by a variety of healthcare providers, showed a positive result in adherence to medication. No single assessment provided a comprehensive measure of adherence to either medication or exercise.ConclusionsThe results underscore the complexity of non-adherence, its changing pattern and dependence on multi-level factors, the need to involve all stakeholders in all steps, the absence of a gold standard for screening and the requirement of multi-component interventions to manage it.

No abstract

BackgroundPersons with fibromyalgia (FM) suffer from numerous symptoms with various levels of intensity, such as widespread pain, fatigue, cognitive dysfunction, non-restorative sleep, depression, and anxiety among others. The patient’s perspective has been recognised by Outcome Measure in Rheumatology (OMERACT) as a key assessment in FM. For that reason, some patient reported outcomes measures (PROMs) have been developed. PROMs allow the comparison of a specific component of the disease in a patient through time, and also provide the opportunity to health professionals to compare patients between them in clinical trials. However, some PROMs are used over others despite a limited validation process. In addition, different versions of the same PROMs can co-exist, what can lead to uncertainty when selecting the adequate instrument.ObjectivesTo identify the existing PROMs for FM and analyse their psychometric properties.MethodsThe authors performed a comprehensive search in electronic databases (Medline, Embase, and Cochrane) in order to identify validation studies of PROMs for FM. Studies published between January 1990 and November 2017 were included. Generic PROMs and validation of diagnostic criteria and related screening tools were not considered as PROMs and were excluded. Information was gathered based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist manual.ResultsThe electronic search produced 1832 records. After screening, a total of 48 studies containing 16 PROMs for FM were included. The PROMs included address different constructs of the disease, Fibromyalgia Impact Questionnaire (FIQ), Revised Fibromyalgia Impact Questionnaire (FIQR), Combined Index of Symptom Severity, Combined Index of Severity of Fibromyalgia, Comprehensive Rating Scale for Fibromyalgia Symptomatology, Fibromyalgia Assessment Status, Fibromyalgia Bladder Index, Fibromyalgia Burden Assessment, Fibromyalgia Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire+Visual Analogue Scales, Fibromyalgia Participation Questionnaire, Fibromyalgia Sleep Diary, Multidimensional Inventory of Subjective Cognitive Impairment, Multidimensional Patient Reported Outcome Measures Questionnaire, PROMIS Fatigue FM Profile, and Multidimensional daily diary of fatigue-fibromyalgia-17 items. Almost all PROMs have adequate content validity. Three PROMs do not report construct validity; seven do not report reliability, and six do not report internal consistency. Only three PROMs evaluate criterion validity and three responsiveness. The FIQ and the FIQR are the PROMs more widely cross-cultural validated with 18 and 13 adaptations respectively.ConclusionsPROMs for FM have, in general, only partial validation of their psychometric properties. Validation of an instrument is a continuous process in which quality is more important than quantity. Instead of creating new PROMs for FM, future works should focus on completing missing parts of the validation process of existing ones. In addition, cultural a...

Objective.This is an update from the Outcome Measures in Rheumatology (OMERACT) Core Outcomes in Longterm Observational Studies Special Interest Group with a focus on rheumatoid arthritis.Methods.Preliminary data and proposed next steps were outlined and discussed by participants.Results.Domains identified after initial steps (systematic review and qualitative research) were pain, physical functioning, participation (i.e., work, social), longterm symptoms, fertility/family planning, emotional well-being, coping, financial status, and adverse events including death.Conclusion.The group agreed conceptually that short-term core outcomes could be different from longer term ones. Participants emphasized the importance of analyzing the need for core domains specifically for longterm longitudinal observational studies.

No abstract