The utility of a single simple question in the evaluation of patients with myasthenia gravis

Abraham, Alon; Breiner, Ari; Barnett, Carolina; Katzberg, Hans D.; Bril, Vera

doi:10.1002/mus.25720

Cited by 30 publications

(38 citation statements)

References 21 publications

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“…The single simple question (SSQ) is a simple and validated question asking what percentage of normal patients feel with respect to their overall MG status, where 0% is worst status and 100% being normal. A recent retrospective study on the utility of the SSQ in MG status showed positive associations with MG scales [3]. Patient acceptable symptom states (PASS) are a way to determine thresholds in outcome measures, where patients feel well overall.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the single simple question and the patient acceptable symptom state in myasthenia gravis

Menon

Barnett

Bril

2020

Euro J of Neurology

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Background and purpose: The single simple question (SSQ) is a simple and validated question asking what percentage of normal a patient feels with respect to their myasthenia gravis (MG), with 100% being normal. Patient acceptable symptom states (PASS) are based on a dichotomous 'Yes' or 'No' response, asking whether a patient is satisfied overall with their current status and thus measures holistic satisfaction with their MG state. Both are patientreported self-assessments but assess different dimensions of MG. The objective was to determine thresholds for the SSQ when patients with MG achieve an acceptable PASS status. Methods: A retrospective chart review was performed of consecutive MG patients attending a neuromuscular clinic, and SSQ and PASS responses, demographic, clinical and serological characteristics and disease severity by the MG impairment index were extracted. Results: One hundred and fifty-seven consecutive patients were identified: 43 (27.4%) patients responded 'No' to the PASS question. Between the PASS 'Yes'/'No' groups, only SSQ (87.5 AE 13.4 vs. 52.3 AE 23.3; P < 0.001) and MG impairment index scores (9.2 AE 10.3 vs. 29.6 AE 16; P < 0.001) were significantly different. The receiver operating characteristic curve for PASS and SSQ had an area under the curve of 0.92 AE 0.024 (confidence interval 0.872-0.965, P < 0.001). An SSQ score ≥72.5% had 84.2% sensitivity and 86% specificity to classify patients as PASS positive. Conclusion: The PASS and SSQ patient-reported outcomes are closely associated and a SSQ threshold ≥72.5% predicts an acceptable MG state. Other demographic and disease-related factors did not influence the PASS response in this study.

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Section: Introductionmentioning

confidence: 99%

Comparison of the single simple question and the patient acceptable symptom state in myasthenia gravis

Menon

Barnett

Bril

2020

Euro J of Neurology

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“…In an earlier study, we found that Myasthenia Gravis Activities of Daily Living (MG-ADL) had a lower sensitivity for changes in generalized weakness [ 5 ]. In addition, a prior study reported that patients considered limb weakness as most the disabling symptom, further stressing the importance of a high sensitivity for generalized weakness [ 6 ]. The recently developed Myasthenia Gravis Impairment Index (MGII) is a promising measure as it has less floor effects and a higher relative efficiency in its responsiveness to treatment effect compared to other MG measures [ 7, 8 ].…”

Section: Introductionmentioning

confidence: 99%

Myasthenia Gravis Impairment Index: Sensitivity for Change in Generalized Muscle Weakness

Meel

Barnett

Bril

et al. 2020

JND

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Introduction: The recently developed Myasthenia Gravis Impairment Index (MGII) is a promising measure as it has less floor effects and a higher relative efficiency in its responsiveness to treatment effect compared to other MG measures. This study aimed at validating the MGII in a Dutch cohort of MG patients and analyzing the sensitivity of MGII compared to MG-ADL for changes in generalized weakness. Methods: We analyzed (generalized items of;-gen) MGII, quantitative myasthenia gravis (QMG), Myasthenia Gravis Activities of Daily Living (MG-ADL), EQ-5D visual analog, Myasthenia Gravis Composite (MGC) and ACTIVLIM (an ADL questionnaire focusing on generalized weakness) scores in a prospective cohort of 99 MG patients. We investigated correlations between MGII and other outcome measures. We used a generalized linear model to assess whether MGIIgen had an additional sensitivity on top of MG-ADLgen for changes () in QMGgen in individual patients. Results: MGII had a lower floor effect (4%) compared to QMG (6%), MG-ADL (11%) and MGC (16%). MGII correlated well with QMG (r = 0.68), MG-ADL (r = 0.83) and MGC (r = 0.74). As expected, the correlations with EQ visual analog and ACTIVLIM were lower (r =-0.57 and-0.48). MGIIgen had an additional value on top of MG-ADLgen in the prediction of QMGgen (B = 0.54, p = 0.01). Discussion: The MGII score was cross-culturally validated in a Dutch cohort of MG patients. MGII had a higher sensitivity for generalized weakness than MG-ADL.

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“…However, as there is significant phenotypic similarity between various types of polyneuropathy, study results are most likely applicable also for diabetic and other types of polyneuropathy. In addition, we have not explored the responsiveness of the question, in order to determine its role for monitoring changes over time in polyneuropathy severity, although changes in “percentage of normal” did show strong correlation with change in the quantitative myasthenia gravis score . In addition, although patients were asked to address specifically the “percentage of normal” regarding their disease, other comorbidities may affect a patient's sense of well‐being and, consequently, the study question.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, we have not explored the responsiveness of the question, in order to determine its role for monitoring changes over time in polyneuropathy severity, although changes in "percentage of normal" did show strong correlation with change in the quantitative myasthenia gravis score. 2 In addition, although patients were asked to address specifically the "percentage of normal" regarding their disease, other comorbidities may affect a patient's sense of well-being and, consequently, the study question. In our study we did not systematically collect data regarding all potential comorbidities and their severity, and therefore we did not perform adjustment for comorbidities.…”

Section: Discussionmentioning

confidence: 99%

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The utility of a single simple question in the evaluation of patients with nondiabetic polyneuropathy

2020

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Introduction A single and simple question, namely “What percentage of normal (PoNL) do you feel regarding your disease?” is feasible and valid in myasthenia gravis. In this study, we aimed to determine the validity of this question in patients with nondiabetic polyneuropathy. Methods Clinical, electrophysiological, and functional and disability assessments were performed in 151 patients with nondiabetic polyneuropathy. One hundred forty patient answers were recorded for the PoNL question, and these were included in the current study. Results The PoNL correlated moderately with functional and disability scales. Discussion “What PoNL do you feel?” is a simple, quick, and valid question, which correlates moderately with functional and disability scales in nondiabetic polyneuropathy, and it may be incorporated in polyneuropathy assessment.

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The utility of a single simple question in the evaluation of patients with myasthenia gravis

Abstract: The question, "What percentage of normal do you feel regarding your MG?" is feasible and valid, and can be incorporated easily into routine clinical evaluation. Muscle Nerve 57: 240-244, 2018.

Cited by 30 publications

References 21 publications

Comparison of the single simple question and the patient acceptable symptom state in myasthenia gravis

Comparison of the single simple question and the patient acceptable symptom state in myasthenia gravis

Myasthenia Gravis Impairment Index: Sensitivity for Change in Generalized Muscle Weakness

The utility of a single simple question in the evaluation of patients with nondiabetic polyneuropathy

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