(249 words)Objective: The integration of the patient in therapeutic decision-making is important in the management of rheumatoid arthritis (RA); but the patient opinion regarding disease status may differ from the physician's opinion. The aim of this study was to assess in the published literature the frequency and drivers of patient-physician discordance in global assessment in RA.Method: Systematic literature review by 2 investigators of all papers published up to January 2015 in Medline or EMBASE, reporting discordance in RA. Discordance was defined based on the absolute difference of patient global and physician global assessments (PGA/PhGA) on 0-10cm scales. The frequency of discordance and its predictors were collected in each study. Frequencies of discordance were pooled by metaanalysis using random effect. Results:In all, 12 studies were selected (i.e.,11,879 patients): weighted mean age 55.1±13.9 years, weighted mean disease duration 10.4±9.3 years, 80.7% were women. The value of the difference |PGA-PhGA| defining discordance varied between ≥0.5cm (N=2 studies) to ≥3cm (N=5 studies); the weighted mean value was 2.7cm. The pooled percentage of patients with discordance was 43% (95% confidence interval 36%-51%, range: 25%-76%). PGA was usually higher than PhGA. The drivers of PGA were pain and functional incapacity, whereas drivers of PhGA were joint counts and acute phase reactants. Conclusion:Discordance in global assessment was most frequently defined as a difference of 3 points or more; even with such a stringent definition, up to half the patients were found to be discordant. The long-term consequences of this discordance remain to be determined.
BackgroundThere is no agreement for the performance assessment of patients who practice exercises.. (2 points to withdraw) This assessment is currently left to the physiotherapist’s personal judgement. We studied the agreement among physiotherapists in rating patient performance during exercises recommended for chronic low-back pain (LBP).MethodsA vignette-based method was used. We first identified ten exercises recommended for LBP in the literature. Then, 42 patients with chronic LBP participating in a rehabilitation program were videotaped during their performance of one of the ten exercises. A vignette was an exercise video preceded by clinical information. Ten physiotherapists from primary (4) and tertiary care (6) viewed the 42 vignettes twice, one month apart, and rated patient performance from zero (worse performance) to ten (excellent performance) by considering the position and duration of the contraction or stretching. Intra-class correlation coefficients (ICCs) and 95% confidence intervals (95% CIs) were computed to assess inter- and intra-rater reliability.ResultsThe overall inter-rater agreement was fair (ICC 0.48 [95% CI 0.33–0.56]) but was better for stretching exercises (0.55 [0.35–0.64]) than strengthening exercises (0.42 [0.20–0.52]) and for tertiary-care physiotherapists (0.66 [0.54–0.76]) than primary-care physiotherapists (0.28 [0.09–0.37]). The intra-rater agreement was overall good (0.72 [0.57–0.81] to 0.88 [0.79–0.94]). It was better for stretching exercises (from 0.68 [0.46–0.81] to 0.96 [0.91–0.98]) than strengthening exercises (from 0.68 [0.38–0.84]) to 0.82 [0.56–0.92]).ConclusionThe agreement in rating patient performance of exercises for LBP is good among physiotherapists trained in managing LBP but is low among non-trained physiotherapists.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2173-9) contains supplementary material, which is available to authorized users.
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