Reproducibility of the Pettersson Scoring System

Erlemann, R.; Rosenthal, H.; Walthers, E. M.; Almeida, Patricia; Calleja, Rodrigo

doi:10.1177/028418518903000206

Cited by 30 publications

(19 citation statements)

References 18 publications

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“…Results of previous reliability studies showed that radiographic scoring systems for evaluation of haemophilic arthropathy are slightly more reliable for assessment of ankles compared with knees [3], which is the opposite of the results of this study. Although different imaging modalities have been used in the study that evaluated radiographic scoring systems and the current study we hypothesized that differences in the degree of severity of findings may have played a role on the reliability of the scoring systems according to the joint under evaluation.…”

Section: Discussioncontrasting

confidence: 99%

“…Arthropathy is a major cause of morbidity for boys with severe haemophilia, especially for those who are not on a prophylactic scheme [1]. Haemarthrosis may occur in one or several joints and may progress to a destructive, disabling arthropathy [2] that most commonly affects large joints such as knees and ankles [3]. Once radiographic changes are present the clinical course of the arthropathy is usually progressive and irreversible.…”

Section: Introductionmentioning

confidence: 99%

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Reliability of progressive and additive MRI scoring systems for evaluation of haemophilic arthropathy in children: Expert MRI Working Group of the International Prophylaxis Study Group

et al. 2005

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Effective treatment of haemophilic arthropathy requires a detailed evaluation of joint integrity. Methodological assessment of magnetic resonance imaging (MRI) scores are needed to assure reproducibility of measurements when comparing results of clinical trials conducted in different centres. We compared the reliability of two MRI scoring systems for assessment of haemophilic arthropathy: one progressive system that displays the most severe change and one additive system that depicts osteochondral and soft tissue-related changes. A total of 47 1.5 T MRI examinations of knees (n = 21) and ankles (n = 26) of 42 haemophilic boys, age range, 22 months to 18 years, performed at different centres (Toronto, n = 20, Europe, n = 12 and Denver, n = 15) were independently reviewed by four radiologists at two occasions. Twenty-two examinations were from children <9 years and 25 from children >/=9. Sagittal and coronal gradient-echo (MPGR, 3D FLASH with fat saturation, GRASS) images were obtained. The MRI examinations of the ankle and knee studies presented with osteochondral abnormalities in 38.5% and 23.8% of the cases respectively. The two scoring systems demonstrated an excellent inter-reader [progressive, 0.88; additive (A, e, s and h components), 0.86] and intra-reader [progressive, 0.92; additive (A, e, s and h components), 0.93] reliability using intraclass correlation coefficients (ICCs). Although ICCs were slightly higher for knees when compared with ankles, and for older children when compared with younger children, all values fell within excellent inter- and intra-reader reliability categories. The two MRI scoring systems demonstrated a comparable reliability. This result constitutes the basis for further development of a combined MRI scoring system for assessment of haemophilic arthropathy, which incorporates progressive and additive components.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reliability of progressive and additive MRI scoring systems for evaluation of haemophilic arthropathy in children: Expert MRI Working Group of the International Prophylaxis Study Group

et al. 2005

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“…These have been widely used in practice and in clinical studies. However, the clinical score has never been validated and the radiological score, although validated, lacks sensitivity and clinical correlation (Erlemann et al, 1987). Limitations with regard to inter-observer variability, ambiguity in definition and lack of clinical significance of certain parameters included in the scores have been noted (Hamel et al, 1988).…”

Section: Dose and Response -Difficulties In Haemophiliamentioning

confidence: 99%

Dose and response in haemophilia – optimization of factor replacement therapy

Srivastava

2004

Br J Haematol

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SummaryThe mainstay of the management of haemophilia is the replacement of clotting factors, using clotting factor concentrates (CFC) in a way that prevents bleeding and its complications. Beginning with small doses, as whole blood and plasma over 50 years ago, highly purified CFCs are now administered frequently in large doses to effectively treat this condition so that even people with severe haemophilia can lead near normal lives. However, with such regimens, compliance and expense have both become significant issues. The question therefore is whether the current models of clotting factor replacement are optimal. This article reviews the literature on the dose-response relationship in haemophilia, with particular reference to management of musculoskeletal bleeding and surgical haemostasis. Current practices are based on uncontrolled observational data. Less intensive protocols could achieve similar outcomes. Large multi-centre prospective studies are needed to provide comparative data on unresolved issues so that factor replacement therapy can be optimized, based on evidence.

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“…These scores have been recommended by the World Federation of Haemophilia (WFH); both have been widely used [6][7][8] but have considerable limitations. The Pettersson score is a validated score [9,10], but it assesses osteochondral changes only and is therefore not suitable to detect early joint damage occurring in soft tissues [11]. The clinical score is a physical examination score which has never been validated and is consistently lower than the Pettersson score [8,12].…”

Section: Introductionmentioning

confidence: 99%

Using the Haemophilia Joint Health Score for assessment of teenagers and young adults: exploring reliability and validity

2013

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Outcome assessment in haemophilia is important to assess results of prophylactic treatment. Recently, the Haemophilia Joint Health Score (HJHS) was developed to assess early joint damage in children with haemophilia. Thus, the aim of this study was to assess reliability and explore validity of the HJHS in teenagers and young adults with haemophilia. Twenty-two patients with haemophilia (mean age 20.4, range 14-30, including 15 severe) were assessed by the HJHS1.0, Haemophilia Activities List (HAL), SF36 and self-evaluation was performed using a Visual Analogue Scale (VAS) scale. A subset of 12 patients were assessed by three physiotherapists to establish interobserver reliability (intraclass correlation coefficient: ICC). Total HJHS1.0 scores were calculated without overall global gait. Validity was explored by the assessment of Pearson's correlation with all outcome parameters and recent Pettersson scores. Overall outcome was good, with median HJHS score of 5.5 of a maximum 144 (range 0-34), median patients' VAS of 96.5 and maximum scores for HAL and SF36 physical functioning for the majority of patients. Pettersson scores were low (median 3.5 of 78, N = 18). Interobserver reliability was good (ICC 0.84), with limits of agreement of ±7.2 points. ICC was unaffected by different score calculation methods. Exploration of validity in 22 patients showed weak correlations of HJHS scores with patients' VAS (0.33) and HAL (-0.40) and strong correlations with SF36-PF (-0.66) and Pettersson scores (0.86). These results suggest that interobserver reliability of the HJHS1.0 in teenagers and young adults with limited joint damage is excellent. Preliminary data on validity were similar or better than those in children.

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Reproducibility of the Pettersson Scoring System

Cited by 30 publications

References 18 publications

Reliability of progressive and additive MRI scoring systems for evaluation of haemophilic arthropathy in children: Expert MRI Working Group of the International Prophylaxis Study Group

Reliability of progressive and additive MRI scoring systems for evaluation of haemophilic arthropathy in children: Expert MRI Working Group of the International Prophylaxis Study Group

Dose and response in haemophilia – optimization of factor replacement therapy

Using the Haemophilia Joint Health Score for assessment of teenagers and young adults: exploring reliability and validity

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