Andréa Marques

Validation of the educational needs assessment tool as a generic instrument for rheumatic diseases in seven European countries

Objectives To validate the educational needs assessment tool (ENAT) as a generic tool for assessing the educational needs of patients with rheumatic diseases in European Countries. Methods A convenience sample of patients from seven European countries was included comprising the following diagnostic groups: ankylosing spondylitis, psoriatic arthritis, systemic sclerosis, systemic lupus erythematosus, osteoarthritis (OA) and fibromyalgia syndrome. Translated versions of the ENAT were completed through surveys in each country. Rasch analysis was used to assess the construct validity of the adapted ENATs including differential item functioning by culture (cross-cultural DIF). Initially, the data from each country and diagnostic group were fitted to the Rasch model separately, and then the pooled data from each diagnostic group. Results The sample comprised 3015 patients; the majority, 1996 (66.2%), were women. Patient characteristics (stratified by diagnostic group) were comparable across countries except the educational background, which was variable. In most occasions, the 39-item ENAT deviated significantly from the Rasch model expectations (item–trait interaction χ2 p<0.05). After correction for local dependency (grouping the items into seven domains and analysing them as ‘testlets’), fit to the model was satisfied (item–trait interaction χ2 p>0.18) in all pooled disease group datasets except OA (χ2=99.91; p=0.002). The internal consistency in each group was high (Person Separation Index above 0.90). There was no significant DIF by person characteristics. Cross-cultural DIF was found in some items, which required adjustments. Subsequently, interval-level scales were calibrated to enable transformation of ENAT scores when required. Conclusions The adapted ENAT is a valid tool with high internal consistency providing accurate estimation of the educational needs of people with rheumatic diseases. Cross-cultural comparison of educational needs is now possible.

Do we need bone mineral density to estimate osteoporotic fracture risk? A 10-year prospective multicentre validation study

Objective Evaluate the performance of FRAX®, with and without bone mineral densitometry (BMD), in predicting the occurrence of fragility fractures over 10 years. Methods Participants aged ≥40 years at baseline, with a complete set of data and a minimum of 8.5 years of follow-up were identified from three cohorts (n=2626). Ten-year fracture risk at baseline were estimated with FRAX® and assessed by comparison with observed fractures and receiver operating characteristic analysis. Results During a mean (SD) follow-up of 9.12 (1.5) years, 178 participants suffered a major osteoporotic (MOP) fracture and 28 sustained a hip fracture. The predictive performance of FRAX® was superior to that of BMD alone for both MOP and hip fractures. The area under the curve (AUC) of FRAX® without BMD was 0.76 (95% CI 0.72 to 0.79) for MOP fractures and 0.78 (95% CI 0.69 to 0.86) for hip fractures. No significant improvements were found when BMD was added to clinical variables to predict either MOP (0.78, 95% CI 0.74 to 0.82, p=0.25) or hip fractures (0.79, 95% CI 0.69 to 0.89, p=0.72). AUCs for FRAX® (with and without BMD) were greater for men than for women. FRAX®, with and without BMD, tended to underestimate the number of MOP fractures and to overestimate the number of hip fractures in females. In men, the number of observed fractures were within the 95% CI of the number predicted, both with and without BMD. Conclusion FRAX® without BMD provided good fracture prediction. Adding BMD to FRAX® did not improve the performance of the tool in the general population.

Como Realizar e Interpretar uma Meta-Análise em Rede para Comparações Indiretas e Mistas: Estratégias Metodológicas Fundamentais

Background : Meta-analysis techniques were traditionally used to assess the effectiveness and safety of a treatment through direct comparison with a single...

THU0370 Hip Fractures in Portugal: 2006-2010 an Epidemiologic Analysis

Background Hip fractures are considered to be the most devastating consequence of osteoporosis. They require long hospitalizations and high health-care costs and represent an important cause of morbidity, disability, and mortality, especially in the elderly1. As patients are invariably hospitalized in most countries the epidemiology of hip fracture is well documented compared with other fracture outcomes and provides a surrogate for the total burden of osteoporosis2. Objectives To carry out an epidemiologic analyses of hip fractures incidence rates in Portugal. Methods All cases of hip fracture occurred at 40 years of age or above from 2006 to 2010 were extracted from the Portuguese National Hospital Discharge Register. Age and gender-stratified population data was collected from the Institute for National Statistics. Average annual incidences were computed for age and gender groups along with the associated mortality, length of hospital stay and destination of the patient after discharge. Statistical differences between genders were assessed trough IBM SPSS® 20 with 0.05 as level of significance. Results A total of 51701 hip fractures occurred in the period under analysis. Hip fracture incidence rates were higher in women than in men and increased with age. The lowest incidence was observed in the 40-44 age group (14.1 and 4.0 per 100,000 inhabitants for men and women, respectively). The highest rate was observed among the 95-100 age-group (2,577.6 and3,551.8/100,000 inhabitants, for men and women, respectively). The mean length of hospital stay was13.4 days for men and 14.2 days for women (t(19271.4)=6.731; p<0.05), respectively. We also found statistically significant differences between genders on patient’s destination after discharge (Chi Square(5)=253.099; p<0.05), the most frequent being: home 88.5% (men=85.3%; women=89.6%), mortality 5.1% (men=7.9%; women=4.3%), transferred for another hospital 3.9% (men=4.9%; women=3.7%), with homecare help 1.9% (men=1.2%; women=1.9%), discharge without medical consent 0.6%( men=0.7%; women=0.5%). Conclusions As expected women have a higher incidence of hip fractures. The Portuguese women are more likely to go home after being discharge of the hospital and have a lower mortality. Men are more likely to be transferred for another hospital. Further studies are necessary for access the mortality rates after discharge. References Kanis, J.A. & Johnell, O. (2005). Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int., 16:229–38. Cooper, C., Cole, Z.A., Holroyd, C.R., Earl, S.C., Harvey, N.C., Dennison, E.M., Melton, L.J., Cummings, S.R., & Kanis, J.A. (2011). Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int., 22:1277–88. Disclosure of Interest None Declared