Cecilia Wilson

Population-Based Normative Values for the Western Ontario and McMaster (WOMAC) Osteoarthritis Index: Part I

OBJECTIVES To develop population-based age- and gender-specific normative values for the pain, stiffness, and physical function subscales of the WOMAC Index for benchmarking applications. METHODS A scannable survey questionnaire capable of capturing WOMAC Index data and demographic information was developed, pretested, and distributed to a stratified random sample of 36,000 members of the Australian general public generated by the Australian Electoral Commission. RESULTS Age- and gender-specific WOMAC normative values were estimated based on approximately 7300 subjects. Age-related differences were noted in all 3 WOMAC subscales. In general, pain, stiffness, and difficulty with physical function percentiles increased with age. CONCLUSIONS WOMAC normative values provide opportunity for benchmarking the health status of individuals with hip and knee osteoarthritis against their age- and gender-matched peers in the general population. These normative values provide unique opportunities for using the WOMAC Index in benchmarking applications in both clinical practice and research.

Population-based normative values for the Western Ontario and McMaster (WOMAC ® ) osteoarthritis index and the Australian/Canadian (AUSCAN) hand osteoarthritis index functional subscales

AimTo develop age- and gender-specific normative values for the physical function subscales of the WOMAC® and AUSCAN Indices.MethodsA scannable survey questionnaire capable of capturing WOMAC® and AUSCAN Index and demographic information was developed, pre-tested, and distributed to a stratified random sample of 24,000 members of the Australian general public generated by the Australian Electoral Commission (AEC).ResultsAge- and gender-specific WOMAC® and AUSCAN normative values were estimated based on approximately 5,500 subjects. Age-related differences were noted at the subscale level. In general, disability increased with age for all items and both Indices.ConclusionsNormative values provide opportunity for benchmarking the health status of individuals against their age- and gender-matched peers in the general population. These normative values provide unique opportunities, for using the WOMAC® and AUSCAN Indices in benchmarking applications, in both clinical practice and research.

Frail older people as participants in research

This article describes the experience of interviewing frail older people in a research project investigating hip fracture risk factors. Specific methodological strategies to maximize participation and data quality and to facilitate the interview process related to participant inclusion criteria, initial approach, questionnaire format, and administration. Results from 387 interviews showed that expectations of problems in interviewing an aged population with high levels of disability were not realized. With careful planning, high response rates can be achieved and the interview experience can be richly rewarding for both participants and researchers.

Osteoarthritis Measurement in Routine Rheumatology Outpatient Practice (OMIRROP) in Australia: A Survey of Practice Style, Instrument Use, Responder Criteria, and State-Attainment Criteria

Objective. The purpose of the 2007 Osteoarthritis Measurement in Routine Rheumatology Outpatient Practice survey was to describe practice styles, instrument usage, and perceptions of responder criteria and state-attainment criteria in osteoarthritis (OA) management in routine clinical rheumatology practice. Methods. A 16-item questionnaire (65 subcomponents) was developed, pretested, revised, formatted, and mailed to rheumatologists residing in Australia. Responses were obtained from 136 rheumatologists (response rate 58%). Results. Approximately half the Australian respondents did not follow up their patients with hip and knee OA and two-thirds did not follow up their patients with hand OA. Health status measures (HSM) were infrequently used, even by those respondents who followed their patients with OA longitudinally, and the scores from those HSM that were used, were rarely if ever formally recorded. Respondents rated the following 6 requirements of a measure for use in clinical practice as very important: validity, reliability, responsiveness, simplicity, quick completion, and easy scoring. One-fifth to one-quarter of respondents indicated they did not know quantitatively what constituted a clinically important improvement, or a health state acceptable to patients with OA. The majority of the remainder selected values not closely aligned with published values in the peer review literature. Conclusion. While simply describing the health status of the patient is interesting, the more strategic applications are in benchmarking, and using the data to inform shared decision-making and therapeutic goal-setting. The OMIRROP survey suggests that further investigation of interpretation issues are essential, before evaluating the role of quantitative measurement in routine OA clinical practice.

Population-based normative values for the Australian/Canadian (AUSCAN) Hand Osteoarthritis Index: Part 2

OBJECTIVES To develop population-based age- and gender-specific normative values for the pain, stiffness, and physical function subscales of the AUSCAN Index for benchmarking applications. METHODS A scannable survey questionnaire capable of capturing AUSCAN Index data and demographic information was developed, pretested, and distributed to a stratified random sample of 36,000 members of the Australian general public generated by the Australian Electoral Commission. RESULTS Age- and gender-specific AUSCAN normative values were estimated based on approximately 7300 subjects. Age-related differences were noted in all 3 AUSCAN subscales. In general, pain, stiffness, and difficulty with physical function percentiles increased with age. CONCLUSIONS AUSCAN normative values provide opportunity for benchmarking the health status of individuals with hand osteoarthritis against their age- and gender-matched peers in the general population. These normative values provide unique opportunities for using the AUSCAN Index in benchmarking applications, in both clinical practice and research.

Observations on Module 4 (Patient Global Assessment) of the Osteoarthritis Modular Measurement System (02MSTM)

Skeletal scintigraphy is one of the most commonly requested nuclear medicine tests. Extraosseous conditions including myositis have been described with this imaging modality. A 75-year-old febrile gentleman was initially suspected to have right lower leg cellulitis. A lower limb Doppler ultrasound revealed fi ndings suggestive of myositis without focal abscess or collection in the right pretibial region. Subsequently, SPECT/CT bone scintigraphy demonstrated abnormal uptake in the pretibial soft tissue as well as in the left piriformis muscle, consistent with multifocal myositis. Clinically, the underlying aetiology was felt to be infectious and the patient improved with antibiotics. This case helps illustrate the usefulness of SPECT/CT bone scintigraphy in demonstrating extraosseous lesions and in excluding common conditions, such as fractures and osteomyelitis.