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Research ArticleArticle

Outcomes Measured in Polymyalgia Rheumatica and Measurement Properties of Instruments Considered for the OMERACT Core Outcome Set: A Systematic Review

Helen Twohig, Claire Owen, Sara Muller, Christian D. Mallen, Caroline Mitchell, Samantha Hider, Catherine Hill, Beverley Shea and Sarah Mackie
The Journal of Rheumatology August 2020, jrheum.200248; DOI: https://doi.org/10.3899/jrheum.200248
Helen Twohig
This work was supported by a Wellcome Trust PhD Programme for Primary Care Clinicians [203921/Z/16/Z], which supports Helen Twohig. CDM is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, the NIHR School for Primary Care Research and a NIHR Research Professorship in General Practice (NIHRRP- 2014-04-026). The views expressed in this paper are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. 1H. Twohig, MRCP, MRCGP, S. Muller, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK; 2C. Owen, MBBS (Hons), FRACP, Department of Rheumatology, Austin Health, and Department of Medicine, University of Melbourne, Melbourne, Australia; 3C.D. Mallen, FRCGP, PhD, S. Hider, FRCP, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, and Midlands Partnership Foundation Trust, Staffordshire, UK; 4C. Mitchell, FRCGP, MD, Academic Department of Primary Medical Care, University of Sheffield, Sheffield, UK; 5C. Hill, FRACP, MD, Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospitals, and Discipline of Medicine, The University of Adelaide, Adelaide, Australia; 6B. Shea, PhD, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; 7S.L. Mackie, MRCP, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Woodhouse, Leeds, UK. S.L. Mackie declares consultancy to Roche, Chugai, and Sanofi on behalf of University of Leeds (no money paid to her directly in last 3 years); Patron of PMRGCAuk; current or recent site investigator on clinical trials for GSK and Sanofi; and EULAR2019 attendance supported by Roche. S. Muller is a trustee of PMRGCAuk. Address correspondence to Dr. H. Twohig, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK. Email: h.j.twohig@keele.ac.uk. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication July 13, 2020.
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Claire Owen
This work was supported by a Wellcome Trust PhD Programme for Primary Care Clinicians [203921/Z/16/Z], which supports Helen Twohig. CDM is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, the NIHR School for Primary Care Research and a NIHR Research Professorship in General Practice (NIHRRP- 2014-04-026). The views expressed in this paper are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. 1H. Twohig, MRCP, MRCGP, S. Muller, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK; 2C. Owen, MBBS (Hons), FRACP, Department of Rheumatology, Austin Health, and Department of Medicine, University of Melbourne, Melbourne, Australia; 3C.D. Mallen, FRCGP, PhD, S. Hider, FRCP, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, and Midlands Partnership Foundation Trust, Staffordshire, UK; 4C. Mitchell, FRCGP, MD, Academic Department of Primary Medical Care, University of Sheffield, Sheffield, UK; 5C. Hill, FRACP, MD, Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospitals, and Discipline of Medicine, The University of Adelaide, Adelaide, Australia; 6B. Shea, PhD, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; 7S.L. Mackie, MRCP, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Woodhouse, Leeds, UK. S.L. Mackie declares consultancy to Roche, Chugai, and Sanofi on behalf of University of Leeds (no money paid to her directly in last 3 years); Patron of PMRGCAuk; current or recent site investigator on clinical trials for GSK and Sanofi; and EULAR2019 attendance supported by Roche. S. Muller is a trustee of PMRGCAuk. Address correspondence to Dr. H. Twohig, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK. Email: h.j.twohig@keele.ac.uk. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication July 13, 2020.
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Sara Muller
This work was supported by a Wellcome Trust PhD Programme for Primary Care Clinicians [203921/Z/16/Z], which supports Helen Twohig. CDM is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, the NIHR School for Primary Care Research and a NIHR Research Professorship in General Practice (NIHRRP- 2014-04-026). The views expressed in this paper are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. 1H. Twohig, MRCP, MRCGP, S. Muller, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK; 2C. Owen, MBBS (Hons), FRACP, Department of Rheumatology, Austin Health, and Department of Medicine, University of Melbourne, Melbourne, Australia; 3C.D. Mallen, FRCGP, PhD, S. Hider, FRCP, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, and Midlands Partnership Foundation Trust, Staffordshire, UK; 4C. Mitchell, FRCGP, MD, Academic Department of Primary Medical Care, University of Sheffield, Sheffield, UK; 5C. Hill, FRACP, MD, Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospitals, and Discipline of Medicine, The University of Adelaide, Adelaide, Australia; 6B. Shea, PhD, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; 7S.L. Mackie, MRCP, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Woodhouse, Leeds, UK. S.L. Mackie declares consultancy to Roche, Chugai, and Sanofi on behalf of University of Leeds (no money paid to her directly in last 3 years); Patron of PMRGCAuk; current or recent site investigator on clinical trials for GSK and Sanofi; and EULAR2019 attendance supported by Roche. S. Muller is a trustee of PMRGCAuk. Address correspondence to Dr. H. Twohig, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK. Email: h.j.twohig@keele.ac.uk. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication July 13, 2020.
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Christian D. Mallen
This work was supported by a Wellcome Trust PhD Programme for Primary Care Clinicians [203921/Z/16/Z], which supports Helen Twohig. CDM is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, the NIHR School for Primary Care Research and a NIHR Research Professorship in General Practice (NIHRRP- 2014-04-026). The views expressed in this paper are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. 1H. Twohig, MRCP, MRCGP, S. Muller, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK; 2C. Owen, MBBS (Hons), FRACP, Department of Rheumatology, Austin Health, and Department of Medicine, University of Melbourne, Melbourne, Australia; 3C.D. Mallen, FRCGP, PhD, S. Hider, FRCP, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, and Midlands Partnership Foundation Trust, Staffordshire, UK; 4C. Mitchell, FRCGP, MD, Academic Department of Primary Medical Care, University of Sheffield, Sheffield, UK; 5C. Hill, FRACP, MD, Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospitals, and Discipline of Medicine, The University of Adelaide, Adelaide, Australia; 6B. Shea, PhD, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; 7S.L. Mackie, MRCP, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Woodhouse, Leeds, UK. S.L. Mackie declares consultancy to Roche, Chugai, and Sanofi on behalf of University of Leeds (no money paid to her directly in last 3 years); Patron of PMRGCAuk; current or recent site investigator on clinical trials for GSK and Sanofi; and EULAR2019 attendance supported by Roche. S. Muller is a trustee of PMRGCAuk. Address correspondence to Dr. H. Twohig, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK. Email: h.j.twohig@keele.ac.uk. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication July 13, 2020.
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Caroline Mitchell
This work was supported by a Wellcome Trust PhD Programme for Primary Care Clinicians [203921/Z/16/Z], which supports Helen Twohig. CDM is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, the NIHR School for Primary Care Research and a NIHR Research Professorship in General Practice (NIHRRP- 2014-04-026). The views expressed in this paper are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. 1H. Twohig, MRCP, MRCGP, S. Muller, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK; 2C. Owen, MBBS (Hons), FRACP, Department of Rheumatology, Austin Health, and Department of Medicine, University of Melbourne, Melbourne, Australia; 3C.D. Mallen, FRCGP, PhD, S. Hider, FRCP, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, and Midlands Partnership Foundation Trust, Staffordshire, UK; 4C. Mitchell, FRCGP, MD, Academic Department of Primary Medical Care, University of Sheffield, Sheffield, UK; 5C. Hill, FRACP, MD, Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospitals, and Discipline of Medicine, The University of Adelaide, Adelaide, Australia; 6B. Shea, PhD, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; 7S.L. Mackie, MRCP, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Woodhouse, Leeds, UK. S.L. Mackie declares consultancy to Roche, Chugai, and Sanofi on behalf of University of Leeds (no money paid to her directly in last 3 years); Patron of PMRGCAuk; current or recent site investigator on clinical trials for GSK and Sanofi; and EULAR2019 attendance supported by Roche. S. Muller is a trustee of PMRGCAuk. Address correspondence to Dr. H. Twohig, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK. Email: h.j.twohig@keele.ac.uk. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication July 13, 2020.
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Samantha Hider
This work was supported by a Wellcome Trust PhD Programme for Primary Care Clinicians [203921/Z/16/Z], which supports Helen Twohig. CDM is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, the NIHR School for Primary Care Research and a NIHR Research Professorship in General Practice (NIHRRP- 2014-04-026). The views expressed in this paper are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. 1H. Twohig, MRCP, MRCGP, S. Muller, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK; 2C. Owen, MBBS (Hons), FRACP, Department of Rheumatology, Austin Health, and Department of Medicine, University of Melbourne, Melbourne, Australia; 3C.D. Mallen, FRCGP, PhD, S. Hider, FRCP, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, and Midlands Partnership Foundation Trust, Staffordshire, UK; 4C. Mitchell, FRCGP, MD, Academic Department of Primary Medical Care, University of Sheffield, Sheffield, UK; 5C. Hill, FRACP, MD, Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospitals, and Discipline of Medicine, The University of Adelaide, Adelaide, Australia; 6B. Shea, PhD, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; 7S.L. Mackie, MRCP, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Woodhouse, Leeds, UK. S.L. Mackie declares consultancy to Roche, Chugai, and Sanofi on behalf of University of Leeds (no money paid to her directly in last 3 years); Patron of PMRGCAuk; current or recent site investigator on clinical trials for GSK and Sanofi; and EULAR2019 attendance supported by Roche. S. Muller is a trustee of PMRGCAuk. Address correspondence to Dr. H. Twohig, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK. Email: h.j.twohig@keele.ac.uk. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication July 13, 2020.
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Catherine Hill
This work was supported by a Wellcome Trust PhD Programme for Primary Care Clinicians [203921/Z/16/Z], which supports Helen Twohig. CDM is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, the NIHR School for Primary Care Research and a NIHR Research Professorship in General Practice (NIHRRP- 2014-04-026). The views expressed in this paper are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. 1H. Twohig, MRCP, MRCGP, S. Muller, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK; 2C. Owen, MBBS (Hons), FRACP, Department of Rheumatology, Austin Health, and Department of Medicine, University of Melbourne, Melbourne, Australia; 3C.D. Mallen, FRCGP, PhD, S. Hider, FRCP, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, and Midlands Partnership Foundation Trust, Staffordshire, UK; 4C. Mitchell, FRCGP, MD, Academic Department of Primary Medical Care, University of Sheffield, Sheffield, UK; 5C. Hill, FRACP, MD, Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospitals, and Discipline of Medicine, The University of Adelaide, Adelaide, Australia; 6B. Shea, PhD, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; 7S.L. Mackie, MRCP, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Woodhouse, Leeds, UK. S.L. Mackie declares consultancy to Roche, Chugai, and Sanofi on behalf of University of Leeds (no money paid to her directly in last 3 years); Patron of PMRGCAuk; current or recent site investigator on clinical trials for GSK and Sanofi; and EULAR2019 attendance supported by Roche. S. Muller is a trustee of PMRGCAuk. Address correspondence to Dr. H. Twohig, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK. Email: h.j.twohig@keele.ac.uk. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication July 13, 2020.
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Beverley Shea
This work was supported by a Wellcome Trust PhD Programme for Primary Care Clinicians [203921/Z/16/Z], which supports Helen Twohig. CDM is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, the NIHR School for Primary Care Research and a NIHR Research Professorship in General Practice (NIHRRP- 2014-04-026). The views expressed in this paper are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. 1H. Twohig, MRCP, MRCGP, S. Muller, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK; 2C. Owen, MBBS (Hons), FRACP, Department of Rheumatology, Austin Health, and Department of Medicine, University of Melbourne, Melbourne, Australia; 3C.D. Mallen, FRCGP, PhD, S. Hider, FRCP, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, and Midlands Partnership Foundation Trust, Staffordshire, UK; 4C. Mitchell, FRCGP, MD, Academic Department of Primary Medical Care, University of Sheffield, Sheffield, UK; 5C. Hill, FRACP, MD, Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospitals, and Discipline of Medicine, The University of Adelaide, Adelaide, Australia; 6B. Shea, PhD, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; 7S.L. Mackie, MRCP, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Woodhouse, Leeds, UK. S.L. Mackie declares consultancy to Roche, Chugai, and Sanofi on behalf of University of Leeds (no money paid to her directly in last 3 years); Patron of PMRGCAuk; current or recent site investigator on clinical trials for GSK and Sanofi; and EULAR2019 attendance supported by Roche. S. Muller is a trustee of PMRGCAuk. Address correspondence to Dr. H. Twohig, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK. Email: h.j.twohig@keele.ac.uk. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication July 13, 2020.
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Sarah Mackie
This work was supported by a Wellcome Trust PhD Programme for Primary Care Clinicians [203921/Z/16/Z], which supports Helen Twohig. CDM is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, the NIHR School for Primary Care Research and a NIHR Research Professorship in General Practice (NIHRRP- 2014-04-026). The views expressed in this paper are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. 1H. Twohig, MRCP, MRCGP, S. Muller, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK; 2C. Owen, MBBS (Hons), FRACP, Department of Rheumatology, Austin Health, and Department of Medicine, University of Melbourne, Melbourne, Australia; 3C.D. Mallen, FRCGP, PhD, S. Hider, FRCP, PhD, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, and Midlands Partnership Foundation Trust, Staffordshire, UK; 4C. Mitchell, FRCGP, MD, Academic Department of Primary Medical Care, University of Sheffield, Sheffield, UK; 5C. Hill, FRACP, MD, Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospitals, and Discipline of Medicine, The University of Adelaide, Adelaide, Australia; 6B. Shea, PhD, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; 7S.L. Mackie, MRCP, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Woodhouse, Leeds, UK. S.L. Mackie declares consultancy to Roche, Chugai, and Sanofi on behalf of University of Leeds (no money paid to her directly in last 3 years); Patron of PMRGCAuk; current or recent site investigator on clinical trials for GSK and Sanofi; and EULAR2019 attendance supported by Roche. S. Muller is a trustee of PMRGCAuk. Address correspondence to Dr. H. Twohig, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK. Email: h.j.twohig@keele.ac.uk. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication July 13, 2020.
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Abstract

Objective To systematically identify the outcome measures and instruments used in clinical studies of polymyalgia rheumatica (PMR) and to evaluate evidence about their measurement properties.

Methods Searches based on the MeSH term “polymyalgia rheumatica” were carried out in 5 databases. Two researchers were involved in screening, data extraction, and risk of bias assessment. Once outcomes and instruments used were identified and categorized, key instruments were selected for further review through a consensus process. Studies on measurement properties of these instruments were appraised against the COSMIN-OMERACT (COnsensus-based Standards for the selection of health Measurement Instruments–Outcome Measures in Rheumatology) checklist to determine the extent of evidence supporting their use in PMR.

Results Forty-six studies were included. In decreasing order of frequency, the most common outcomes (and instruments) used were markers of systemic inflammation [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)], pain [visual analog scale (VAS)], stiffness (duration in minutes), and physical function (elevation of upper limbs). Instruments selected for further evaluation were ESR, CRP, pain VAS, morning stiffness duration, and the Health Assessment Questionnaire. Five studies evaluated measurement properties of these instruments, but none met all of the COSMIN-OMERACT checklist criteria.

Conclusion Measurement of outcomes in studies of PMR lacks consistency. The critical patient-centered domain of physical function is poorly assessed. None of the candidate instruments considered for inclusion in the core outcome set had high-quality evidence, derived from populations with PMR, on their full range of measurement properties. Further studies are needed to determine whether these instruments are suitable for inclusion in a core outcome measurement set for PMR.

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Outcomes Measured in Polymyalgia Rheumatica and Measurement Properties of Instruments Considered for the OMERACT Core Outcome Set: A Systematic Review
Helen Twohig, Claire Owen, Sara Muller, Christian D. Mallen, Caroline Mitchell, Samantha Hider, Catherine Hill, Beverley Shea, Sarah Mackie
The Journal of Rheumatology Aug 2020, jrheum.200248; DOI: 10.3899/jrheum.200248

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Outcomes Measured in Polymyalgia Rheumatica and Measurement Properties of Instruments Considered for the OMERACT Core Outcome Set: A Systematic Review
Helen Twohig, Claire Owen, Sara Muller, Christian D. Mallen, Caroline Mitchell, Samantha Hider, Catherine Hill, Beverley Shea, Sarah Mackie
The Journal of Rheumatology Aug 2020, jrheum.200248; DOI: 10.3899/jrheum.200248
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