human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Health status measures are conceptually relevant to the assessment of clinical outcome in the rheumatic diseases , but their ability to detect meaningful changes in health has not been clearly demonstrated . This report describes the performance of a self-administered health status question naire in a r and omized , double-blind , 21-week comparison of placebo , oral gold , and injectable gold in rheumatoid arthritis patients . Outcome was assessed by st and ard clinical measures , including joint count , grip strength , and laboratory tests , and by the Arthritis Impact Measurement Scales , a reliable and valid health status measure that assesses physical disability , psychological status , and pain . Data from the clinical and health status measures produced highly similar conclusions : injectable and oral gold are more effective than placebo for rheumatoid arthritis , and injections are slightly more effective than oral gold . The health status measure was thus quite sensitive to clinical ly meaningful drug-induced improvements . These findings provide justification for the further application of health status measures to clinical trials of chronic disease OBJECTIVE To determine the discriminant validity of the core set of outcome measures proposed by the American College of Rheumatology ( ACR ) and the Outcome Measures in Clinical Trials ( OMERACT ) conference committee to be used in clinical trials of rheumatoid arthritis ( RA ) . METHODS Utilizing data from a multicenter r and omized double-blind clinical trial of low-dose cyclosporine and placebo in RA , we estimated the relative efficiency ( RE ) of measures to detect a treatment effect ( relative to tender joint count , which was assigned a value of 1 ) . Four pain measures ( 10-cm visual analog scale [ VAS ] , 5-point categorical scale , Health Assessment Question naire [ HAQ ] pain index , Arthritis Impact Measurement Scales [ AIMS ] pain score ) and 3 quality -of-life measures ( Problem Elicitation Technique [ PET ] , HAQ , AIMS )  were compared . RESULTS Physician and patient global measures were the most responsive instruments , although neither was statistically superior to tender joint count . Swollen joint count , grip strength , pain measured on a 10-cm VAS , and functional status as measured by the PET and HAQ were all of intermediate responsiveness . Morning stiffness , 5-point pain scale , and erythrocyte sedimentation rate were the least responsive instruments . CONCLUSION This study provides further evidence to support the core set of outcome measures proposed by the ACR and OMERACT Observational and longitudinal observational studies ( LOS ) provide essential information about the course and outcome of rheumatic disorders that can not be provided by r and omized controlled trials , and they constitute the major clinical scientific communication in rheumatology . There has been no consensus as to the full and appropriate content of LOS . This report defines a core set of domains and reporting requirements for LOS . At the 1998 OMERACT IV Conference a consensus process evaluated the literature of rheumatology in light of the constructs , variables , and outcomes of rheumatology by using introductory lectures , nominal groups , and plenary sessions . The result of this process was to identify 5 " core " domains that should be included in every LOS : Health Status , Disease Process , Damage , Mortality , and Toxicity/Adverse Reactions . Two additional domains , Work Disability and Costs , were recognized as important , but need not be used in all LOS . Eleven subdomains were identified that divided the domains into convenient clinical and conceptual units . A set of reporting requirements was also determined . The core recommendations , which follow on the WHO ICIDH-2 outline , are not disease-specific ; the substitution of different " disease process " and " damage " measures make them suitable for many rheumatic disorders . The core set is intended to serve as a core for LOS in almost all rheumatic conditions Is the modified aneroid sphygmomanometer a valid instrument to measure isometric quadriceps strength ? Three techniques were compared : the cuff method , in which the original cuff and bladder were folded then secured by rubber b and s ; the bag method , in which the folded bladder was secured in a sewn bag ; and a st and ard method , employing weights . Using a design to control for method and order of measurement , five physiotherapists measured quadriceps muscle strength in five rheumatoid patients . The design features explained 97 % of the variation amongst the measurements . Order of observation and the observers had no effect on the measurements . Patients were quite different and methods of measurement were different . The cuff and bag methods obtained higher readings than the weights , and the bag readings were higher than the cuff . Compared to the st and ard weights , the sphygmomanometer methods were : equally sensitive and reproducible , performed in 16th of the time , independent of gravity and potentially adaptable to 24 different muscle groups OBJECTIVE To determine the reliability , validity , and responsiveness of the modified Kap and ji index ( MKI ) . DESIGN Prospect i ve study . A cohort of patients planned for surgery of the wrist and /or fingers was evaluated within 48 hours before surgery and at least 6 months after surgery . SETTING Patients were in hospitalized or private care in France . PARTICIPANTS Patients with rheumatoid arthritis according to criteria of the American College of Rheumatology . Forty-two patients ( 36 women ; mean age , 57.5y ; range , 22 - 80y ) were included in the reliability study . Fifty patients ( 42 women ; mean age , 54.18y ; range , 19 - 77y ) were included in the validity study . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Clinical outcome measures included the MKI , the overall mobility score of the wrist and fingers , the finger mobility score , a visual analog scale ( VAS ) of pain in the h and s and wrists , morning stiffness duration , total score of tenderness , total score of swelling , grip and pinch strength , the H and Functional Index ( HFI ) , and the Cochin rheumatoid h and disability scale . Reliability was studied with the intraclass correlation coefficient ( ICC ) and the Bl and and Altman method . Convergent and divergent validity were assessed with the Spearman correlation coefficient . Responsiveness was assessed by the paired t test , the effect size , and the st and ardized response mean ( SRM ) . RESULTS Interobserver reliability was good with an ICC of.90 , and the Bl and and Altman analysis showed homogeneous distribution of the differences , with no systematic trend . The MKI correlated well with the other mobility measures ( HFI , the finger mobility score measured with the finger goniometer ) , indicating a good convergent validity , and the expected divergent validity with the other outcome measures ( grip and pinch strength , total score of swelling , total score of Ritchie Articular Index , Cochin scale , VAS of pain ) was observed . The 50 patients in the validity study were evaluated twice , before and after surgery , at a mean interval + /- st and ard deviation of 7.16+/-2.10 months ( range , 6 - 15mo ) . Thirty-six patients ( 72 % ) were very satisfied or satisfied with the results of surgery , 7 ( 14 % ) were not satisfied or dissatisfied , and 7 ( 14 % ) were dissatisfied or very dissatisfied . The SRM and effect size values of the MKI were -.19 and -.10 , respectively . Individual changes in the score had the best correlation ( r(s)=.51 ) with overall patient satisfaction . CONCLUSIONS The MKI has excellent validity and reliability . Individual changes in the score are clinical ly relevant . This index can be used in clinical practice and in therapeutic trials ; it needs further study concerning its use for h and surgery OBJECTIVES To determine the agreement of scores on the original visual analog scale ( VAS ) or Likert scale of the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , Bath Ankylosing Spondylitis Functional Index ( BASFI ) , and Dougados Functional Index ( DFI ) with scores on a numerical rating scale ( NRS ) . To assess the reproducibility and responsiveness of the instruments with the original scale and NRS . METHODS Five hundred thirty-six patients with ankylosing spondylitis from the Netherl and s , Mexico , and Switzerl and completed a question naire  in which all questions from the BASDAI , BASFI , and DFI were presented twice in r and om order with an 11-point NRS and either a 10-cm VAS ( BASDAI and BASFI ) or a 5-point Likert scale ( DFI ) . Agreement of scores using Bl and -Altman plots and intraclass correlation coefficients ( ICCs ) , reproducibility using ICCs , and responsiveness were assessed . RESULTS Large variability between the scores on the original scales and the NRS was found in individual questions of all 3 question naires , although total scores showed ICCs of at least 0.88 . Reproducibility of all answer modalities showed low ICCs in individual questions , but moderate to good ICCs in total scores ( Dutch group 0.62 - 0.89 ; Mexican group 0.53 - 0.72 ) . Moderate to large effects ( 0.48 - 1.04 ) were found in responsiveness scores in the 3 question naires . No major differences in reproducibility and responsiveness between the answer modalities were found . CONCLUSION Although large variability between the scores on the original answer scales and the NRS was observed , the BASDAI , BASFI , and DFI can be administered with an NRS , which does not show important differences compared with the original scales An articular index was devised for the sequential assessment of patients with osteoarthritis ( OA ) . Forty-eight joint units , chosen to reflect the characteristic pattern of the disease , were scored for tenderness on pressure or movement on a 4-point scale . Four observers examined patients to assess inter- and intraobserver error . The index was highly reproducible both within and between observers ; intraobserver error was , however , significantly smaller . In a double-blind , cross-over trial the index was sufficiently sensitive to detect a statistically significant difference between the responses of patients with OA to an anti-inflammatory agent and to a simple analgesic . It is likely to be a useful addition to current methods of measurement in osteoarthritis To assess the effect of grading of tenderness on the interrater reliability of the Ritchie articular index ( RAI ) , 3 physicians recorded independent joint scores on each of 18 patients , examined in r and om order . Our results indicate that close agreement ( Intraclass Correlation Coefficient = 0.85 ) can be achieved on global RAI scores , and that raters can achieve reasonable agreement ( kappa = 0.40 - 0.59 ) on the absolute presence or absence of tenderness of individual joints . By contrast , interrater agreement hardly exceeds the chance level ( kappa = 0.008 - 0.148 ) when degree of tenderness is independently assessed . The grading system of the RAI may thus be implicated as an important source of the instrument 's interrater error This study represents a long-term effort to find optimal techniques for evaluating outcome in patients who have undergone total joint arthroplasty . Sensitivity of five health status question naires was studied in a longitudinal evaluation of orthopedic surgery . The question naires ( Arthritis Impact Measurement Scales [ AIMS ] , Functional Status Index [ FSI ] ,  Health  Assessment  Question naire [ HAQ ] , Index of  Well  Being [ IWB ] , and Sickness Impact Profile  [ SIP ] ) were administered to 38 patients with end-stage arthritis at three points in time : two weeks before hip or knee arthroplasty , and at three-month and 12- to 15-month follow-up . Response values ( i.e. , changes within patients ) were calculated on four scales : global health , pain , mobility , and social function . By the three-month follow-up , most instruments detected large mean responses in global health , pain scores , and mobility . Smaller changes on these scales were found between three and 12 to 15 months . Social function showed small to modest gains at successive follow-ups . St and ardized response means were calculated to assess sensitivity to detect change . Confidence intervals for these indices were constructed using a jackknife procedure , and significance tests were performed by pairing selected indices . Finally , the study projected sample sizes required to assess a new therapy , using each response . These statistical tools facilitated comparisons among instruments and may prove useful in other setting Summary A simple pressure dolorimeter for the detection and quantification of joint tenderness is described and evaluated . The pressure dolorimeter was more sensitive than a modified Ritchie Index in measuring degree of joint tenderness and as sensitive in detecting tender joints . The interobserver error of the pressure dolorimeter was low , and in a drug withdrawal study , the pressure dolorimeter was able to detect change in joint tenderness whereas the conventional Ritchie Index was not . These results suggest that the pressure dolorimeter is a simple , reliable and sensitive instrument for measuring joint tenderness in patients with inflammatory joint disease . It is also inexpensive and readily available Five health status instruments were administered in r and om order to 50 arthritis patients before and after total joint arthroplasty . Relative efficiency and sensitivity in measurement of change in pain , mobility and physical function , social role and social activity , and global health were assessed . The instruments had highly correlated scores , but had differences in certain dimensions . Inter-instrument differentials were larger for social and global outcomes than for pain or mobility . NO single instrument consistently outperformed the others . A method for determining relative efficiency is described OBJECTIVE Evaluation of joint range of motion ( ROM )  is important in the therapeutic approach to patients with rheumatoid arthritis ( RA ) . The reliability , construct validity and sensitivity to change of the Escola Paulista de Medicina (EPM)--range of motion scale that measures 10 distinct movements of small and large joints were examined . METHODS Fifty patients with active RA who 
    Output:
    
agent
Only a limited number of the identified instruments for the assessment of impairments is both reliable and valid .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Health status measures are conceptually relevant to the assessment of clinical outcome in the rheumatic diseases , but their ability to detect meaningful changes in health has not been clearly demonstrated . This report describes the performance of a self-administered health status question naire in a r and omized , double-blind , 21-week comparison of placebo , oral gold , and injectable gold in rheumatoid arthritis patients . Outcome was assessed by st and ard clinical measures , including joint count , grip strength , and laboratory tests , and by the Arthritis Impact Measurement Scales , a reliable and valid health status measure that assesses physical disability , psychological status , and pain . Data from the clinical and health status measures produced highly similar conclusions : injectable and oral gold are more effective than placebo for rheumatoid arthritis , and injections are slightly more effective than oral gold . The health status measure was thus quite sensitive to clinical ly meaningful drug-induced improvements . These findings provide justification for the further application of health status measures to clinical trials of chronic disease OBJECTIVE To determine the discriminant validity of the core set of outcome measures proposed by the American College of Rheumatology ( ACR ) and the Outcome Measures in Clinical Trials ( OMERACT ) conference committee to be used in clinical trials of rheumatoid arthritis ( RA ) . METHODS Utilizing data from a multicenter r and omized double-blind clinical trial of low-dose cyclosporine and placebo in RA , we estimated the relative efficiency ( RE ) of measures to detect a treatment effect ( relative to tender joint count , which was assigned a value of 1 ) . Four pain measures ( 10-cm visual analog scale [ VAS ] , 5-point categorical scale , Health Assessment Question naire [ HAQ ] pain index , Arthritis Impact Measurement Scales [ AIMS ] pain score ) and 3 quality -of-life measures ( Problem Elicitation Technique [ PET ] , HAQ , AIMS )  were compared . RESULTS Physician and patient global measures were the most responsive instruments , although neither was statistically superior to tender joint count . Swollen joint count , grip strength , pain measured on a 10-cm VAS , and functional status as measured by the PET and HAQ were all of intermediate responsiveness . Morning stiffness , 5-point pain scale , and erythrocyte sedimentation rate were the least responsive instruments . CONCLUSION This study provides further evidence to support the core set of outcome measures proposed by the ACR and OMERACT Observational and longitudinal observational studies ( LOS ) provide essential information about the course and outcome of rheumatic disorders that can not be provided by r and omized controlled trials , and they constitute the major clinical scientific communication in rheumatology . There has been no consensus as to the full and appropriate content of LOS . This report defines a core set of domains and reporting requirements for LOS . At the 1998 OMERACT IV Conference a consensus process evaluated the literature of rheumatology in light of the constructs , variables , and outcomes of rheumatology by using introductory lectures , nominal groups , and plenary sessions . The result of this process was to identify 5 " core " domains that should be included in every LOS : Health Status , Disease Process , Damage , Mortality , and Toxicity/Adverse Reactions . Two additional domains , Work Disability and Costs , were recognized as important , but need not be used in all LOS . Eleven subdomains were identified that divided the domains into convenient clinical and conceptual units . A set of reporting requirements was also determined . The core recommendations , which follow on the WHO ICIDH-2 outline , are not disease-specific ; the substitution of different " disease process " and " damage " measures make them suitable for many rheumatic disorders . The core set is intended to serve as a core for LOS in almost all rheumatic conditions Is the modified aneroid sphygmomanometer a valid instrument to measure isometric quadriceps strength ? Three techniques were compared : the cuff method , in which the original cuff and bladder were folded then secured by rubber b and s ; the bag method , in which the folded bladder was secured in a sewn bag ; and a st and ard method , employing weights . Using a design to control for method and order of measurement , five physiotherapists measured quadriceps muscle strength in five rheumatoid patients . The design features explained 97 % of the variation amongst the measurements . Order of observation and the observers had no effect on the measurements . Patients were quite different and methods of measurement were different . The cuff and bag methods obtained higher readings than the weights , and the bag readings were higher than the cuff . Compared to the st and ard weights , the sphygmomanometer methods were : equally sensitive and reproducible , performed in 16th of the time , independent of gravity and potentially adaptable to 24 different muscle groups OBJECTIVE To determine the reliability , validity , and responsiveness of the modified Kap and ji index ( MKI ) . DESIGN Prospect i ve study . A cohort of patients planned for surgery of the wrist and /or fingers was evaluated within 48 hours before surgery and at least 6 months after surgery . SETTING Patients were in hospitalized or private care in France . PARTICIPANTS Patients with rheumatoid arthritis according to criteria of the American College of Rheumatology . Forty-two patients ( 36 women ; mean age , 57.5y ; range , 22 - 80y ) were included in the reliability study . Fifty patients ( 42 women ; mean age , 54.18y ; range , 19 - 77y ) were included in the validity study . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Clinical outcome measures included the MKI , the overall mobility score of the wrist and fingers , the finger mobility score , a visual analog scale ( VAS ) of pain in the h and s and wrists , morning stiffness duration , total score of tenderness , total score of swelling , grip and pinch strength , the H and Functional Index ( HFI ) , and the Cochin rheumatoid h and disability scale . Reliability was studied with the intraclass correlation coefficient ( ICC ) and the Bl and and Altman method . Convergent and divergent validity were assessed with the Spearman correlation coefficient . Responsiveness was assessed by the paired t test , the effect size , and the st and ardized response mean ( SRM ) . RESULTS Interobserver reliability was good with an ICC of.90 , and the Bl and and Altman analysis showed homogeneous distribution of the differences , with no systematic trend . The MKI correlated well with the other mobility measures ( HFI , the finger mobility score measured with the finger goniometer ) , indicating a good convergent validity , and the expected divergent validity with the other outcome measures ( grip and pinch strength , total score of swelling , total score of Ritchie Articular Index , Cochin scale , VAS of pain ) was observed . The 50 patients in the validity study were evaluated twice , before and after surgery , at a mean interval + /- st and ard deviation of 7.16+/-2.10 months ( range , 6 - 15mo ) . Thirty-six patients ( 72 % ) were very satisfied or satisfied with the results of surgery , 7 ( 14 % ) were not satisfied or dissatisfied , and 7 ( 14 % ) were dissatisfied or very dissatisfied . The SRM and effect size values of the MKI were -.19 and -.10 , respectively . Individual changes in the score had the best correlation ( r(s)=.51 ) with overall patient satisfaction . CONCLUSIONS The MKI has excellent validity and reliability . Individual changes in the score are clinical ly relevant . This index can be used in clinical practice and in therapeutic trials ; it needs further study concerning its use for h and surgery OBJECTIVES To determine the agreement of scores on the original visual analog scale ( VAS ) or Likert scale of the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , Bath Ankylosing Spondylitis Functional Index ( BASFI ) , and Dougados Functional Index ( DFI ) with scores on a numerical rating scale ( NRS ) . To assess the reproducibility and responsiveness of the instruments with the original scale and NRS . METHODS Five hundred thirty-six patients with ankylosing spondylitis from the Netherl and s , Mexico , and Switzerl and completed a question naire  in which all questions from the BASDAI , BASFI , and DFI were presented twice in r and om order with an 11-point NRS and either a 10-cm VAS ( BASDAI and BASFI ) or a 5-point Likert scale ( DFI ) . Agreement of scores using Bl and -Altman plots and intraclass correlation coefficients ( ICCs ) , reproducibility using ICCs , and responsiveness were assessed . RESULTS Large variability between the scores on the original scales and the NRS was found in individual questions of all 3 question naires , although total scores showed ICCs of at least 0.88 . Reproducibility of all answer modalities showed low ICCs in individual questions , but moderate to good ICCs in total scores ( Dutch group 0.62 - 0.89 ; Mexican group 0.53 - 0.72 ) . Moderate to large effects ( 0.48 - 1.04 ) were found in responsiveness scores in the 3 question naires . No major differences in reproducibility and responsiveness between the answer modalities were found . CONCLUSION Although large variability between the scores on the original answer scales and the NRS was observed , the BASDAI , BASFI , and DFI can be administered with an NRS , which does not show important differences compared with the original scales An articular index was devised for the sequential assessment of patients with osteoarthritis ( OA ) . Forty-eight joint units , chosen to reflect the characteristic pattern of the disease , were scored for tenderness on pressure or movement on a 4-point scale . Four observers examined patients to assess inter- and intraobserver error . The index was highly reproducible both within and between observers ; intraobserver error was , however , significantly smaller . In a double-blind , cross-over trial the index was sufficiently sensitive to detect a statistically significant difference between the responses of patients with OA to an anti-inflammatory agent and to a simple analgesic . It is likely to be a useful addition to current methods of measurement in osteoarthritis To assess the effect of grading of tenderness on the interrater reliability of the Ritchie articular index ( RAI ) , 3 physicians recorded independent joint scores on each of 18 patients , examined in r and om order . Our results indicate that close agreement ( Intraclass Correlation Coefficient = 0.85 ) can be achieved on global RAI scores , and that raters can achieve reasonable agreement ( kappa = 0.40 - 0.59 ) on the absolute presence or absence of tenderness of individual joints . By contrast , interrater agreement hardly exceeds the chance level ( kappa = 0.008 - 0.148 ) when degree of tenderness is independently assessed . The grading system of the RAI may thus be implicated as an important source of the instrument 's interrater error This study represents a long-term effort to find optimal techniques for evaluating outcome in patients who have undergone total joint arthroplasty . Sensitivity of five health status question naires was studied in a longitudinal evaluation of orthopedic surgery . The question naires ( Arthritis Impact Measurement Scales [ AIMS ] , Functional Status Index [ FSI ] ,  Health  Assessment  Question naire [ HAQ ] , Index of  Well  Being [ IWB ] , and Sickness Impact Profile  [ SIP ] ) were administered to 38 patients with end-stage arthritis at three points in time : two weeks before hip or knee arthroplasty , and at three-month and 12- to 15-month follow-up . Response values ( i.e. , changes within patients ) were calculated on four scales : global health , pain , mobility , and social function . By the three-month follow-up , most instruments detected large mean responses in global health , pain scores , and mobility . Smaller changes on these scales were found between three and 12 to 15 months . Social function showed small to modest gains at successive follow-ups . St and ardized response means were calculated to assess sensitivity to detect change . Confidence intervals for these indices were constructed using a jackknife procedure , and significance tests were performed by pairing selected indices . Finally , the study projected sample sizes required to assess a new therapy , using each response . These statistical tools facilitated comparisons among instruments and may prove useful in other setting Summary A simple pressure dolorimeter for the detection and quantification of joint tenderness is described and evaluated . The pressure dolorimeter was more sensitive than a modified Ritchie Index in measuring degree of joint tenderness and as sensitive in detecting tender joints . The interobserver error of the pressure dolorimeter was low , and in a drug withdrawal study , the pressure dolorimeter was able to detect change in joint tenderness whereas the conventional Ritchie Index was not . These results suggest that the pressure dolorimeter is a simple , reliable and sensitive instrument for measuring joint tenderness in patients with inflammatory joint disease . It is also inexpensive and readily available Five health status instruments were administered in r and om order to 50 arthritis patients before and after total joint arthroplasty . Relative efficiency and sensitivity in measurement of change in pain , mobility and physical function , social role and social activity , and global health were assessed . The instruments had highly correlated scores , but had differences in certain dimensions . Inter-instrument differentials were larger for social and global outcomes than for pain or mobility . NO single instrument consistently outperformed the others . A method for determining relative efficiency is described OBJECTIVE Evaluation of joint range of motion ( ROM )  is important in the therapeutic approach to patients with rheumatoid arthritis ( RA ) . The reliability , construct validity and sensitivity to change of the Escola Paulista de Medicina (EPM)--range of motion scale that measures 10 distinct movements of small and large joints were examined . METHODS Fifty patients with active RA who 
    Output:
    