Does expert opinion match the operational definition of the Lupus Low Disease Activity State (LLDAS)? A case-based construct validity study

Vera Golder, Molla Huq, Kate Franklyn, Alicia Calderone, Aisha Lateef, Chak Sing Lau, Alfred Lok Hang Lee, Sandra Teresa V Navarra, Timothy Godfrey, Shereen Oon, Alberta Yik Bun Hoi, Eric Morand, Mandana Nikpour

Research output: Contribution to journalArticleResearchpeer-review

6 Citations (Scopus)

Abstract

Objective: To evaluate the construct validity of the Lupus Low Disease Activity State (LLDAS), a treatment target in systemic lupus erythematosus (SLE). Methods: Fifty SLE case summaries based on real patients were prepared and assessed independently for meeting the operational definition of LLDAS. Fifty international rheumatologists with expertise in SLE, but with no prior involvement in the LLDAS project, responded to a survey in which they were asked to categorize the disease activity state of each case as remission, low, moderate, or high. Agreement between expert opinion and LLDAS was assessed using Cohen's kappa. Results: Overall agreement between expert opinion and the operational definition of LLDAS was 77.96% (95% CI: 76.34-79.58%), with a Cohen's kappa of 0.57 (95% CI: 0.55-0.61). Of the cases (22 of 50) that fulfilled the operational definition of LLDAS, only 5.34% (59 of 22 × 50) of responses classified the cases as moderate/high activity. Of the cases that did not fulfill the operational definition of LLDAS (28 of 50), 35.14% (492 of 28 × 50) of responses classified the cases as remission/low activity. Common reasons for discordance were assignment to remission/low activity of cases with higher corticosteroid doses than defined in LLDAS (prednisolone ≤ 7.5. mg) or with SLEDAI-2K >4 due to serological activity (high anti-dsDNA antibody and/or low complement). Conclusions: LLDAS has good construct validity with high overall agreement between the operational definition of LLDAS and expert opinion. Discordance of results suggests that the operational definition of LLDAS is more stringent than expert opinion at defining a low disease activity state.

Original languageEnglish
Pages (from-to)798-803
Number of pages6
JournalSeminars in Arthritis and Rheumatism
Volume46
Issue number6
DOIs
Publication statusPublished - Jun 2017

Keywords

  • Outcome measures
  • Systemic lupus erythematosus

Cite this

Golder, Vera ; Huq, Molla ; Franklyn, Kate ; Calderone, Alicia ; Lateef, Aisha ; Lau, Chak Sing ; Lee, Alfred Lok Hang ; Navarra, Sandra Teresa V ; Godfrey, Timothy ; Oon, Shereen ; Hoi, Alberta Yik Bun ; Morand, Eric ; Nikpour, Mandana. / Does expert opinion match the operational definition of the Lupus Low Disease Activity State (LLDAS)? A case-based construct validity study. In: Seminars in Arthritis and Rheumatism. 2017 ; Vol. 46, No. 6. pp. 798-803.
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title = "Does expert opinion match the operational definition of the Lupus Low Disease Activity State (LLDAS)? A case-based construct validity study",
abstract = "Objective: To evaluate the construct validity of the Lupus Low Disease Activity State (LLDAS), a treatment target in systemic lupus erythematosus (SLE). Methods: Fifty SLE case summaries based on real patients were prepared and assessed independently for meeting the operational definition of LLDAS. Fifty international rheumatologists with expertise in SLE, but with no prior involvement in the LLDAS project, responded to a survey in which they were asked to categorize the disease activity state of each case as remission, low, moderate, or high. Agreement between expert opinion and LLDAS was assessed using Cohen's kappa. Results: Overall agreement between expert opinion and the operational definition of LLDAS was 77.96{\%} (95{\%} CI: 76.34-79.58{\%}), with a Cohen's kappa of 0.57 (95{\%} CI: 0.55-0.61). Of the cases (22 of 50) that fulfilled the operational definition of LLDAS, only 5.34{\%} (59 of 22 × 50) of responses classified the cases as moderate/high activity. Of the cases that did not fulfill the operational definition of LLDAS (28 of 50), 35.14{\%} (492 of 28 × 50) of responses classified the cases as remission/low activity. Common reasons for discordance were assignment to remission/low activity of cases with higher corticosteroid doses than defined in LLDAS (prednisolone ≤ 7.5. mg) or with SLEDAI-2K >4 due to serological activity (high anti-dsDNA antibody and/or low complement). Conclusions: LLDAS has good construct validity with high overall agreement between the operational definition of LLDAS and expert opinion. Discordance of results suggests that the operational definition of LLDAS is more stringent than expert opinion at defining a low disease activity state.",
keywords = "Outcome measures, Systemic lupus erythematosus",
author = "Vera Golder and Molla Huq and Kate Franklyn and Alicia Calderone and Aisha Lateef and Lau, {Chak Sing} and Lee, {Alfred Lok Hang} and Navarra, {Sandra Teresa V} and Timothy Godfrey and Shereen Oon and Hoi, {Alberta Yik Bun} and Eric Morand and Mandana Nikpour",
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Does expert opinion match the operational definition of the Lupus Low Disease Activity State (LLDAS)? A case-based construct validity study. / Golder, Vera; Huq, Molla; Franklyn, Kate; Calderone, Alicia; Lateef, Aisha; Lau, Chak Sing; Lee, Alfred Lok Hang; Navarra, Sandra Teresa V; Godfrey, Timothy; Oon, Shereen; Hoi, Alberta Yik Bun; Morand, Eric; Nikpour, Mandana.

In: Seminars in Arthritis and Rheumatism, Vol. 46, No. 6, 06.2017, p. 798-803.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Does expert opinion match the operational definition of the Lupus Low Disease Activity State (LLDAS)? A case-based construct validity study

AU - Golder, Vera

AU - Huq, Molla

AU - Franklyn, Kate

AU - Calderone, Alicia

AU - Lateef, Aisha

AU - Lau, Chak Sing

AU - Lee, Alfred Lok Hang

AU - Navarra, Sandra Teresa V

AU - Godfrey, Timothy

AU - Oon, Shereen

AU - Hoi, Alberta Yik Bun

AU - Morand, Eric

AU - Nikpour, Mandana

PY - 2017/6

Y1 - 2017/6

N2 - Objective: To evaluate the construct validity of the Lupus Low Disease Activity State (LLDAS), a treatment target in systemic lupus erythematosus (SLE). Methods: Fifty SLE case summaries based on real patients were prepared and assessed independently for meeting the operational definition of LLDAS. Fifty international rheumatologists with expertise in SLE, but with no prior involvement in the LLDAS project, responded to a survey in which they were asked to categorize the disease activity state of each case as remission, low, moderate, or high. Agreement between expert opinion and LLDAS was assessed using Cohen's kappa. Results: Overall agreement between expert opinion and the operational definition of LLDAS was 77.96% (95% CI: 76.34-79.58%), with a Cohen's kappa of 0.57 (95% CI: 0.55-0.61). Of the cases (22 of 50) that fulfilled the operational definition of LLDAS, only 5.34% (59 of 22 × 50) of responses classified the cases as moderate/high activity. Of the cases that did not fulfill the operational definition of LLDAS (28 of 50), 35.14% (492 of 28 × 50) of responses classified the cases as remission/low activity. Common reasons for discordance were assignment to remission/low activity of cases with higher corticosteroid doses than defined in LLDAS (prednisolone ≤ 7.5. mg) or with SLEDAI-2K >4 due to serological activity (high anti-dsDNA antibody and/or low complement). Conclusions: LLDAS has good construct validity with high overall agreement between the operational definition of LLDAS and expert opinion. Discordance of results suggests that the operational definition of LLDAS is more stringent than expert opinion at defining a low disease activity state.

AB - Objective: To evaluate the construct validity of the Lupus Low Disease Activity State (LLDAS), a treatment target in systemic lupus erythematosus (SLE). Methods: Fifty SLE case summaries based on real patients were prepared and assessed independently for meeting the operational definition of LLDAS. Fifty international rheumatologists with expertise in SLE, but with no prior involvement in the LLDAS project, responded to a survey in which they were asked to categorize the disease activity state of each case as remission, low, moderate, or high. Agreement between expert opinion and LLDAS was assessed using Cohen's kappa. Results: Overall agreement between expert opinion and the operational definition of LLDAS was 77.96% (95% CI: 76.34-79.58%), with a Cohen's kappa of 0.57 (95% CI: 0.55-0.61). Of the cases (22 of 50) that fulfilled the operational definition of LLDAS, only 5.34% (59 of 22 × 50) of responses classified the cases as moderate/high activity. Of the cases that did not fulfill the operational definition of LLDAS (28 of 50), 35.14% (492 of 28 × 50) of responses classified the cases as remission/low activity. Common reasons for discordance were assignment to remission/low activity of cases with higher corticosteroid doses than defined in LLDAS (prednisolone ≤ 7.5. mg) or with SLEDAI-2K >4 due to serological activity (high anti-dsDNA antibody and/or low complement). Conclusions: LLDAS has good construct validity with high overall agreement between the operational definition of LLDAS and expert opinion. Discordance of results suggests that the operational definition of LLDAS is more stringent than expert opinion at defining a low disease activity state.

KW - Outcome measures

KW - Systemic lupus erythematosus

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U2 - 10.1016/j.semarthrit.2017.01.007

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M3 - Article

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SN - 0049-0172

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ER -