ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 446

A Multi-Group Confirmatory Factor Analyses of the Lupuspro Between Southern California and Filipino Samples of Patients with SLE

Desiree Azizoddin1, R. Olmstead2, Chelsie Cost3, Geraldine Zamora Racaza4, Julia Ayeroff5, Lekeisha Sumner6, Michael Weisman7, Perry M. Nicassio8 and Meenakshi Jolly9, 1Department of Psychology, Loma Linda University, Loma Linda, CA, 2UCLA, Los Angeles, CA, 3Rheumatology, Harbor-UCLA Medical Center, Torrance, CA, 4Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, 5Postbaccalaureate Premedical Program, University of Southern California, Los Angeles, CA, CA, 6Department of Psychology, Cedars Sinai Medical Center, Los Angeles, CA, 7Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, 8Cousins Center for PNI, UCLA, LA, CA, 9Rush, Chicago, IL

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: ,

Session Information

Date: Sunday, November 13, 2016

Title: Quality Measures and Quality of Care - ARHP Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:  Systemic lupus erythematosus (SLE) leads to a variety of health outcomes through complex disease paths. The LupusPro (LP) is a comprehensive self-report measure which assesses health and non-health related quality of life for patients with SLE. It is increasingly used in a variety of ethnicities and diverse populations, and continues to hold psychometric integrity. Research, however, is needed that examines the validity and factor structure of the LP in order to precisely understand its psychometric integrity as an outcome measure used cross-culturally. The major purpose of this research was to evaluate the performance of the LP in two divergent patient samples and to identify differences in model fit between the two samples that would illustrate the potential for adapting the LP measure in future research.

Methods:  Two diverse samples including 236 patients with SLE were included one from an ethnically-diverse, urban region in Southern California, and the other from an ethnically-homogenous, rural region in Manila, Philippines. All patients met ACR classification criteria for SLE. Confirmatory factor analyses (CFA) were conducted in each sample separately and combined to provide evidence of the factorial integrity of the 12 subscales comprising the LP.

Results:  Demographic analyses indicated significant differences in age, disease activity and duration, education, income, and medication use between groups. Results of the separate CFA’s indicated moderate fit to the data for the hypothesized 12-factor model for both the Manila and California groups, respectively [χ2 (794)=1283.32, p<.001, CFI=.793; χ2 (794)=1398.44, p<.001, CFI=.858] (note: with large scales, χ2 less than double the degrees of freedom indicated reasonable fit). The factor structures between the California and Manila groups were constrained to be equal between the two groups, and findings revealed that the factor structures of measured variables fit the two groups reasonably well (χ2=2950.413, df =1697, p<.000; CFI=0.811) [14]. After removing seven constraints and eight correlations suggested by the Lagrange multiplier test, the model fit improved significantly [χ2(15) = 147.165, p < .000].

Conclusion:  This research provides for significant support for the subscale structure of the LP in two disparate cultural samples of SLE patients. Despite significant sociodemographic and clinical differences between the two samples, for the most part, the LP performed similarly in both samples. Table 1. Demographics and general characteristics

< td width="12%"> (95.6)

Multiethnic in SoCal

(n = 136)

Filipinos in Manila

(n = 100)

p

Female, n (%)

126

(92.7)

94

(94.0)

.683

Age (years), Mean ± SD

48.57

± 13.87

34.75

± 10.99

<.001***

Disease duration (years), Mean ± SD

16.90

± 11.90

5.70

± 5.18

<.001***

Education level, n (%)

.004**

Less than college

34

(25.0)

44

(44.0)

Attended college

98

(72.1)

56

(56.0)

Not specified

4

(2.9)

0

(0.0)

Married/lives with partner, n (%)

76

(55.9)

52

(52.0)

.554

With gainful occupation, n (%)

71

(52.2)

36

(36.0)

.013*

Income level, n (%)

<.001***

Below poverty line

27

(19.9)

41

(41.0)

Lower middle class

26

(19.1)

38

(38.0)

Upper middle class

34

(25.0)

15

(15.0)

Upper class

49

(36.0)

6

(6.0)

Health insurance coverage, n (%)

<.001***

Insured

130

50

(50.0)

Uninsured

6

(4.4)

45

(45.0)

Not specified

0

(0.0)

5

(5.0)

Active SLE disease, n (%)*

11

(8.1)

30

(30.0)

<.001***

Medication use

Prednisone, n (%)

59

(43.4)

92

(92.0)

<.001***

Immunosuppressants, n (%)

88

(64.7)

88

(88.0)

<.001***

Cytotoxics, n (%)

24

(17.6)

22

(22.0)

.404

Biologics, n (%)

62

(45.6)

1

(1.0)

<.001***

Note. Group comparisons made using χ2 and t tests for categorical and continuous variables, respectively. Active disease as indicated by a Mex-SLEDAI score > 5. * p < 0.05, ** p < 0.01, *** p < 0.001.

  Table 2. Means, standard deviations, and factor loadings of measured variables (LupusPRO) in the confirmatory factor analyses

Southern California

Manila

LupusPRO Factors and Items

Mean (SD)

Factor loading

Mean (SD)

Factor loading

I – Lupus Symptoms
1. Hair loss

2.36 (1.43)

.49

2.86 (1.15)

.18

2. Skin rash

2.90 (1.45)

.58

2.94 (1.15)

.62

3. Lupus Flare

2.56 (1.18)

.72

2.93 (1.17)

.56

II – Cognition

4. Memory

2.11 (1.27)

.80

2.86 (0.99)

.42

5. Concentration

2.24 (1.17)

.97

2.84 (0.96)

.84

III – Lupus Medications

6. Med side effects

2.96 (1.22)

.84

2.91 (1.18)

.51

7. Number of meds

2.87 (1.26)

.70

2.59 (1.13)

.55

IV – Procreation

8. Effect of meds on pregnancy

3.52 (1.11)

.86

2.96 (1.36)

.91

9. Unplanned pregnancy worry

3.87 (0.56)

.54

3.03 (1.30)

.48

V – Physical Health

10. Meeting personal needs

3.39 (0.99)

.73

2.82 (1.41)

.61

11. In and out of bed

3.30 (0.98)

.79

2.94 (1.19)

.60

12. Meeting family responsibility

2.89 (1.09)

.77

2.65 (1.37)

.51

13. Taking care of dependents

2.99 (1.14)

.77

2.72 (1.37)

.56

14. Burden to others

2.94 (1.20)

.78

2.05 (1.12)

.12

VI – Pain Vitality

15. Feel worn out

1.94 (1.22)

.81

3.06 (1.04)

.18

16. Pain and ache

1.96 (1.24)

.76

2.51 (1.02)

.37

17. Limited usual activities

2.66 (1.15)

.81

2.78 (1.09)

.66

18. Limited usual activities for long time

2.35 (1.28)

.94

2.66 (1.16)

.90

19. Limited in types of tasks and activities

2.24 (1.23)

.94

2.70 (1.14)

.84

VII – Emotional Health

20. Worry for lupus impact on future

2.34 (1.34)

.77

2.34 (1.23)

.52

21. Loss of income worry

2.57 (1.48)

.72

2.20 (1.21)

.50

22. Anxious

2.51 (1.25)

.84

2.29 (1.05)

.60

23. Depressed

2.80 (1.19)

.75

2.44 (0.96)

.48

24. Lupus and more health problems

2.37 (1.27)

.81

2.18 (0.98)

.60

25. Concern for lupus symptom longevity

2.15 (1.33)

.84

2.09 (1.02)

.49

VIII – Body Image

26. Dislike appearance

2.63 (1.29)

.91

2.73 (1.05)

.72

27. Thought less of self

3.00 (1.20)

.82

3.00 (1.00)

.32

28. Lack control over appearance

2.92 (1.20)

.89

2.94 (0.99)

.58

29. Self conscious of appearance

2.56 (1.35)

.92

2.58 (1.14)

.73

30. Embarrass of others’ perceptions

2.88 (1.31)

.84

2.59 (1.07)

.73

IX – Desires-Goals

31. Ability to plan events

2.59 (1.22)

.69

2.35 (1.14)

.47

32. Overall life satisfaction

2.43 (1.09)

.93

2.44 (1.21)

.60

33. Life enjoyment

2.50 (1.15)

.90

2.05 (1.30)

.88

34. Fulfill career goals

2.47 (1.46)

.58

2.22 (1.20)

.58

X – Social Support

35. Support from friends

2.42 (1.37)

.82

2.15 (1.36)

.31

36. Support from family

2.67 (1.35)

.75

2.99 (1.06)

.46

XI – Coping

37. Focus to improve my situation

2.79 (1.09)

.76

3.08 (0.94)

.53

38. Learn to live with lupus

3.18 (1.01)

.74

3.03 (1.00)

.42

39. Strength from spiritual/ religious beliefs

2.35 (1.58)

.32

3.06 (1.16)

.58

XII – Satisfaction with Care

40. Dr. accessible for questions

3.61 (0.86)

.84

3.24 (0.96)

.71

41. Dr. understood impact of lupus on me

3.47 (0.92)

.89

3.43 (0.91)

.76

42. Dr. gave me lupus info

3.61 (0.86)

.86

3.39 (1.02)

.92

43. Dr. discussed side effects of lupus meds

3.50 (0.97)

.92

3.36 (0.99)

.84

Disclosure: D. Azizoddin, None; R. Olmstead, None; C. Cost, None; G. Z. Racaza, None; J. Ayeroff, None; L. Sumner, None; M. Weisman, None; P. M. Nicassio, None; M. Jolly, Pfizer Inc, 9.

To cite this abstract in AMA style:

Azizoddin D, Olmstead R, Cost C, Racaza GZ, Ayeroff J, Sumner L, Weisman M, Nicassio PM, Jolly M. A Multi-Group Confirmatory Factor Analyses of the Lupuspro Between Southern California and Filipino Samples of Patients with SLE [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/a-multi-group-confirmatory-factor-analyses-of-the-lupuspro-between-southern-california-and-filipino-samples-of-patients-with-sle/. Accessed .

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