Data Abstraction Forms

Alex R Kemper; Remy Coeytaux; Gillian D Sanders; Heather Van Mater; John W Williams; Rebecca N Gray; R Julian Irvine; Amy Kendrick

This publication is provided for historical reference only and the information may be out of date.

Appendix CData Abstraction Forms

Publication Details

Publication Details

Copyright

Publisher

Agency for Healthcare Research and Quality (US), Rockville (MD)

NLM Citation

Kemper AR, Coeytaux R, Sanders GD, et al. Disease-Modifying Antirheumatic Drugs (DMARDs) in Children With Juvenile Idiopathic Arthritis (JIA) [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Sep. (Comparative Effectiveness Reviews, No. 28.) Appendix C, Data Abstraction Forms.

KQ 1–4—Blank ET/Data Abstraction Form

Study

Interventions and study design

Patient characteristics

Results

Comments/quality/applicability

StudyID

Geographical location:

Study dates:

Funding source:

Setting:

Study design:
RCT
Nonrandomized comparative study
Other

Intervention(s):

-: DMARD name:

-: Dose:

-: Titration:

-: N:

Comparator(s):

Were additional arthritis medications allowed?:

If Yes to above, was this done:
Per protocol At discretion of clinician/investigator NR

Study duration:

Primary outcome(s):

Secondary outcome(s):

Number of patients:

-: Screened for inclusion:

-: Eligible for inclusion:

-: Randomized:

-: Began treatment:

-: Completed treatment:

-: Withdrawals/losses to followup:

Age:

-: Mean (SD):

-: Median:

-: Range:

Sex:

-: Female:

-: Male:

Race/ethnicity:

JIA diagnosis:
JRA
JCA
JIA
Spondyloarthropathy
Psoriatic arthritis
Other (describe)

Baseline severity:
Active joint count:
Duration of disease:
Other (specify):
NR

Percentage with uveitis:

Inclusion criteria:

Exclusion criteria:

Active joint count:
Quality of life/functional status:
Number of joints with limited range of motion:
Global assessment of current status:
-
Physician:
-
Patient/Parent:
Laboratory measures of inflammation:
-
ESR:
-
Other:
Radiographic evidence of progression of disease:
Pain control:
Clinical remission:
Flare of disease:
Discontinuation of DMARD due to:
-
Remission of disease:
-
Inefficacy:
-
Intolerance/AEs:
Mortality:
Adverse events reported?:
- Yes
- No
Other:

Exclusion reasons (if appropriate):

General comments:

Quality assessment:
Primary outcome:

-: Overall rating:

-: Comments:

Adverse events:

-: Overall rating:

-: Comments:

Applicability:

This article is relevant to:
Question #_____

KQ 5—Blank ET/Data Abstraction Form

Study

Study design

Patient characteristics

Instrument(s)

Results

Comments/quality/applicability

StudyID

Geographical location:

Setting:
Specialty clinic Other [specify]

Study design:
RCT
Longitudinal non-RCT
Cross-sectional
Other [specify]

Study objective(s):

Duration of followup:

Number of patients:

Age:

-: Mean (SD):

-: Median:

-: Range:

Sex:

-: Female:

-: Male:

Race/ethnicity:
JIA diagnosis:
JRA
JCA
JIA
Spondyloarthropathy
Psoriatic arthritis
Other (describe)

Percentage with systemic JIA:

Baseline severity:
Time since diagnosis:
Active joint count:
Other [specify]:
NR

Inclusion criteria:

Exclusion criteria:

Instrument(s) evaluated:

Mode of administration:
Self-administered
Interviewer-administered
Other [specify]

1) Reliability:

-: Test-retest:

-: Kappa statistics:

-: Inter-rater:

-: Intra-rater:

-: Intra-class correlation:

2) Validity:

-: Versus clinical outcomes:

-: Versus lab results:

-: Versus radiological results:

-: New instrument versus established instrument:

3) Other:

-: Feasibility: NR [or report results]

-: Responsiveness: NR [or report results]

-: ROC curves: NR [or report results]

Exclusion reasons (if appropriate):

General comments:

Quality assessment:

Appendix CData Abstraction Forms

Table

Table

Publication Details

Copyright

Publisher

NLM Citation

KQ 1–4—Blank ET/Data Abstraction Form

KQ 5—Blank ET/Data Abstraction Form