Symptom heterogeneity and patient subgroup classification among US patients with post-treatment Lyme disease: an observational study

Objectives To identify underlying subgroups with distinct symptom profiles, and to characterise and compare these subgroups across a range of demographic, clinical and psychosocial factors, within a heterogeneous group of patients with well-defined post-treatment Lyme disease (PTLD).Design A clinica...

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Autores principales:	Ting Yang, Alison W Rebman, John N Aucott
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/1d2c31bf8e28410e9b71b5ed92072c13
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spelling	oai:doaj.org-article:1d2c31bf8e28410e9b71b5ed92072c132021-11-16T02:00:05ZSymptom heterogeneity and patient subgroup classification among US patients with post-treatment Lyme disease: an observational study10.1136/bmjopen-2020-0403992044-6055https://doaj.org/article/1d2c31bf8e28410e9b71b5ed92072c132021-01-01T00:00:00Zhttps://bmjopen.bmj.com/content/11/1/e040399.fullhttps://doaj.org/toc/2044-6055Objectives To identify underlying subgroups with distinct symptom profiles, and to characterise and compare these subgroups across a range of demographic, clinical and psychosocial factors, within a heterogeneous group of patients with well-defined post-treatment Lyme disease (PTLD).Design A clinical case series of patents.Setting Participants were recruited from a single-site, Lyme disease referral clinic patient population and were evaluated by physical exam, clinical laboratory testing and standardised questionnaires.Participants Two hundred and twelve participants met study criteria for PTLD, with medical record-confirmed prior Lyme disease as well as current symptoms and functional impact.Results Exploratory factor analysis classified 30 self-reported symptoms into 6 factors: ‘Fatigue Cognitive’, ‘Ocular Disequilibrium’, ‘Infection-Type’, ‘Mood-Related’, ‘Musculoskeletal Pain’ and ‘Neurologic’. A final latent profile analysis was conducted using ‘Fatigue Cognitive’, ‘Musculoskeletal Pain’ and ‘Mood-Related’ factor-based scores, which produced three emergent symptom profiles, and participants were classified into corresponding subgroups with 59.0%, 18.9% and 22.2% of the sample, respectively. Compared with the other two groups, subgroup 1 had similarly low levels across all factors relative to the sample as a whole, and reported lower rates of disability (1.6% vs 10.0%, 12.8%; q=0.126, 0.035) and higher self-efficacy (median: 7.5 vs 6.0, 5.3; q=0.068,<0.001). Subgroup 2 had the highest ‘Musculoskeletal Pain’ factor-based scores (q≤0.001). Subgroup 3 was characterised overall by higher symptom factor-based scores, and reported higher depression (q≤0.001).Conclusions This analysis identified six symptom factors and three potentially clinically relevant subgroups among patients with well-characterised PTLD. We found that these subgroups were differentiated not only by symptom phenotype, but also by a range of other factors. This may serve as an initial step towards engaging with the symptom heterogeneity that has long been observed among patients with this condition.Ting YangAlison W RebmanJohn N AucottBMJ Publishing GrouparticleMedicineRENBMJ Open, Vol 11, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Ting Yang Alison W Rebman John N Aucott Symptom heterogeneity and patient subgroup classification among US patients with post-treatment Lyme disease: an observational study
description	Objectives To identify underlying subgroups with distinct symptom profiles, and to characterise and compare these subgroups across a range of demographic, clinical and psychosocial factors, within a heterogeneous group of patients with well-defined post-treatment Lyme disease (PTLD).Design A clinical case series of patents.Setting Participants were recruited from a single-site, Lyme disease referral clinic patient population and were evaluated by physical exam, clinical laboratory testing and standardised questionnaires.Participants Two hundred and twelve participants met study criteria for PTLD, with medical record-confirmed prior Lyme disease as well as current symptoms and functional impact.Results Exploratory factor analysis classified 30 self-reported symptoms into 6 factors: ‘Fatigue Cognitive’, ‘Ocular Disequilibrium’, ‘Infection-Type’, ‘Mood-Related’, ‘Musculoskeletal Pain’ and ‘Neurologic’. A final latent profile analysis was conducted using ‘Fatigue Cognitive’, ‘Musculoskeletal Pain’ and ‘Mood-Related’ factor-based scores, which produced three emergent symptom profiles, and participants were classified into corresponding subgroups with 59.0%, 18.9% and 22.2% of the sample, respectively. Compared with the other two groups, subgroup 1 had similarly low levels across all factors relative to the sample as a whole, and reported lower rates of disability (1.6% vs 10.0%, 12.8%; q=0.126, 0.035) and higher self-efficacy (median: 7.5 vs 6.0, 5.3; q=0.068,<0.001). Subgroup 2 had the highest ‘Musculoskeletal Pain’ factor-based scores (q≤0.001). Subgroup 3 was characterised overall by higher symptom factor-based scores, and reported higher depression (q≤0.001).Conclusions This analysis identified six symptom factors and three potentially clinically relevant subgroups among patients with well-characterised PTLD. We found that these subgroups were differentiated not only by symptom phenotype, but also by a range of other factors. This may serve as an initial step towards engaging with the symptom heterogeneity that has long been observed among patients with this condition.
format	article
author	Ting Yang Alison W Rebman John N Aucott
author_facet	Ting Yang Alison W Rebman John N Aucott
author_sort	Ting Yang
title	Symptom heterogeneity and patient subgroup classification among US patients with post-treatment Lyme disease: an observational study
title_short	Symptom heterogeneity and patient subgroup classification among US patients with post-treatment Lyme disease: an observational study
title_full	Symptom heterogeneity and patient subgroup classification among US patients with post-treatment Lyme disease: an observational study
title_fullStr	Symptom heterogeneity and patient subgroup classification among US patients with post-treatment Lyme disease: an observational study
title_full_unstemmed	Symptom heterogeneity and patient subgroup classification among US patients with post-treatment Lyme disease: an observational study
title_sort	symptom heterogeneity and patient subgroup classification among us patients with post-treatment lyme disease: an observational study
publisher	BMJ Publishing Group
publishDate	2021
url	https://doaj.org/article/1d2c31bf8e28410e9b71b5ed92072c13
work_keys_str_mv	AT tingyang symptomheterogeneityandpatientsubgroupclassificationamonguspatientswithposttreatmentlymediseaseanobservationalstudy AT alisonwrebman symptomheterogeneityandpatientsubgroupclassificationamonguspatientswithposttreatmentlymediseaseanobservationalstudy AT johnnaucott symptomheterogeneityandpatientsubgroupclassificationamonguspatientswithposttreatmentlymediseaseanobservationalstudy
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Symptom heterogeneity and patient subgroup classification among US patients with post-treatment Lyme disease: an observational study

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