scholarly journals Comparison of the Construct Validity and Sensitivity to Change of the Visual Analog Scale and a Modified Rating Scale as Measures of Patient Global Assessment in Rheumatoid Arthritis

2010 ◽  
Vol 37 (4) ◽  
pp. 717-722 ◽  
Author(s):  
CHILI LATI ◽  
LORI C. GUTHRIE ◽  
MICHAEL M. WARD
Keyword(s):  
Rheumatoid Arthritis ◽  
Depressive Symptoms ◽  
Construct Validity ◽  
Visual Analog Scale ◽  
Global Assessment ◽  
Rating Scale ◽  
Patient Global Assessment ◽  
Physician Global Assessment ◽  
Sensitivity To Change ◽  
Analog Scale

Objective.Patient global assessment (PGA) is commonly measured using a visual analog scale (VAS). The VAS asks patients to integrate many dimensions of rheumatoid arthritis (RA) activity, yet its scope is poorly defined and its endpoints are vague. We investigated whether a modified Rating Scale that used marker states and more defined endpoints would provide a more valid measure of PGA.Methods.In our prospective longitudinal study, 164 patients with active RA rated their global arthritis activity using the VAS and Rating Scale before and after treatment. To compare construct validity, we correlated each score with 2 reference measures of RA activity, the 28-joint count Disease Activity Score (DAS28) and the physician global assessment, and examined how each measure was associated with different aspects of RA activity, including pain, functioning, and depressive symptoms, in multivariate regression analyses. We also examined sensitivity to change.Results.Both measures were correlated with the DAS28 (r = 0.39 for VAS; r = 0.35 for Rating Scale) and physician global assessment (r = 0.41 for VAS; r = 0.26 for Rating Scale) at the baseline visit. Pain and depressive symptoms had the strongest association with the VAS, while functional limitations and depressive symptoms had the strongest association with the Rating Scale. Residual analysis showed no differences in heterogeneity of patients’ ratings. VAS was more sensitive to change than the Rating Scale (standardized response means of 0.55 and 0.45).Conclusion.As measures of PGA, the VAS and Rating Scale had comparable construct validity, but differed in which aspects of arthritis activity influenced scores. VAS was more sensitive to change.

Test-Retest Reliability of Patient Global Assessment and Physician Global Assessment in Rheumatoid Arthritis

2009 ◽  
Vol 36 (10) ◽  
pp. 2178-2182 ◽  
Author(s):  
GINA ROHEKAR ◽  
JANET POPE
Keyword(s):  
Rheumatoid Arthritis ◽  
Global Assessment ◽  
Clinic Visit ◽  
Time Of Day ◽  
Patient Global Assessment ◽  
Physician Global Assessment ◽  
Retest Reliability ◽  
Reliability Characteristics ◽  
Similar Item ◽  
Test Retest Reliability

Objective.As a guide to treatment of rheumatoid arthritis (RA), physicians use measurement tools to quantify disease activity. The Patient Global Assessment (PGA) asks a patient to rate on a scale how they feel overall. The Physician Global Assessment (MDGA) is a similar item completed by the assessing physician. Both these measures are frequently incorporated into other indices. We studied reliability characteristics for global assessments and compared test-retest reliability of both the PGA and the MDGA, as well as other commonly used measures in RA.Methods.We studied 122 patients with RA age 17 years or older. Patients who received steroid injection or change in steroid dose at the visit were excluded. Patients completed the HAQ, PGA, visual analog scale for pain (VAS Pain), VAS Fatigue, and VAS Sleep. After seeing their physician, they received another questionnaire to complete within 2 days at the same time of day as clinic visit. Physicians completed the MDGA at the time of the patient’s appointment and at the end of their clinic day. Test-retest results were assessed using intraclass correlations (ICC). “Substantial” reliability is between 0.61–0.80 and “almost perfect” > 0.80.Results.Four rheumatologists and 146 patients participated, with 122 questionnaires returned (response rate 83.6%). Test-retest reliability was 0.702 for PGA, 0.961 for MDGA, and 0.897 for HAQ; VAS results were 0.742 for Pain, 0.741 for Fatigue, and 0.800 for Sleep. The correlation between PGA and MDGA was −0.172.Conclusion.PGA, MDGA, HAQ, and VAS Pain, VAS Fatigue, and VAS Sleep all showed good to excellent test-retest reliability in RA. MDGA was more reliable than PGA. The correlation between PGA and MDGA was poor.

Is Fatigue an Inflammatory Variable in Rheumatoid Arthritis (RA)? Analyses of Fatigue in RA, Osteoarthritis, and Fibromyalgia

2009 ◽  
Vol 36 (12) ◽  
pp. 2788-2794 ◽  
Author(s):  
MARTIN J. BERGMAN ◽  
SHADI S. SHAHOURI ◽  
TIMOTHY S. SHAVER ◽  
JAMES D. ANDERSON ◽  
DAVID N. WEIDENSAUL ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Global Assessment ◽  
Health Assessment ◽  
Patient Global Assessment ◽  
Hierarchical Regression ◽  
Tender Joint Count ◽  
Physician Global Assessment ◽  
Tender Joint ◽  
Variable Contribution ◽  
Explained Variance

Objective.To investigate whether fatigue is an inflammatory (rheumatoid arthritis; RA) variable, the contributions of RA variables to fatigue, and the levels of fatigue in RA compared with osteoarthritis (OA) and fibromyalgia (FM).Methods.We studied 2096 RA patients, 1440 with OA, and 1073 with FM in a clinical setting, and 14,607 RA, 3173 OA, and 2487 patients with FM in survey research. We partitioned variables into inflammatory and noninflammatory factors and examined variable contribution to fatigue (0–10 visual analog scale).Results.Factor analysis identified Disease Activity Score-28 (DAS28) and swollen (SJC) and tender joint count (TJC) as a physician-inflammation factor, and patient global assessment, pain, Health Assessment Questionnaire, and fatigue as patient components. Fatigue demonstrated weak correlations with erythrocyte sedimentation rate (ESR; r = 0.071) and SJC (r = 0.112), weak to fair correlations with TJC (r = 0.294), physician global assessment of RA activity (r = 0.384), and DAS28 (r = 0.399), but strong correlation with patient global assessment of severity (r = 0.567). In hierarchical regression analysis, patient global explained 43.1% of DAS28 fatigue variance; when SJC, TJC, and ESR were entered, the explained variance increased to 43.7%. In reverse order, SJC, TJC, and ESR explained 9.2% of the variance, but explained variance increased to 43.7% when patient global was added. The mean clinic fatigue scores were RA 4.9, OA 4.8, FM 7.6; mean survey scores were RA 4.5, OA 4.4, FM 6.3. Adjusted for age and sex, RA and OA fatigue scores were not significantly different.Conclusion.Inflammatory components of the DAS28 contribute minimally to fatigue. RA and OA fatigue levels do not differ. Fatigue is not an inflammatory variable and has no unique association with RA or RA therapy.

scholarly journals Content and Construct Validity, Reliability, and Responsiveness of the Rheumatoid Arthritis Flare Questionnaire: OMERACT 2016 Workshop Report

2017 ◽  
Vol 44 (10) ◽  
pp. 1536-1543 ◽  
Author(s):  
Susan J. Bartlett ◽  
Skye P. Barbic ◽  
Vivian P. Bykerk ◽  
Ernest H. Choy ◽  
Rieke Alten ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Construct Validity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Field Testing ◽  
Sensitivity Factor ◽  
Instrument Selection ◽  
Item Functioning ◽  
Numerical Rating ◽  
The Rasch Model

Objective.The Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis (RA) Flare Group was established to develop a reliable way to identify and measure RA flares in randomized controlled trials (RCT). Here, we summarized the development and field testing of the RA Flare Questionnaire (RA-FQ), and the voting results at OMERACT 2016.Methods.Classic and modern psychometric methods were used to assess reliability, validity, sensitivity, factor structure, scoring, and thresholds. Interviews with patients and clinicians also assessed content validity, utility, and meaningfulness of RA-FQ scores.Results.People with RA in observational trials in Canada (n = 896) and France (n = 138), and an RCT in the Netherlands (n = 178) completed 5 items (11-point numerical rating scale) representing RA Flare core domains. There was moderate to high evidence of reliability, content and construct validity, and responsiveness. Factor analysis supported unidimensionality. Rasch analysis showed acceptable fit to the Rasch model, with items and people covering a broad measurement continuum and evidence of appropriate targeting of items to people, ordered thresholds, minimal differential item functioning by language, sex, or age. A summative score across items is defensible, yielding an interval score (0–50) where higher scores reflect worsening flare. The RA-FQ received endorsement from 88% of attendees that it passed the OMERACT Filter 2.0 “Eyeball Test” for instrument selection.Conclusion.The RA-FQ has been developed to identify and measure RA flares. Its review through OMERACT Filter 2.0 shows evidence of reliability, content and construct validity, and responsiveness. These properties merit its further validation as an outcome for clinical trials.

scholarly journals A comparison of pain registration by Visual Analog Scale and Numeric Rating Scale – a cross-sectional study of primary triage registration

2020 ◽  
Author(s):  
Jofrid Kollltveit ◽  
Malin Osaland ◽  
Marianne Reimers ◽  
Magnus Berle
Keyword(s):  
Emergency Department ◽  
Visual Analog Scale ◽  
Rating Scale ◽  
Emergency Admission ◽  
Numeric Rating Scale ◽  
University Hospital ◽  
Analog Scale ◽  
Cross Sectional ◽  
Significant Difference ◽  
Numeric Rating

BackgroundPain is a subjective sensation; self-reporting is important for quantifying pain intensity. There are several different validated tools for this, such as Visual Analog Scale and Numeric Rating Scale. In the clinic, these terms are often used as equivalent. The objective of this study was to examine correlation and agreement between the pain registration tools in triage in an emergency department.Materials and MethodsThe study was performed in the Department of Emergency Medicine at Haukeland University Hospital in the period June-August 2019. We registered the pain score with two tools in 200 unselected patients in emergency admission with pain. In addition, we registrered gender, age, triage and general department affiliation.ResultsWe found a strong correlation between the pain registration tools by Spearmans correlation test (rho=0,930, p<0,001). There were no significant difference between the pain registration tools within the subgroups. Bland-Altman analysis show agreement between the two pain registration tools.ConclusionsIn an Emergency Department triage is it acceptable to use Visual Analog Scale and Numeric Rating Scale as equivalent, as long as the correct terminology is used.

Influence of Gastrointestinal Symptoms on Patient Global Assessment in Patients with Rheumatoid Arthritis

2020 ◽  
Vol 2 (5) ◽  
pp. 619-626
Author(s):  
Shuji Asai ◽  
Nobunori Takahashi ◽  
Kaoru Nagai ◽  
Tatsuo Watanabe ◽  
Takuya Matsumoto ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Global Assessment ◽  
Gastrointestinal Symptoms ◽  
Patient Global Assessment

scholarly journals Revisiting the use of remission criteria for rheumatoid arthritis by excluding patient global assessment: an individual meta-analysis of 5792 patients

2020 ◽  
pp. annrheumdis-2020-217171 ◽  
Author(s):  
Ricardo J O Ferreira ◽  
Paco M J Welsing ◽  
Johannes W G Jacobs ◽  
Laure Gossec ◽  
Mwidimi Ndosi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Functional Outcome ◽  
Global Assessment ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Health Assessment ◽  
Patient Data ◽  
Patient Global Assessment ◽  
Remission Criteria ◽  
The Impact

ObjectivesTo determine the impact of excluding patient global assessment (PGA) from the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean remission criteria, on prediction of radiographic and functional outcome of rheumatoid arthritis (RA).MethodsMeta-analyses using individual patient data from randomised controlled trials testing the efficacy of biological agents on radiographic and functional outcomes at ≥2 years. Remission states were defined by 4 variants of the ACR/EULAR Boolean definition: (i) tender and swollen 28-joint counts (TJC28/SJC28), C reactive protein (CRP, mg/dL) and PGA (0–10=worst) all ≤1 (4V-remission); (ii) the same, except PGA >1 (4V-near-remission); (iii) 3V-remission (i and ii combined; similar to 4V, but without PGA); (iv) non-remission (TJC28 >1 and/or SJC28 >1 and/or CRP >1). The most stringent class achieved at 6 or 12 months was considered. Good radiographic (GRO) and functional outcome (GFO) were defined as no worsening (ie, change in modified total Sharp score (ΔmTSS) ≤0.5 units and ≤0.0 Health Assessment Questionnaire–Disability Index points, respectively, during the second year). The pooled probabilities of GRO and GFO for the different definitions of remission were estimated and compared.ResultsIndividual patient data (n=5792) from 11 trials were analysed. 4V-remission was achieved by 23% of patients and 4V-near-remission by 19%. The probability of GRO in the 4V-near-remission group was numerically, but non-significantly, lower than that in the 4V-remission (78 vs 81%) and significantly higher than that for non-remission (72%; difference=6%, 95% CI 2% to 10%). Applying 3V-remission could have prevented therapy escalation in 19% of all participants, at the cost of an additional 6.1%, 4.0% and 0.7% of patients having ΔmTSS >0.0, >0.5 and >5 units over 2 years, respectively. The probability of GFO (assessed in 8 trials) in 4V-near-remission (67%, 95% CI 63% to 71%) was significantly lower than in 4V-remission (78%, 74% to 81%) and similar to non-remission (69%, 66% to 72%).Conclusion4V-near-remission and 3V-remission have similar validity as the original 4V-remission definition in predicting GRO, despite expected worse prediction of GFO, while potentially reducing the risk of overtreatment. This supports further exploration of 3V-remission as the target for immunosuppressive therapy complemented by patient-oriented targets.

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