Background Patient global assessments (PGA) of disease activity as measured by self-administered visual analog scales (VAS) are widely used in rheumatoid arthritis (RA) clinical practice and research trials. These patient outcome measures facilitate the incorporation of the patient’s perspective in assessing disease activity. However, completion of this self-administered instrument requires patients to use a written instrument and comprehend both the wording of the PGA question and the translation of disease activity on to a VAS. These activities present a challenge to patients with limited health literacy, as well as those with neurologic disease, severe deformities, visual impairment or those unable or unwilling to complete forms.
Objectives To validate PGA-VAS read by patients who provide a verbal numeric response (VO-PGA1) and PGA-VAS read to patients who provide a verbal numeric response (VO-PGA2). We examined PGA-VAS using the language of the multi-dimentional health assessment questionnaire (MD-HAQ) and the disease activity score with 28 joint count (DAS28).
Methods Subjects meeting the 1987 American Rheumatism Association criteria for rheumatoid arthritis who attended the Denver Health Rheumatology Clinic were enrolled. Patients completed a PGA-VAS at the beginning of their clinical visit and following their clinic visit. Every patient completed the traditional written PGA-VAS and one of the VO-PGA’s, and the order of PGA-VAS were randomly assigned. For the VO-PGAs, subjects either read the instructions/question and provided a verbal numeric response (VO-PGA1), had the instructions/question read to them and provided a verbal numeric response (VO-PGA2), or had the instructions/question read to them over the phone immediately following the clinic visit and provided a verbal numeric response (VO-PGA2p). Spearman correlations comparing traditional PGA-VAS’s with VO-PGAs were determined for the various responses.
Conclusions Verbally administered PGA-VAS demonstrate good, though not excellent, correlation with traditional PGA-VAS captured on forms. The correlation was similar between PGA-VAS utilizing language of the MD-HAQ compared to that of the DAS28 and administering the PGA-VAS over the phone produced comparable results. Our findings support the adoption of these patient-reported outcomes using verbal approaches, which will serve patients otherwise excluded from traditional means of data collection. Extensive surveys have been completed to identify the source of patient’s confusion in completing PGA-VAS and this analysis is ongoing.
Disclosure of Interest None Declared
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