Background Pain is multifaceted and difficult to capture. RAPS (Anderson D. Arthritis Care Res 2001; 45:317) was designed to measure physiologic, affective, sensory-discriminative, and cognitive aspects but so far finds sparse recognition. There are no gold standard pain instruments. Against this perspective, a suitable version was validated for use in our community.
Objectives To validate an Indian version of RAPS for pain measure in RA
Methods RAPS after suitable translation (contextual) was administered in face-face interview to 99 consenting active painful patients suffering from RA (ACR 1987 criteria; 93% women, mean age and disease duration 46.9 years and 8.7 months respectively, mean Pain VAS 5.3.; 76% seropositive RF) and on supervised rheumatology care in a popular community center. Standard of care medical documents captured the required data [included joint counts pain/swelling (JCPT/SW), patient & physician global assess, Indian version HAQ, SF 36]. RAPS contained 24pain questions [score 0-6 per question, total 0-144; anchor scored 0 (never) and 6 (always].This was a cross sectional prospective design study but all patients were followed for 16 weeks in a 3 arm controlled dietary intervention study with MTX background; SPSS used for statistical analysis (significant “S” p<0.05).
Results RAPS showed good face and content validity. Other validity measures- Test-retest Cronbach's Alpha =0.91 and overall good content and construct validity for total and individual domain score except for a low alpha for “affective domain”; Correlation Matrix (Pearson r):age 0.02, duration disease 0.16, JCPT 0.15, JCSW 0.06, patient global 0.14, ESR -0.04, CRP 0.06, pain VAS 0.30 (S) & HAQ 0.30 (S). Pain VAS was the only significant predictor (multiple multivariable linear regressions). RAPS was found to load along with HAQ, pain VAS,JCPT and patient global (all patient centric)in the ‘first’ factor of the principle component “factor analysis” ;successive factors were lab and JCSW. Further data (construct and criterion/external validity) will be presented on (i) RAPS subscale analysis (ii)SF 36 physical & mental scores analysis (iii)sensitivity to change (fair-moderate). Patient satisfaction was high and it seems to impact compliance.
Conclusions RAPS is a valid and clinically relevant instrument to measure and monitor pain and response to treatment in patients of RA. It deserves to be recognized in rheumatology practice
Chopra, Saluja. Validation and usefulness of Indian version (CRD Pune) health assessment questionnaire: drug trials, community practice and COPCORD Bhigwan population study (1994-2012). Indian J Rheumatol 2012;7(2):74-82.
Acknowledgements Patients, Management & colleagues at CRD Pune and in particular Dr S Sarmukkadam, Dr N Kulkarni, Ms Manjit Saluja, Dr Anuradha V, Dr R Rane
Disclosure of Interest None declared