Background In order to interpret better the patient-reported outcomes (PROs) score changes in clinical routine, some cut-points have been determined. One of these cut-points is the Patient-Acceptable Symptom State (PASS) that is defined as the highest level of symptom beyond which patients consider themselves well . It is strictly a PRO, and consists of a global dichotomized simple question about patient's satisfaction of their state of symptoms .
Objectives To provide information on the value of PASS in rheumatoid arthritis (RA) by the identification of PASS thresholds for PROs composite scores.
Methods The characteristics of RA patients with affirmative and negative assignment to PASS were compared. Contributors to physician response were estimated by logistic regression models and PASS thresholds by the 75th percentile and receiver-operating characteristic (ROC) curve methods.
Results 303 RA patients completed the study. All PROs were different between the PASS (+) and PASS (-) groups (p<0.0001). The thresholds with the 75th percentile approach were 2.0 for the RA Impact of Disease (RAID) score, 2.5 for the PRO-CLinical ARthritis Activity (PRO-CLARA) index, 1.0 for the Recent-Onset Arthritis Disability (ROAD) questionnaire and 3.3 for patients assessment of general health (Table). The cut-off values for Clinical Disease Activity Index (CDAI) were in the moderate range of disease activity. Assessing the size of the logistic regression coefficients, the strongest predictors of PASS were the disease activity (p=0.0007) and functional state level (0.006).
Conclusions PASS thresholds were relatively high and many patients in PASS had moderate disease activity states according to CDAI. Factors such as disease activity and physical function may influence a negative PASS.
Kvien TK, Heiberg T, Hagen KB. Minimal clinically important improvement/difference (MCII/MCID) and patient acceptable symptom state (PASS): what do these concepts mean? Ann Rheum Dis 2007; 66(Suppl III): iii40-iii41.
Tubach F, Ravaud P, Beaton D, et al. Minimal clinically important improvement and patient acceptable symptom state for subjective outcome measures in rheumatic disorders. J Rheumatol 2007; 34(5): 1188-93.
Disclosure of Interest None declared
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