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Abstract Number: 1103

Towards Recommendations on Functional Assessment Status Measures for Rheumatoid Arthritis: Preliminary Results from a Systematic Review

Claire Barber1, JoAnn Zell2, Jinoos Yazdany3, Aileen Davis4, Linda S. Ehrlich-Jones5, Carter Thorne6, Donna Everix7, Laura Cappelli8 and Kaleb Michaud9, 1Medicine, University of Calgary, Calgary, AB, Canada, 2National Jewish Medical Center, Denver, CO, 3Medicine/Rheumatology, University of California San Francisco, San Francisco, CA, 4Health Care and Outcomes Rsrch, Toronto Western Research Institute, University Health Network, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, 5Rehabilitation Institute Chicago, Chicago, IL, 6Southlake Regional Health Centre, Newmarket, Newmarket, ON, Canada, 7OnMyCare Home Health, Fremont, CA, 8Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, 9Rheumatology & Immunology, University of Nebraska Medical Center and National Data Bank for Rheumatic Diseases, Omaha, NE

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: functional status and rheumatoid arthritis (RA)

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Session Information

Date: Monday, November 6, 2017

Title: Measures and Measurement of Healthcare Quality Poster I

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Functional status assessment measures (FSAMs) are important outcomes in rheumatology and used to monitor response to treatment and aid in prediction of rheumatic disease outcomes. We conducted a systematic review of FSAMs used in the evaluation of patients with rheumatoid arthritis (RA). In this first phase of the study, we report on the identification and characteristics of the FSAMS. The ultimate objective is to develop American College of Rheumatology (ACR) recommendations for the use of FSAMs in clinical practice and quality measurement.

Methods: A search strategy was developed in consultation with a medical librarian and based on a published strategy for finding studies that evaluate the measurement properties of clinical instruments from the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) group. This strategy involves the use of MeSH terms/keywords in three themes: #1 construct search (functional status), #2 population search (rheumatoid arthritis), #3 instrument search (including terms for instruments of interest). MEDLINE, EMBASE, Cochrane Library and CINHAL were searched from inception until March 16th 2017. Two reviewers independently considered papers for inclusion with disagreements resolved by consensus. FSAMs were included if the primary objective of the study was to develop, validate or establish the psychometric properties of a patient-reported FSAMs. Performance-based measures (e.g., grip strength, walk tests) and FSAMs addressing function of a single body part/region were excluded. Health related quality of life or health status measures that only in part addressed function were also excluded as they captured different constructs.

Results: 11,835 unique citations were found and 649 were selected for full-text review. Twenty-three FSAMs met inclusion criteria including 7 published variations of the Health Assessment Questionnaire (HAQ). Eleven measures were developed in the USA (48%), while the remainder were developed in Europe or with international participation. All of the FSAMs were questionnaires varying in length from 2 to 47 items with the exception of a single visual analogue scale. Eight (35%) FSAMs included questions about the use of assistive devices and one FSAM was specific to valued life activities. Range of scores was also often based on the original HAQ range of 0-3 (52% of measures). Where reported, time to administer scores was universally <10 minutes. Preliminary results indicate that the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function questionnaires were highly robust and were correlated with the HAQ but had fewer ceiling effects, were sensitive to change and had high convergent validity.

Conclusion: There are 23 FSAMs for RA in the published literature of varying complexity. Further evaluation of the FSAMs along the 9 domains of COSMIN rating (internal consistency, reliability, measurement error, hypothesis testing, responsiveness and validity (content, structural, criterion and cross-cultural) is presently ongoing and will help determine final ACR recommendations for FSAM use in clinical practice.


Disclosure: C. Barber, None; J. Zell, None; J. Yazdany, None; A. Davis, Osteoarthritis & Cartilage, 6,OARSI, 6,Ontaril Trillium Foundation, 2,The Arthritis Society, 2,Bone and Joint Canada, 6; L. S. Ehrlich-Jones, Eation Vance, 1,Abbott Labs, 1,CMS, 2,NIH-NIAMs, 2,Craig H. Neilsen Foundation, 2,NIDILRR, 2,Rehabilitation Institute of Chicago, 3,Rush University Medical Center, 3,University of Illinois at Chicago, 3,Northwestern University, 3; C. Thorne, AbbVie, Amgen, Celgene, Lilly, Novartis, Pfizer, Sanofi, and UCB, 2,Medexus/Medac, 8,AbbVie, Amgen, Celgene, Centocor, Genzyme, Hospira, Janssen, Lilly, Medexus/Medac, Merck, Novartis, Pfizer, Sanofi, and UCB, 5; D. Everix, None; L. Cappelli, Bristol-Myers Squibb, 2; K. Michaud, None.

To cite this abstract in AMA style:

Barber C, Zell J, Yazdany J, Davis A, Ehrlich-Jones LS, Thorne C, Everix D, Cappelli L, Michaud K. Towards Recommendations on Functional Assessment Status Measures for Rheumatoid Arthritis: Preliminary Results from a Systematic Review [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/towards-recommendations-on-functional-assessment-status-measures-for-rheumatoid-arthritis-preliminary-results-from-a-systematic-review/. Accessed .
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