Faculty Bibliography

OBJECTIVE: To compare 4 categories (high, moderate, and low severity, and near-remission) of RAPID3 (Routine Assessment of Patient Index Data 3), an index without formal joint counts, which is scored in < 10 seconds to 4 categories of the Disease Activity Score (DAS28) and Clinical Disease Activity Index (CDAI) in patients with rheumatoid arthritis (RA). METHODS: All patients complete a Multidimensional Health Assessment Questionnaire (MDHAQ) at each visit. A physician/assessor 28-joint count and erythrocyte sedimentation rate (ESR) were completed in 285 patients with RA in usual care by 3 rheumatologists to score DAS28, CDAI, and RAPID3. RAPID3 includes the 3 MDHAQ patient self-report RA Core Data Set measures for physical function, pain, and patient global estimate. Proposed RAPID3 (range 0-10) severity categories of high (> 4), moderate (2.01-4), low (1.01-2), and near-remission (</= 1) were compared to DAS (0-10) activity categories of high (> 5.1), moderate (3.21-5.1), low (2.61-3.2), and remission (</= 2.6), and CDAI (0-76) categories of > 22, 10.1-22.0, 2.9-10.0, and </= 2.8. Additional RAPID scores, which add to RAPID3 a physician/assessor or patient self-report joint count and/or assessor global estimate, were also analyzed. Statistical significance was analyzed using Spearman correlations, cross-tabulations, and kappa statistics. RESULTS: All RAPID scores were correlated significantly with DAS28 and CDAI (rho > 0.65, p < 0.001). Overall, 78%-84% of patients who met DAS28 or CDAI moderate/high activity criteria met similar RAPID severity criteria, and 68%-77% who met DAS28 or CDAI remission/low activity criteria also met similar RAPID criteria. RAPID3 was as informative as other indices. CONCLUSION: RAPID3 provides a feasible, informative quantitative index for busy clinical settings

OBJECTIVE: To analyze visual analog scales (VAS) for pain and patient global estimate on a Multidimensional Health Assessment Questionnaire (MDHAQ) in formats other than a traditional 10 cm horizontal line, designed to facilitate scoring on MDHAQ in usual clinical care. METHODS: The MDHAQ with VAS for pain and global estimate was completed by each patient at each visit. VAS formats other than a traditional (unnumbered) 10 cm horizontal line based on 21 circles at 0.5 intervals were analyzed. Formats included unnumbered, symbol at the 11th circle, numbers and/or squares (instead of circles) at selected intermittent scores, and numbers at each circle. Analyses were performed to study the time to score MDHAQ with different VAS formats, possible 'clustering' of responses in any format, particularly with intermittent numbers and/or symbols, and test-retest reliability of various formats. RESULTS: The median time to score MDHAQ with a 10 cm line VAS was 15.6 seconds, compared to 7.4 seconds for the 21 numbered circle VAS. No other format was scored in fewer seconds. Clustering was seen for scores of VAS formats with intermittent numbers or symbols, which rendered them unsuitable for use. No clustering was seen for the 21 numbered circle VAS format, for which test-retest agreement was significant, and similar to the 10 cm line VAS format. CONCLUSION: A 21 numbered circle VAS may be a desirable alternative to a 10 cm horizontal line, yielding similar results and requiring less than half the time to score