Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Rheumatoid Arthirtis Patients Interpretation of the DAS Patient Global Used at Bristol Royal Infirmary
Sanderson1, Tessa, Morris2, Marianne, Calnan3, Michael, Richards4, Pamela, Hewlett2, Sarah
University of West England, Bristol, United Kingdom,
University of West of England, Bristol, United Kingdom,
University of Kent, Canterbury, United Kingdom,
University of Bristol, Bristol, United Kingdom
The Disease Activity Score (DAS) provides evidence of clinical need for anti-TNF therapy in the UK, and is a composite score including patient opinion. However, the formulation of the patient VAS may vary between departments and may not capture the intended data. This abstract describes how RA patients interpreted the DAS patient VAS as routinely used at one busy outpatient clinic.
Five focus groups (n=26) were held as part of a larger study for the development of a patient-generated core set of outcomes, purposively sampled for disease duration, disease severity, medication, age, gender and work status. The DAS patient VAS used in the clinic is "Considering all the ways your arthritis affects you, please mark the line to show how well you are doing". Patients were asked their opinion of what the VAS was intended to measure, and subsequently, whether there was a better way of asking about global health/disease activity from the patient perspective. The discussions were tape recorded, transcribed verbatim and analysed for relevant items.
Patients reported a range of interpretations of what the DAS patient VAS was measuring: general health, coping, emotions, function, and physical status. Speaking generally, one woman said "I think it's taking everything into consideration". However, most patients gave uni-dimensional responses. Many participants interpreted the VAS as asking about coping or emotion: e.g. "How do you cope with it?" and "For me it's always an emotional thing". Other patients interpreted the VAS as asking about function or physical status, e.g. "Day to day living", "How much you can do", and "If you've got a lot of pain or whatever".
Many participants felt that a single global question would give an inaccurate answer because it was difficult to assess that global status from dimensions: "You could be alright physically, but not emotionally and you could be different with finances". Overall, the preference was to have separate questions for different aspects of health: physical, emotional, adaptation, and impact of external stresses. Those on anti-TNF therapy were surprised that the patient opinion in the DAS was not more detailed if their clinical need was to be partially assessed in this way. In relation to the physical scale, one group suggested using the specific words "disease activity" with examples, such as pain, stiffness, swelling, fatigue and ability to carry out everyday activities.
There is evidence that patients interpret the DAS patient global used in this clinic in a range of ways, which may affect their response. The originators of the DAS have states that either the patient's opinion of general health or disease activity can be used in calculating the DAS28. Efforts should be made to standardise the scale in all clinics and research studies.
To cite this abstract, please use the following information:
Sanderson, Tessa, Morris, Marianne, Calnan, Michael, Richards, Pamela, Hewlett, Sarah; Rheumatoid Arthirtis Patients Interpretation of the DAS Patient Global Used at Bristol Royal Infirmary [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1207