Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Testing Patient Knowledge about Methotrexate: Development and Validation of the Methotrexate in Rheumatoid Arthritis Knowledge Test (MiRAK).

Ciciriello3,  Sabina, Wicks4,  Ian, Osborne2,  Richard H., Buchbinder1,  Rachelle

Cabrini Medical Center, Malvern, Australia
Deakin University, Melbourne, Australia
Royal Melbourne Hospital, Melbourne, Victoria, Australia
Royal Melbourne Hospital, Melbourne, Australia


The study describes the development and validation of the MiRAK, a new tool designed to specifically measure patient knowledge about methotrexate (MTX) treatment for RA. MTX is an effective treatment for RA and is the cornerstone of modern RA treatment. However it is not without risks and patients need to understand complex information in order to make an informed decision about starting MTX and to take it safely. In planning a randomized controlled trial to assess the effectiveness of a new multimedia patient education program about MTX and RA we found no suitable outcome tool designed to measure patient knowledge about MTX.


The knowledge tested by the MiRAK was guided by a literature review and consultation with rheumatologists (N=15) as well as concept mapping workshops with RA patients (N=24) exploring their information needs when starting MTX. To ensure face validity, draft items of the MiRAK were tested with both patients and rheumatologists. The draft questionnaire was administered to 317 RA patients treated with MTX (response rate 53%). The data was analyzed using item response theory with a Rasch model. To assess test-retest reliability, 146 respondents were sent a second copy of the MiRAK two weeks later (response rate 90%).


60 candidate questions were generated, with True/False/Don't Know response options, to test a wide range of knowledge about MTX. Rasch analyses revealed that the MiRAK was unidimensional allowing the questions to be summated into a single knowledge score. Scores ranged from 8–57 correct responses out of 60 (mean (SD) 35.78 (7.7)). Scale fit indices revealed that the observed responses fit well with the Rasch model indicating sound measurement properties. The MiRAK questions covered all levels of underlying knowledge in the sample population. The MiRAK had excellent internal consistency (Cronbach's alpha 0.84) and test-retest reliability (ICC 0.89).


Advanced psychometric analyses were used to generate the MiRAK and provide strong evidence for its validity and reliability. Further work is underway to evaluate its sensitivity to change. The MiRAK may be useful as an outcome measure in both clinical trials of interventions designed to educate patients about MTX, and in routine care to assess patient knowledge of MTX prior to commencement of treatment.

To cite this abstract, please use the following information:
Ciciriello, Sabina, Wicks, Ian, Osborne, Richard H., Buchbinder, Rachelle; Testing Patient Knowledge about Methotrexate: Development and Validation of the Methotrexate in Rheumatoid Arthritis Knowledge Test (MiRAK). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1009
DOI: 10.1002/art.28776

Abstract Supplement

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