Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Sensitivity to Change of the Bristol Rheumatoid Arthritis Fatigue Scales.

Hewlett1,  Sarah, Dures1,  Emma, Kirwan2,  John R., Cramp1,  Fiona, Nicklin3,  Joanna, Almeida1,  Celia, Mitchell3,  Kathryn

University of the West of England, Bristol, United Kingdom
University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
University of Bristol, Bristol, United Kingdom


Fatigue in RA is a major problem and measurement is recommended in clinical trials. The Bristol RA Fatigue Multi-Dimensional Questionnaire (BRAF-MDQ) is a validated 20 item patient reported outcome measure (PROM) (global score 0–70) with 4 subscales: Physical (0–22), Living with fatigue (0–21); Cognitive (0–15) and Emotional (0–12). Three single item numerical rating scales (BRAF NRS) measure fatigue Severity and Effect (0–10) and Coping (10–0).1,2 This study examined their sensitivity to change.


RA outpatients given a single high dose of i/m glucocorticoids for clinical reasons, completed PROMs at weeks 0 and 2: BRAF scales, comparator fatigue PROMs [Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F), Multi-dimensional Assessment of Fatigue (MAF), Profile of Mood States (POMS), Short Form 36 Health Survey Vitality Subscale (SF-36 VT)], VAS pain and global opinion of disease, and Health Assessment Questionnaire (HAQ).


42 patients participated: 34 female, mean age 56.7yrs (30–76, SD 12.6yrs), disease duration 10.7yrs (0.05–43, SD 10.7yrs); HAQ 1.875, (0–3, SD 0.65), pain 70.83 (SD 19.9) and global opinion 58.24 (SD 24.93). 15% MAF not scored due to missing data (POMS 9%, SF36 2%, BRAFs 1%). Baseline BRAF fatigue was high: BRAF-MDQ global 43.00/70 (SD 14.51), BRAF-Physical 16.80/22 (3.42), BRAF-Living 11.45/21 (5.60), BRAF-Cognitive 7.90/15 (4.3) and BRAF-Emotion 6.24/12 (3.63); BRAF-NRS Severity 7.15/10 (1.67), Effect 7.04/10 (2.32) and Coping 5.56/10 (low bad) (2.25).

Mean change and effect sizes (change/SD at baseline) show all scales sensitive to change except BRAF-NRS coping (Table 1).

Table 1.

 Mean change95% confidence intervalP value for paired t testEffect size
BRAF Global-7.74(-12.11, -3.38)0.0010.56
BRAF Physical-2.89(-4.59, -1.2)0.0010.54
BRAF Living-2.32(-3.69, -0.95)0.0010.53
BRAF Cognition-1.20(-2.34, -0.05)0.0410.33
BRAF Emotion-1.34(-2.34, -0.34)0.0100.42
BRAF NRS Sev-1.25(-2.07, -0.43)0.0040.47
BRAF NRS Effect-1.25(-2.09, -0.41)0.0050.46
BRAF Cope (Rev)-0.13(-1.03, 0.77)0.7710.05
SF36 (Rev)7.68(0.48, 14.88)0.0370.34
FACIT (Rev)5.57(2.43, 8.71)0.0010.55
POMS-3.46(-5.59, -1.32)0.0020.53
MAF-5.34(-8.65, -2.04)0.0020.57
Pain-20.43(-27.89, -12.96)0.0010.87
Global opinion-7.93(-15.81, -0.05)0.0490.31

Using a fatigue transition question as an anchor, BRAF-MDQ Global mean change was +3.57 for worse fatigue (SD 5.77, n=7) -2.42 for no change (SD 8.3, n=13) and -15.81 for less fatigue (SD 14.3, n=20); BRAF-NRS Severity was +0.29 (SD 1.38), 0.75 (SD 1.3) and -3.30 (SD 2.27); NRS Effect was +0.71 (SD 1.25), +0.39 (SD 1.9) and -3.0 (SD 2.39).


The BRAF MDQ, NRS Severity and Effect are sensitive to change. The BRAF Coping NRS was not sensitive to change after a pharmacological intervention. Along with the differential effect sizes in the BRAF-MDQ subscales, this supports the theory that fatigue consequences and coping are distinct concepts that require separate PROMs and interventions.

1Nicklin,  et al, AC&R 2010;62:1552–58

2Nicklin,  et al, AC&R 2010;62:1559–68

To cite this abstract, please use the following information:
Hewlett, Sarah, Dures, Emma, Kirwan, John R., Cramp, Fiona, Nicklin, Joanna, Almeida, Celia, et al; Sensitivity to Change of the Bristol Rheumatoid Arthritis Fatigue Scales. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2425

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