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Comparison between self-report measures & clinical observations of functional disability in ankylosing spondylitis, rheumatoid arthritis & fibromyalgia (FM)

  [ 48 votes ]   [ Discuss This Article ] • May 3, 1994

OBJECTIVE. To study concordance between self-report measures
and clinical observations of functional disability in
ankylosing spondylitis (AS), rheumatoid arthritis (RA), and
fibromyalgia (FM).

METHODS. 35 patients with AS completed 9
selected items of the Functional Index questionnaire, whereas
12 patients with RA and 13 with FM completed 7 selected items
of the Arthritis Impact Measurement Scales. Five days later,
all 60 patients and 4 controls actually performed the selected
activities, which were recorded on video. The tapes were
assessed in random order by 12 observers (6 occupational
therapists and 6 physicians). Both patients and observers
indicated functional disability on a 10 cm visual analog scale

RESULTS. Interobserver agreement was high (Cronbach's
alpha 0.98). All observers scored the 4 healthy controls as
having no disability at all. Mean discordance scores (VAS
patients minus VAS observers) for the selected items were
negligible in AS [-0.17 cm (p = 0.30)], moderate in RA [+1.10
cm (p = 0.06)] and high in FM [+2.44 cm (p < 0.01)].

CONCLUSION. Discordance between self-report
questionnaires and observed functional disability is a feature
most striking in FM. In validation of self-report
questionnaires of functional disability the appropriate
spectrum of rheumatological diagnoses should be considered.

Hidding A, van Santen M, De Klerk E, Gielen X, Boers M, Geenen R,
Vlaeyen J, Kester A, van der Linden S

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