Full Papers
Can numerical rating scales of disease impact be used as targets for patient-centred management in rheumatoid arthritis?
C. Duarte1, E. Santos2, S.C. Barreira3, P. Ávila-Ribeiro4, F. Costa5, P. Freitas6, F. Araújo7, R. Freitas8, J. Marona9, S.R. Manica10, J. Ferreira11, M. Couto12, M. Guerra13, L.H. Calabrese14, M. De Wit15, R.J. Ferreira16, J.A. Da Silva17
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, and iCBR-Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal. catiacmduarte@gmail.com
- Health School of the Polytechnic Institute of Viseu, Portugal, and Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal.
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Centro Académico de Medicina de Lisboa, and Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal.
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Centro Académico de Medicina de Lisboa, and Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal.
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Portugal.
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Portugal.
- Rheumatology and Osteoporosis Unit, Hospital de Sant’Ana, SCML, Lisboa, Portugal.
- Department Rheumatology, Garcia de Orta Hospital, Almada, Portugal.
- Department of Rheumatology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental Lisboa, and CEDOC, NOVA Medical School, Universidade de Lisboa, Portugal.
- Department of Rheumatology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental Lisboa, and CEDOC, NOVA Medical School, Universidade de Lisboa, Portugal.
- Rheumatology Department of Health Unit of Guarda, and Faculty of Health Sciences, Beira Interior University, Covilhã, Portugal.
- Rheumatology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
- Rheumatology Department, Centro Hospitalar de Gaia, Vila Nova de Gaia, Portugal.
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, USA.
- EULAR PARE Patient research partner.
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, and Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal.
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, and iCBR-Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal.
CER15690
2023 Vol.41, N°3
PI 0704, PF 0710
Full Papers
PMID: 35930489 [PubMed]
Received: 19/03/2022
Accepted : 13/06/2022
In Press: 05/08/2022
Published: 23/03/2023
Abstract
OBJECTIVES:
Patient centred care is an increasingly important paradigm. Applying a treat-to-target strategy to the impact of the disease in patients’ lives seems a very promising tool to serve this purpose. We aimed to evaluate if maximum acceptable impact scores (target-values) defined at the population level provide an appropriate representation for most individual patients. To determine if the individually established target values of impact are consistent enough to be used in a treat-to-target strategy.
METHODS:
Consecutive patients with rheumatoid arthritis were asked to indicate, in two consecutive visits, the maximum severity of impact they considered acceptable to live with for the rest of their lives, in the seven domains of Rheumatoid Arthritis Impact of Disease score. The individual adequacy of population-based reference values was assessed by measures of dispersion. Stability of individual target-values were evaluated through intraclass correlation coefficient. Socio-demographic, clinical and psychological features were tested as co-factors of stability.
RESULTS:
299 patients were included. The dispersion of targets was wide (CV>0.68), thus limiting the use of any population-based single values as targets for the individual patients. Although the mean target values were very similar in both visits for all domains, reliability was poor in all cases (ICCs: 0.37–0.47). Only 25–30% of the patients selected the same target value in the 2 visits. No explanatory factors for (non-)stability were identified.
CONCLUSIONS:
Quantified impact targets defined at population level are not appropriate for individual patient care. Research on alternative tools to support patient-centred, target-oriented management strategies is warranted.
