Ab1307 study of Concordance and Equivalence Among Barthel, Lawton, Haq and Basfi Questionnaires in Rheumatoid and Spondyloarthritis Patients

Abstract

Background:Assessment of functional capacity of patients is usually performed using disease-specific questionnaires for rheumatoid arthritis (HAQ) and for axial spondyloarthropathies (BASFI). However, frequently non disease-specific, general indexes such as Barthel and Lawton-Brody (LB) are used to establish disability in legal environtments and in emergency rooms. Few studies have compared specific vs. generic questionnaires in rheumatic patients (1).Objectives:To assess the equivalence between disability questionnaires of generic type, applicable to general population and various diseases (Barthel and LB), with specific questionnaires for rheumatic diseases (HAQ and BASFI).Methods:A cross-sectional study was conducted in consecutive outpatients with inflammatory rheumatic diseases (rheumatoid arthritis, psoriatic arthritis, spondyloarthropathies) in usual daily clinical practice in a rheumatology clinic of a tertiary hospital.The patients self-completed the questionnaires (Barthel, LB, HAQ, and BASFI) in a single session. HAQ was only filled by peripheral arthritis patients, while BASFI was only given to spondyloarthropathy subjects. Scores were also computed for SDAI, DAS28 and BASDAI in most patients. Intraclass correlation was used to measure concordance between questionnaires.Results:A total of 214 patients where studied. There was good correlation between the scores of the indexes studied, especially between the two general questionnaires (R = 0.45 p <0.01). We observed a high ceiling effect in the scores of both Barthel, (70% of patients obtained values> 95 over a maximum of 100) and Lawton-Brody (60% had values> 23 over a maximum of 24) tests. The disease-specific questionnaires showed a less skewed distribution. The agreement between Barthel’s and Lawton’s tests was significant when measured by the intraclass correlation (R = 0.48 p <0.01). However, we could not find any significant correlation between the generic questionnaires and the HAQ questionnaire or the BASFI (R < 0.3).Conclusion:The Barthel and Lawton-Brody indices show an important ceiling effect in rheumatic patients, and seem to evaluate dimensions of health other than rheumatic questionnaires such as HAQ and BASFI, and thus they are not interchangeable. This point must be taken into account when performing medicolegal or emergency room assessments. Our result is in line with other previous studies(1)Reference[1] Zochling J, Stucki G, Grill E, Braun J. A comparative study of patient-reported functional outcomes in acute rheumatoid arthritis. J Rheumatol 2007;34(1):64–9.Disclosure of Interests:None declared