Assessment of the reliability and validity of the arthritis impact measurement scales for children with juvenile arthritis

780

484

Objective. The goal of this project was to develop a more comprehensive and sensitive version of the Arthritis Impact Measurement Scales (AIMS).Methods. AIMS scale items were revised, and 3 new scales were added to evaluate arm function, work, and social support. Sections were also added to assess satisfaction with function, attribution of problems to arthritis, and self-designation of priority areas for improvement. The new instrument was designated the -2.A pilot test of format and content and a performance test of reliability and validity were carried out.Results. Questionnaire completion times in a pilot study of 24 subjects averaged 23 minutes, and evaluations were positive regarding the instrument's length and ease of completion, and the subjects' willingness to complete serial forms and return them by mail. Mea- Submitted for publication February 20, 1991; accepted in revised form August 19, 1991. surement performance was tested in 408 subjects: 299 with rheumatoid arthritis (RA) and 109 with osteoarthritis (OA); 45 of these subjects completed a second AIMS2 within 3 weeks. Internal consistency coefficients for the 12 scales were 0.72-0.91 in the RA group and 0.74-0.96 in the OA group. Test-retest reliability was 0.78-0.94. All withm-scale factor analyses produced single factors, except for mobility level in OA. Validity analyses in both the RA and the OA groups showed that patient designation of an area as a problem or as a priority for improvement was significantly associated with a poorer AIMS2 scale score in that area. Reliability, factor analysis, and validity results were consistent in age, sex, and education subgroups. Satisfaction was moderately correlated with level of function in the same health status area, and the satisfaction items formed a reliable scale. Responses to the arthritis attribution items showed that most dysfunction in this sample was due to arthritis. Conclusion.The AIMS2 is a revised and expanded health status questionnaire with excellent measurement properties that should be useful in arthritis clinical trials and in outcomes research.

Section: Discussionmentioning

confidence: 99%

AIMS2. The Content and Properties of a Revised and Expanded Arthritis Impact Measurement Scales Health Status Questionnaire

Meenan

Mason

Anderson

et al. 1992

780

484

“…measures to more comprehensively assess the experience of pain and resulting functional losses in JRA patients. Coulton et al [23] modified the Arthritis Impact Measurement Scales (AIMS) [26], an instrument developed to assess physical and psychological disability and pain in adults, for use with children and adolescents between the ages of 2 and 17 years with JRA. Although preliminary reliability and validity data were found, this modified AIMS questionnaire for JRA patients has been criticized for its relatively poor measurement qualities [24].…”

Section: Assessment Of Functional Lossesmentioning

confidence: 99%

Juvenile rheumatoid arthritis: pain‐related and psychosocial aspects and their relevance for assessment and treatment

Jaworsk

1993

Objective. To review literature in the area of juvenile rheumatoid arthritis that has focused on pain experience, functional losses, and psychosocial functioning.Methods. This article provides a critical review of research addressing these three primary issues.Results. Subjective and behavioral measures have been developed to assess pain in juvenile rheumatoid arthritis patients, but further work is needed to determine the validity and reliability of these instruments. Tools to assess functional losses in juvenile rheumatoid arthritis patients also appear promising in preliminary studies. Patients can be at risk for difficulties in psychosocial functioning, although research suggests that there are a variety of family, parental, and child variables that influence child and sibling adaptation. Methodologic shortcomings prevent definitive conclusions in this area.Conclusions. A1 t hough met hodologic limitations have plagued this research in the past, new advances are facilitating improved understanding of children and adolescents with juvenile rheumatoid arthritis. Implications for future study with this challenging population are offered. Theresa M. Jaworski. PhD, is at the Mayo Clinic Foundation, Rochester, Minnesota.Address correspondence to Theresa M. Jaworski, PhD, Section of Psychology, Mayo Clinic Foundation, 200 First Street, SW, Rochester, MN 55905.Submitted for publication February 3,1993; accepted July 15,1993. 0 11193 by the Arthritis Foundation.Key Words: Juvenile rheumatoid arthritis; Psychosocial aspects; Pain; Assessment.It has been estimated that 60,000 to 250,000 children in the United States are affected with juvenile rheumatoid arthritis (JRA); thus, JRA is one of the most common chronic diseases in children [1,2]. Juvenile rheumatoid arthritis is an inclusive term for children with joint involvement occurring before or at age 16 years. Three distinct forms are recognized at diseaseonset: (1) the systemic form, characterized mainly by fever, rash, and modest arthritis; (2) the pauciarticular form, characterized by involvement of four joints or fewer; and (3) the polyarticular form, which involves more than four joints. The pauci-and polyarticular forms are further subdivided into two types each. Pauciarticular type I occurs mainly in young girls who may also have eye involvement, whereas type I1 is more frequent in older boys and primarily involves the lower extremities and the axial skeleton. The polyarticular form also has two types, seropositive and seronegative (for immunoglobulin M-rheumatoid faotor). (Children with systemic-onset JRA that evolves into polyarthritis and those with seropositive polyarthritis tend to have persistent joint inflammation and joint cdestruction and must cope with chronic pain and experience greater functional losses [3-51. Psychologically-related research has been conducted to better understand three aspects of JRA: (1) the experience of pain in children and adolescents with JRA; ( 2 ) how functional activity levels might be compromised by the disease and t...

“…The AIMS mobility, physical activity dexterity, and ADL scales can be partially modified for children [94]. The solcial role, social activity, pain, depression, and anxiety scales of the AIMS can potentially provide some items applicable to children [95].…”

Section: Arthritis Impact Measurement Scales (Aims)mentioning

confidence: 99%

“…Coulton and co-workers attempted to apply selected components of the AIMS to a sample of 77 children with juvenile arthritis [94]. They used (a) a revised physical disability dimension that did not include the household activities scale and (b) the pain dimension.…”

Section: Existing Instruments To Measure Pediatric Arthritis Health Smentioning

confidence: 99%

“…Of importance, 4 2 patients had polyarticular JA, but there were 34 with pauciarticular disease. The AIMS questions were embedded in a survey that contained other unknown questions; items relating to dexterity and to ADL were not administered to the 20 parents whose children were less than 6 years old [94]. Disease activity was defined partly by retrospective chart review, could be positive even if only one joint was limited, and did not include a sedimentation rate.…”

Section: Existing Instruments To Measure Pediatric Arthritis Health Smentioning

confidence: 99%

See 1 more Smart Citation

Health status (arthritis impact) in children with chronic rheumatic diseases. Current measurement issues and an approach to instrument design

Singsen

1991

Arthritis outcome measures in adults have evolved from biologic “disease activity,” to observations of motor/movement based “functional status,” to assessment of “health status.” This monograph suggests a framework for developing a pediatric arthritis health status (impact) instrument in which measurable global outcome dimensions include psychological, social, ADL, pain, school, family, behavioral, and developmental variables. Physical and laboratory parameters of inflammation/disease activity are not part of either functional status or arthritis impact, but rather perhaps the most important predictor variable of outcome. Juvenile rheumatoid arthritis (JRA) is a prototypic chronic disease for development of a health status instrument for children. Prior obstacles have been (a) that systemic, polyarticular, and pauciarticular JRA appear to have very different amounts of impact on health status; and (b) although juvenile arthritis has proven a useful term for medical and public education, its value as a study entry criterion for functional status instrument development is limited. Any new pediatric arthritis impact instrument must fulfill five criteria: enable quantification; demonstrate reliability, validity, and precision; and specify data collection procedures. Important design issues include (a) developing a self‐report format for children, (b) ensuring generalizability across age groups, and (c) the parent as proxy in most patient‐related dialogue and interventions. Instrument elements could come from 8–10 adult and pediatric health/functional status instruments already in use. By 10 years of age, children can provide much independent information. Whether global assessments by patient, parent, and physician should be included, or be a separate “gold standard,” is not yet clear. The creation of better health status measures is an important and formidable challenge for pediatric rheumatology.