Application of the OMERACT filter to measures of core outcome domains in recent clinical studies of acute gout

OBJECTIVE

To determine the extent to which instruments that measure core outcome domains in acute gout fulfill the Outcome Measures in Rheumatology (OMERACT) filter requirements of truth, discrimination, and feasibility.

METHODS

Patient-level data from 4 randomized controlled trials of agents designed to treat acute gout and 1 observational study of acute gout were analyzed. For each available measure, construct validity, test-retest reliability, within-group change using effect size, between-group change using the Kruskall-Wallis statistic, and repeated measures generalized estimating equations were assessed. Floor and ceiling effects were also assessed and minimal clinically important difference was estimated. These analyses were presented to participants at OMERACT 11 to help inform voting for possible endorsement.

RESULTS

There was evidence for construct validity and discriminative ability for 3 measures of pain [0 to 4 Likert, 0 to 10 numeric rating scale (NRS), 0 to 100 mm visual analog scale (VAS)]. Likewise, there appears to be sufficient evidence for a 4-point Likert scale to possess construct validity and discriminative ability for physician assessment of joint swelling and joint tenderness. There was some evidence for construct validity and within-group discriminative ability for the Health Assessment Questionnaire as a measure of activity limitations, but not for discrimination between groups allocated to different treatment.

CONCLUSION

There is sufficient evidence to support measures of pain (using Likert, NRS, or VAS), joint tenderness, and swelling (using Likert scale) as fulfilling the requirements of the OMERACT filter. Further research on a measure of activity limitations in acute gout clinical trials is required.

OMERACT endorsement of measures of outcome for studies of acute gout

OBJECTIVE

To determine the extent to which participants at the Outcome Measures in Rheumatology (OMERACT) 11 meeting agree that instruments used in clinical trials to measure OMERACT core outcome domains in acute gout fulfill OMERACT filter requirements of truth, discrimination, and feasibility; and where future research efforts need to be directed.

METHODS

Results of a systematic literature review and analysis of individual-level data from recent clinical studies of acute gout were presented to OMERACT participants. The information was discussed in breakout groups, and opinion was defined by subsequent voting in a plenary session. Endorsement was defined as at least 70% of participants voting in agreement with the proposition (where the denominator excluded those participants who did not vote or who voted "don't know").

RESULTS

The following measures were endorsed for use in clinical trials of acute gout: (1) 5-point Likert scale and/or visual analog scale (0 to 100 mm) to measure pain; (2) 4-point Likert scale for joint swelling; (3) 4-point Likert scale for joint tenderness; and (4) 5-point Likert scale for patient global assessment of response to treatment. Measures for the activity limitations domain were not endorsed.

CONCLUSION

Measures of pain, joint swelling, joint tenderness, and patient global assessment in acute gout were endorsed at OMERACT 11. These measures should now be used in clinical trials of acute gout.

Development, sensibility, and reliability of the Toronto Axial Spondyloarthritis Questionnaire in inflammatory bowel disease

OBJECTIVE

There is an unacceptable delay in the diagnosis of axial spondyloarthritis (axSpA) in its early stages among patients at high risk, in particular those with inflammatory bowel disease (IBD). Our objectives were to develop a sensible and reliable questionnaire to identify undetected axSpA among patients with IBD.

METHODS

Literature was reviewed for item generation in the Toronto axSpA Questionnaire on IBD (TASQ-IBD). Sensibility of the questionnaire was assessed among healthcare professionals and patients. This assessment was related to purpose and framework (clinical function, clinical justification, and clinical applicability), face validity, comprehensiveness [oligo-variability (limiting the questionnaire to important items) and transparency], replicability, content validity, and feasibility. The test-retest reliability study was administered to 77 patients with established IBD and axSpA. Kappa agreement coefficients and absolute agreement were calculated for items.

RESULTS

Three domains included IBD, inflammatory back symptoms, and extraaxial features. The entry criterion required a patient to have IBD and back pain or stiffness that ever persisted for ≥ 3 months. Iterative sensibility assessment involved 16 items and a diagram of the back. Kappa coefficients ranged from 0.81-1.00 for each item. Absolute agreement across all items ranged from 91% to 100%.

CONCLUSION

TASQ-IBD is a newly developed, sensible, and reliable case-finding questionnaire to be administered to patients with IBD who have ever had chronic back pain or stiffness persisting for ≥ 3 months. It should facilitate identification and timely referral of patients with IBD to rheumatologists and minimize the delay in diagnosis of axSpA. Consequently, it should assess the prevalence of axSpA in IBD.

THE EYSENCK PERSONALITY INVENTORY: SOME CONSIDERATIONS

The aim of this paper is to report our experience with a new psychometric test, the Eysenck Personality Inventory, or E.P.I. (Eysenck and Eysenck, 1964).

THE MAUDSLEY PERSONALITY INVENTORY (SHORT FORM). DISTRIBUTION OF SCORES AND TEST-RETEST RELIABILITY IN AN URBAN POPULATION

During the course of a morbidity study in two communities in the town of Croydon, carried out between 1960 and 1962, it proved possible to incorporate an investigation of the shortened version of the Maudsley Personality Inventory (M.P.I.). This twelve-item questionnaire, constructed by Eysenck (1958) for studies of this type, gives measures of neuroticism and extraversion as defined within his personality theory (Eysenck, 1959). Initially the inventory used was identical with that described by Eysenck. After a time (during which test-retest was carried out on 130 adults), however, it was felt that three of the questions relating to extraversion were rather cumbersome, and the following changes were made. Question D, “Are you happiest when you get involved in some project that calls for rapid action?”, was amended to “Are you happiest when you get involved in something that calls for rapid action?”. Question G, “Do you usually take the initiative in making new friends?”, was amended to “Do you usually take the first step in making new friends?”. Question L, “Would you be very unhappy if you were prevented from making numerous social contacts?”, was amended to “Would you be very unhappy if you were prevented from meeting lots of people ?”. It was assumed that these minor alterations would not significantly affect the extraversion scores, and this assumption is borne out by the fact that neither the means of scores nor the test-retest correlations were significantly different on comparison of the two versions. This present study reports the frequency distribution of M.P.I. scores in the population studied and the test-retest reliability of the inventory.