Test-Retest Reliability of Patient Global Assessment and Physician Global Assessment in Rheumatoid Arthritis

St. Joseph's Health Care, Department of Rheumatology, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
The Journal of Rheumatology (Impact Factor: 3.19). 09/2009; 36(10):2178-82. DOI: 10.3899/jrheum.090084
Source: PubMed


As a guide to treatment of rheumatoid arthritis (RA), physicians use measurement tools to quantify disease activity. The Patient Global Assessment (PGA) asks a patient to rate on a scale how they feel overall. The Physician Global Assessment (MDGA) is a similar item completed by the assessing physician. Both these measures are frequently incorporated into other indices. We studied reliability characteristics for global assessments and compared test-retest reliability of both the PGA and the MDGA, as well as other commonly used measures in RA.
We studied 122 patients with RA age 17 years or older. Patients who received steroid injection or change in steroid dose at the visit were excluded. Patients completed the HAQ, PGA, visual analog scale for pain (VAS Pain), VAS Fatigue, and VAS Sleep. After seeing their physician, they received another questionnaire to complete within 2 days at the same time of day as clinic visit. Physicians completed the MDGA at the time of the patient's appointment and at the end of their clinic day. Test-retest results were assessed using intraclass correlations (ICC). "Substantial" reliability is between 0.61-0.80 and "almost perfect" > 0.80.
Four rheumatologists and 146 patients participated, with 122 questionnaires returned (response rate 83.6%). Test-retest reliability was 0.702 for PGA, 0.961 for MDGA, and 0.897 for HAQ; VAS results were 0.742 for Pain, 0.741 for Fatigue, and 0.800 for Sleep. The correlation between PGA and MDGA was -0.172.
PGA, MDGA, HAQ, and VAS Pain, VAS Fatigue, and VAS Sleep all showed good to excellent test-retest reliability in RA. MDGA was more reliable than PGA. The correlation between PGA and MDGA was poor.

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    • "The Patient Global Assessment (PGA) required patients to rate how they felt overall using a scale of 0 (very well) to 10 (very poor). Previous studies have proven that PGA has good (0.702) test-retest reliability in RA.17 "
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    ABSTRACT: Objective: The main objective of this study was to determine the predictors of frequent oral analgesic use among Rheumatoid Arthritis (RA) patients who were prescribed with the above medication on an ‘as-needed’ basis. Methods: Patients with RA were recruited consecutively from the Rheumatology outpatient clinics in this cross-sectional study. The sociodemographic data, frequency of oral analgesic intake, Patient Global Assessment (PGA) scores and HAQ (Health Assessment Questionnaire) scores were determined by interviewing the subjects. Subjects were divided into 2 groups; frequent users (3 days and above in a week) and less frequent users (less than 3 days in a week). Results: In a total of 112 subjects, 39 (34.8%) were frequent analgesic users. Both the HAQ and PGA scores were significantly higher among the frequent users (p<0.05). Using multivariate analysis, the HAQ scores (p=0.015, odds ratio 3.161 [95% confidence interval of 1.246-8.015]) and PGA scores (p=0.039 odds ratio 1.291 [95% confidence interval of 1.012-1.646]) were found to be independent predictors of frequent analgesic use. Conclusions: Our study confirms that the frequency of analgesic intake in Rheumatoid Arthritis has a significant relationship with patient-reported functional capacity and well being.
    Full-text · Article · Sep 2014 · Pakistan Journal of Medical Sciences Online
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    • "We searched for RC values in the literature. Six RCTs of rheumatoid arthritis patients (the three in Table 1 and three additional publications) reported RCs of 0.74 [20], 0.75 [12], 0.88 [21], 0.88 [10], 0.94 [11], and 0.94 [22]. The median RC was 0.88. "
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    ABSTRACT: Our objective was to develop a working definition of nonresponse to analgesic treatment of arthritis, focusing on the measurement of pain on the 0-100 mm pain visual analog scale (VAS). We reviewed the literature to assess the smallest detectable difference (SDD), the minimal detectable change (MDC), and the minimal clinically important difference (MCID). The SDD for improvement reported in three studies of rheumatoid arthritis was 18.6, 19.0, and 20.0. The median MDC was 25.4 for 7 studies of osteoarthritis and 5 studies of rheumatoid arthritis (calculated for a reliability coefficient of 0.85). The MCID increased with increasing baseline pain score. For baseline VAS tertiles defined by scores of 30-49, 50-65, and >65, the MCID for improvement was, respectively, 7-11 units, 19-27 units, and 29-37 units. Nonresponse can thus be defined in terms of the MDC for low baseline pain scores and in terms of the MCID for high baseline scores.
    Full-text · Article · May 2011
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    ABSTRACT: ABILHAND is a Rasch-built questionnaire that measures manual ability in rheumatoid arthritis (RA) patients. This study aimed to examine the test-retest reliability and the responsiveness of ABILHAND in RA patients. Eighty-eight patients underwent 3 evaluations: the first evaluation was at baseline (time 1), the second was 2 weeks later (time 2), and the third was 1 year later (time 3). Disease activity was assessed using the Disease Activity Score in 28 joints using the C-reactive protein level (DAS28-CRP). Patients rated the intensity of their RA-related pain using a 100-mm visual analog scale for pain and completed questionnaires based on their activity limitations (ABILHAND and the Health Assessment Questionnaire) and quality of life. The responsiveness analyses were conducted by using global, group, and individual approaches. The global approach showed significant differences between the time 1 and time 3 scores of the DAS28-CRP (P = 0.04) and ABILHAND (P = 0.04). Based on the changes in disease activity scores and the European League Against Rheumatism response criteria, the sample was divided into 3 groups: deteriorated, stable, and improved. The mean ± SD changes in manual ability were higher in the deteriorated (-1.23 ± 1.53 logit) and in the improved (1.22 ± 2.06 logits) groups than in the stable group (0.48 ± 1.09 logit). The effect size and standardized response mean confirmed that observation. The minimal clinically important difference was assessed in each group of patients. The ABILHAND questionnaire exhibited responsiveness in detecting slight changes in RA patients. Therefore, the ABILHAND tool can be used to evaluate the functional status of RA patients in clinical trials and settings.
    Full-text · Article · Jan 2011
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