Poiraudeau S, Lefevre-Colau M M, Fermanian J, Revel M
Department of Physical and Rehabilitation Medicine, Hôpital Cochin, Université René Descartes, Paris, France.
Arthritis Care Res. 2000 Oct;13(5):296-303. doi: 10.1002/1529-0131(200010)13:5<296::aid-anr9>3.0.co;2-f.
To assess changes measured with the Cochin rheumatoid arthritis (RA) hand functional disability scale during the course of the disease.
A cohort study evaluating outcome measure responsiveness in RA was conducted in a referral center. Ambulatory or hospitalized patients with RA according to the 1987 American College of Rheumatology (formerly the American Rheumatism Association) criteria were evaluated twice. Clinical measures included Cochin's scale, Revel's functional index, hand functional index, visual analog scale of patient-perceived handicap, visual analog scale of pain in hands and wrists, total score of swelling, total score of tenderness, and morning stiffness duration. Responsiveness was assessed by the effect size (ES) and the standardized response mean (SRM). The nonparametric Spearman rank correlation coefficient (r) was used to assess the correlation between two quantitative variable changes.
Fifty-five patients (44 women) were evaluated twice at an interval of 15.4 +/- 1.4 months (mean +/- SD) (range 13-18 months). The Cochin scale total score had worsened at the second visit (95% confidence interval for mean differences -5.16, 0.73). Its SRM and ES values were -0.20 and -0.15, respectively. Changes in the score had the highest correlation (r = 0.58) with changes in the patient-perceived handicap, while it had only fair or little correlation with changes in the disease activity measures. The factor 2 scale subscore significantly worsened and had the highest values of SRM and ES (SRM = -0.40 and ES = -0.31).
The Cochin scale can detect small but meaningful changes in RA hand disability.
评估在疾病过程中使用科钦类风湿关节炎（RA）手部功能残疾量表所测得的变化。
在一个转诊中心进行了一项队列研究，以评估RA结局指标的反应性。根据1987年美国风湿病学会（原美国风湿病协会）标准确定的门诊或住院RA患者接受了两次评估。临床指标包括科钦量表、雷维尔功能指数、手部功能指数、患者自我感知残疾的视觉模拟量表、手部和腕部疼痛的视觉模拟量表、肿胀总分、压痛总分以及晨僵持续时间。通过效应量（ES）和标准化反应均值（SRM）评估反应性。使用非参数Spearman等级相关系数（r）评估两个定量变量变化之间的相关性。
55例患者（44名女性）在间隔15.4±1.4个月（均值±标准差）（范围13 - 18个月）时接受了两次评估。第二次评估时科钦量表总分恶化（平均差异的95%置信区间为 -5.16，0.73）。其SRM和ES值分别为 -0.20和 -0.15。该量表得分的变化与患者自我感知残疾的变化相关性最高（r = 0.58），而与疾病活动度指标的变化相关性一般或较弱。因子2量表子得分显著恶化，且SRM和ES值最高（SRM = -0.40，ES = -0.31）。
科钦量表能够检测出RA手部残疾的微小但有意义的变化。
