Brown G Ted, Wright F Virginia, Lang Bianca A, Birdi Nina, Oen Kim, Stephens Derek, McComas Joan, Feldman Brian M
Monash University, Frankston, Victoria, Australia.
Arthritis Rheum. 2005 Dec 15;53(6):897-904. doi: 10.1002/art.21599.
The Childhood Health Assessment Questionnaire (CHAQ), Juvenile Arthritis Functional Assessment Report (JAFAR), and Juvenile Arthritis Functional Status Index (JASI) are widely used functional measures for juvenile idiopathic arthritis (JIA) that differ in content, format, and completion time. We compared the responsiveness and child-parent agreement of the JAFAR, CHAQ, and JASI in a prospective, multicenter study.
Children and adolescents from 5 rheumatology centers were enrolled. Subjects were about to undergo therapy (intraarticular corticosteroid injections [IAS] and methotrexate or hip surgery (MTX/hip]) expected to produce a functional improvement. All subjects were studied before the intervention and at 6 weeks and 6 months posttreatment. At each study visit, the 3 measures were administered in randomized, balanced order to both parents and children.
A total of 92 subjects (mean age 12.8 years) were enrolled in the study, 74 of which were in the IAS group. The responsiveness of all 3 measures was moderate to strong. The standardized response mean at 6 weeks for the IAS group on the JAFAR, CHAQ, and JASI was 0.41 (95% confidence interval [95% CI] 0.18, 0.64), 0.70 (95% CI 0.47, 0.93), and 0.36 (95% CI 0.13, 0.59), respectively. The CHAQ was somewhat more responsive to change at 6 weeks (IAS group: relative efficiency 0.34 [JAFAR], 0.27 [JASI]), but less responsive at 6 months (MTX/hip group: relative efficiency 5.1 [JAFAR], 3.9 [JASI]). All 3 questionnaires showed acceptable parent-child agreement, and overall, there were few differences between the 3 questionnaires.
The functional outcome measures currently used for JIA are all adequately responsive for use in trials or in the clinic setting. The choice of which measure to use should therefore be based on the time available for completion, the intended clinical/research use, and the depth of content required.
儿童健康评估问卷（CHAQ）、青少年关节炎功能评估报告（JAFAR）和青少年关节炎功能状态指数（JASI）是广泛用于青少年特发性关节炎（JIA）的功能评估工具，它们在内容、形式和完成时间上存在差异。我们在一项前瞻性多中心研究中比较了JAFAR、CHAQ和JASI的反应性以及儿童与家长之间的一致性。
招募了来自5个风湿病中心的儿童和青少年。受试者即将接受预期能改善功能的治疗（关节内注射皮质类固醇[IAS]和甲氨蝶呤或髋关节手术[MTX/髋关节]）。所有受试者在干预前、治疗后6周和6个月时接受研究。在每次研究访视时，以随机、平衡的顺序向家长和儿童发放这3种评估工具。
共有92名受试者（平均年龄12.8岁）纳入研究，其中74名在IAS组。所有3种评估工具的反应性均为中度至高度。IAS组在JAFAR、CHAQ和JASI上6周时的标准化反应均值分别为0.41（95%置信区间[95%CI]0.18，0.64）、0.70（95%CI 0.47，0.93）和0.36（95%CI 0.13，0.59）。CHAQ在6周时对变化的反应稍强（IAS组：相对效率0.34[JAFAR]，0.27[JASI]），但在6个月时反应较弱（MTX/髋关节组：相对效率5.¹[JAFAR]，3.9[JASI]）。所有3种问卷均显示出可接受的亲子一致性，总体而言，3种问卷之间差异不大。
目前用于JIA的功能结局评估工具在试验或临床环境中均具有足够的反应性。因此，选择使用哪种评估工具应基于可用于完成评估的时间、预期的临床/研究用途以及所需的内容深度。
