Pediatria II, Istituto G. Gaslini, Largo G. Gaslini 5, 16147 Genoa, Italy.
J Rheumatol. 2012 Apr;39(4):856-63. doi: 10.3899/jrheum.110745. Epub 2012 Feb 1.
To explore the parent and child acceptable symptom state in juvenile arthritis (JA-PASS and JA-CASS, respectively) and estimate the JA-PASS and JA-CASS cutoff values for outcome measures.
Children with juvenile idiopathic arthritis (JIA) and their parents completed a multi-dimensional questionnaire that included parent-reported and child-reported outcomes and a question about whether they considered the disease state as satisfactory. Additional assessments included demographic data, physician-reported outcomes, and acute-phase reactant levels. Stepwise logistic regression was used to assess contributors to JA-PASS and JA-CASS. Cutoff values of outcome measures that defined JA-PASS and JA-CASS were determined using both 75th percentile and receiver-operating characteristic (ROC) curve methods. Testing procedures included evaluation of discriminative and construct validity of the satisfaction question and assessment of reliability of JA-PASS and JA-PASS cutoffs.
Of 584 parents, 385 (65.9%) considered their child in JA-PASS. Of 343 children, 236 (68.8%) considered themselves in JA-CASS. Significant contributors to being in either JA-PASS or JA-CASS were absence of active joints, better rating of overall well-being, and better physical function or health. Cutoff values yielded by 75th percentile and ROC curve methods were similar. Parent, child, and physician global ratings yielded the lowest percentage of false-positive misclassification and the best tradeoff between sensitivity and specificity. The satisfaction question showed good discriminative and construct validity and the JA-PASS and JA-PASS cutoffs were found to be stable over time.
The acceptable symptom state is a relevant concept for children with JIA and their parents and constitutes a valid outcome measure that is potentially applicable in routine practice and clinical trials.
探索青少年关节炎（JA-PASS 和 JA-CASS）中父母和儿童可接受的症状状态，并确定用于评估结果的 JA-PASS 和 JA-CASS 截断值。
患有幼年特发性关节炎（JIA）的儿童及其父母完成了一份多维问卷，其中包括父母报告和儿童报告的结果，以及一个关于他们是否认为疾病状态令人满意的问题。其他评估包括人口统计学数据、医生报告的结果和急性期反应物水平。逐步逻辑回归用于评估 JA-PASS 和 JA-CASS 的贡献因素。使用第 75 百分位数和受试者工作特征（ROC）曲线方法确定定义 JA-PASS 和 JA-CASS 的结果测量的截断值。测试程序包括评估满意度问题的判别和结构有效性，以及评估 JA-PASS 和 JA-PASS 截断值的可靠性。
在 584 位家长中，有 385 位（65.9%）认为他们的孩子处于 JA-PASS 状态。在 343 位儿童中，有 236 位（68.8%）认为自己处于 JA-CASS 状态。处于 JA-PASS 或 JA-CASS 状态的重要因素是无活动关节、整体幸福感评分较好以及身体功能或健康状况较好。第 75 百分位数和 ROC 曲线方法得出的截断值相似。家长、儿童和医生的总体评分产生的假阳性错误分类百分比最低，并且在敏感性和特异性之间具有最佳的权衡。满意度问题表现出良好的判别和结构有效性，并且 JA-PASS 和 JA-PASS 截断值在时间上是稳定的。
可接受的症状状态是儿童和父母患有 JIA 的一个相关概念，并且是一种有效的结果测量方法，可能适用于常规实践和临床试验。
