Academic Rheumatology, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
Rheumatology (Oxford). 2013 Oct;52(10):1832-9. doi: 10.1093/rheumatology/ket218. Epub 2013 Jul 9.
To examine the reliability (stability) and sensitivity of the Bristol Rheumatoid Arthritis Fatigue scales (BRAFs) and patient-reported outcome measures (PROMs) developed to capture the fatigue experience. The Multi-Dimensional Questionnaire (BRAF-MDQ) has a global score and four subscales (Physical Fatigue, Living with Fatigue, Cognitive Fatigue and Emotional Fatigue), while three numerical rating scales (BRAF-NRS) measure fatigue Severity, Effect and Coping.
RA patients completed the BRAFs plus comparator PROMs. Reliability (study 1): 50 patients completed questionnaires twice. A same-day test-retest interval (minimum 60 min) ensured both time points related to the same 7 days, minimizing the capture of fatigue fluctuations. Reliability (study 2): 50 patients completed the same procedure with a re-worded BRAF-NRS Coping. Sensitivity to change (study 3): 42 patients being given clinically a single high dose of i.m. glucocorticoids completed questionnaires at weeks 0 and 2.
The BRAF-MDQ, its subscales and the BRAF-NRS showed very strong reliability (r = 0.82-0.95). BRAF-NRS Coping had lower moderate reliability in both wording formats (r = 0.62, 0.60). The BRAF-MDQ, its subscales and the BRAF-NRS Severity and Effect were sensitive to change, with effect sizes (ESs) of 0.33-0.56. As hypothesized, the BRF-NRS Coping was not responsive to the pharmaceutical intervention (ES 0.05). Preliminary exploration suggests a minimum clinically important difference of 17.5% for improvement and 6.1% for fatigue worsening.
The BRAF scales show good reliability and sensitivity to change. The lack of BRAF-NRS Coping responsiveness to medication supports the theory that coping with fatigue is a concept distinct from severity and effect that is worth measuring separately.
研究用于评估类风湿关节炎患者疲劳体验的布里斯托关节炎疲劳量表（BRAFs）和患者报告结局测量（PROMs）的可靠性（稳定性）和敏感性。多维问卷（BRAF-MDQ）包含一个总体评分和四个分量表（身体疲劳、疲劳生活、认知疲劳和情绪疲劳），三个数字评定量表（BRAF-NRS）则分别评估疲劳的严重程度、效应和应对情况。
RA 患者完成了 BRAFs 和对照性 PROMs。可靠性（研究 1）：50 例患者两次完成问卷。当天的测试-重测间隔（至少 60 分钟）确保两个时间点均与相同的 7 天相关，最大程度减少了疲劳波动的捕捉。可靠性（研究 2）：50 例患者使用重新措辞的 BRAF-NRS 应对方式完成了相同的程序。变化敏感性（研究 3）：42 例患者接受单次大剂量肌内注射糖皮质激素治疗，在 0 周和 2 周时完成问卷。
BRAF-MDQ、其分量表和 BRAF-NRS 显示出非常强的可靠性（r = 0.82-0.95）。两种表述形式的 BRAF-NRS 应对方式均具有中等适度可靠性（r = 0.62、0.60）。BRAF-MDQ、其分量表和 BRAF-NRS 严重程度和效应均对变化敏感，效应大小（ES）为 0.33-0.56。如假设的那样，BRF-NRS 应对方式对药物干预没有反应（ES 0.05）。初步探索表明，改善的最小临床重要差异为 17.5%，疲劳恶化的最小临床重要差异为 6.1%。
BRAF 量表具有良好的可靠性和对变化的敏感性。BRF-NRS 应对方式对药物无反应支持这样一种理论，即应对疲劳是一个与严重程度和效应不同的概念，值得单独测量。
