From the Division of Rheumatology, Department of Medicine, Denver Health Medical Center, in conjunction with the Division of Rheumatology, Department of Medicine, University of Colorado Denver School of Medicine (SOM), and the Department of Medicine, Denver Veterans Affairs (VA) Medical Center, Denver, Colorado, USA.
J Rheumatol. 2014 Feb;41(2):256-64. doi: 10.3899/jrheum.130664. Epub 2013 Dec 15.
Patient assessments of disease activity (PtGA) and general health (GH) measured by visual analog scale (VAS) are widely used in rheumatoid arthritis (RA) clinical practice and research. These require comprehension of the question's wording and translation of disease activity onto a written VAS, which is problematic for patients with limited health literacy (HL) or difficulty completing forms. This study's objective was to validate verbally administered versions of patient assessments and identify factors that might explain discrepancies between verbal and written measures.
We enrolled patients with RA at the Denver Health rheumatology clinic (n = 300). Subjects were randomized to complete the traditional written PtGA and GH and one of the verbal assessments. Subjects provided a verbal numeric response after reading the question, having the question read to them in person, or hearing the question over the phone. Spearman and Lin correlations comparing written and verbal assessments were determined. Multivariate logistic regression was performed to explain any discrepancies.
The instruments administered verbally in-person showed good, but not excellent, correlation with traditional written VAS forms (Spearman coefficients 0.59 to 0.70; p < 0.001 for all correlations). Twenty-three percent of subjects were unable to complete 1 of the written VAS assessments without assistance. HL predicted missing written data and discrepancies between verbal and written assessments (p < 0.05 for all correlations).
Providers should use verbal versions of PtGA and GH with caution while caring for patients unable to complete traditional written version. Limited HL is widely prevalent and a barrier to obtaining patient-oriented data.
通过视觉模拟量表（VAS）评估患者的疾病活动度（PtGA）和一般健康状况（GH）在类风湿关节炎（RA）的临床实践和研究中得到广泛应用。这些评估需要患者理解问题的措辞并将疾病活动度转化为书面 VAS，这对于健康素养有限或难以完成表格的患者来说存在问题。本研究的目的是验证口头评估的有效性，并确定可能导致口头和书面测量结果差异的因素。
我们在丹佛健康风湿病诊所招募了 RA 患者（n=300）。受试者被随机分配完成传统的书面 PtGA 和 GH 以及口头评估之一。受试者在阅读问题后、亲自听问题或通过电话听问题后，提供口头数字回答。通过 Spearman 和 Lin 相关性分析来比较书面和口头评估。采用多元逻辑回归分析来解释任何差异。
亲自口头进行的评估工具与传统书面 VAS 形式具有良好但非极佳的相关性（Spearman 系数为 0.59 至 0.70；所有相关性均 p<0.001）。23%的受试者在没有帮助的情况下无法完成 1 份书面 VAS 评估。健康素养预测了缺失的书面数据和口头与书面评估之间的差异（所有相关性均 p<0.05）。
在照顾无法完成传统书面版本的患者时，临床医生应谨慎使用口头版本的 PtGA 和 GH。健康素养有限普遍存在，是获得以患者为中心的数据的障碍。
