Denver Health and Hospital Authority Denver, Colorado and University of Colorado Medical School, Denver, Colorado.
Denver Veterans Affairs and Medical Center, and University of Colorado Medical School, Denver, Colorado.
Arthritis Care Res (Hoboken). 2019 May;71(5):611-619. doi: 10.1002/acr.23692. Epub 2019 Apr 10.
Patient global assessment visual analog scales (PGA-VAS) are widely used in rheumatoid arthritis (RA) practice and research, and low PGA-VAS scores are required for remission. Vulnerable patients with RA may have difficulty completing the PGA-VAS. There is limited information about both patients' perceptions of PGA-VAS and how patients score VAS model disease states. The objective of this study was to understand the perspectives of vulnerable patients regarding PGA-VAS and model disease states.
We enrolled patients with RA at Denver Health (n = 300). Subjects completed the PGA-VAS in the Disease Activity Score in 28 joints and the Multidimensional Health Assessment Questionnaire and completed a questionnaire regarding these PGA-VAS. Subjects also scored remission, mild, moderate, and severe model disease states by VAS. We performed analyses by linear and logistic regression and by using summary statistics. Outcomes included whether subjects found the PGA-VAS confusing, whether subjects' responses to the model disease states followed a natural progression (remission <mild <moderate <severe), and whether responses to the remission model would meet Boolean and Simplified Disease Activity Index-based remission criteria.
Approximately 40% of subjects found the PGA-VAS confusing; lower health literacy and depressive symptoms were associated with finding them confusing. Less than 25% of subjects ranked the model disease states with natural progression and ranked the remission model at the threshold for remission; higher health literacy and income were associated with accomplishing these objectives.
Vulnerable patients perceive difficulty with PGA-VAS and do not reliably rate a model disease state VAS. These patients are potentially at risk for disease activity misclassification because of literacy and other barriers in completing VAS.
患者整体评估视觉模拟量表（PGA-VAS）在类风湿关节炎（RA）实践和研究中被广泛应用，且需要低 PGA-VAS 评分才能达到缓解。RA 易损患者可能难以完成 PGA-VAS。关于患者对 PGA-VAS 的看法以及患者如何对 VAS 模型疾病状态进行评分的信息有限。本研究旨在了解易损患者对 PGA-VAS 和模型疾病状态的看法。
我们招募了丹佛健康中心（Denver Health）的 RA 患者（n=300）。受试者完成了 28 关节疾病活动评分（DAS28）和多维健康评估问卷中的 PGA-VAS，并完成了一份关于 PGA-VAS 的问卷。受试者还通过 VAS 对缓解、轻度、中度和重度模型疾病状态进行评分。我们通过线性和逻辑回归以及汇总统计进行了分析。结果包括受试者是否认为 PGA-VAS 令人困惑，受试者对模型疾病状态的反应是否遵循自然进展（缓解<轻度<中度<重度），以及对缓解模型的反应是否符合布尔和简化疾病活动指数（SDAI）缓解标准。
约 40%的受试者认为 PGA-VAS 令人困惑；较低的健康素养和抑郁症状与认为 PGA-VAS 令人困惑有关。不到 25%的受试者按照自然进展对模型疾病状态进行了排序，并将缓解模型排在缓解的阈值上；较高的健康素养和收入与完成这些目标有关。
易损患者认为 PGA-VAS 有难度，并且不能可靠地对模型疾病状态 VAS 进行评分。由于在完成 VAS 时存在文化程度和其他障碍，这些患者可能面临疾病活动分类错误的风险。
