Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA.
University of Washington, Seattle, Washington, USA.
Clin Rheumatol. 2020 Jan;39(1):189-199. doi: 10.1007/s10067-019-04755-3. Epub 2019 Sep 6.
To evaluate use of a British English version of the validated French FLARE-RA questionnaire among American English speaking patients. In addition, to create a culturally adapted American English (AmE) FLARE-RA questionnaire and to examine its attributes of patient-reported RA flare status.
Using standardized cultural adaptation guidelines, we cognitively debriefed 25 American English speaking rheumatoid arthritis (RA) outpatients and created AmE-FLARE-RA with their input. One hundred three additional RA patients were recruited. Patients completed the Routine Assessment of Patient Index Data 3 (RAPID3), patient global visual analogue scale (VAS), AmE-FLARE-RA, and self-reports of flare. Physician global VAS, physician-assessed flare, swollen and tender joint count (TJC), and clinical disease activity index (CDAI) were documented. AmE-FLARE-RA and disease activity measures were compared between patient-reported and physician-reported flare categories.
Patients were female (89%), with mean (SD) age 51.1 (± 15.3) years and mean disease duration (SD) 11.9 (± 10.1) years, with 26% in remission/low disease activity. Total AmE-FLARE-RA scores, RAPID3, CDAI, and patient global VAS were significantly higher for both patient-reported flares and physician-reported flares compared with non-flaring patients by self- or physician report (p < 0.05). Total AmE-FLARE-RA scores correlated significantly with RAPID3 (corr = 0.50, p < 0.0001) and with CDAI (corr = 0.45, p < 0.0001). Across "no flares," "one flare," and "several flare" groups, there was a non-significant increase in AmE-FLARE-RA scores (p = 0.07).
The British English FLARE-RA was successfully adapted for AmE-speaking RA patients. AmE-FLARE-RA significantly correlated with RAPID3 and CDAI and distinguished between patient-reported and physician-reported flares, making it useful to detect flares in American RA patients.Key Points• The American English FLARE-RA (AmE-FLARE-RA) questionnaire is the result of cognitive debriefing with American RA patients using the British English version of the validated French FLARE-RA and incorporates patient-recommended language modifications..• Patients self-reporting flares had significantly higher AmE-FLARE-RA scores, compared with those without flares at the time of visit. AmE-FLARE-RA scores correlate with RAPID3 and CDAI.• There was a non-statistically significant trend using the AmE-FLARE-RA scores when examining patients with no flare, one flare, or several flares.• AmE-FLARE-RA total scores are uniformly elevated (~ 6.0 on a 0-10 scale), regardless of discordance between patient and MD assessment of flare at time of visit (~ 30%).
评估经验证的法语 FLARE-RA 问卷的英式英语版本在美国英语患者中的使用情况。此外，创建具有文化适应性的美式英语（AmE）FLARE-RA 问卷，并检验其评估患者 RA 发作状态的属性。
使用标准化的文化适应指南，我们对 25 名讲美式英语的类风湿关节炎（RA）门诊患者进行了认知性访谈，并根据他们的意见创建了 AmE-FLARE-RA。另外招募了 103 名 RA 患者。患者完成常规评估患者指数数据 3 （RAPID3）、患者总体视觉模拟量表（VAS）、AmE-FLARE-RA 和自我报告的发作情况。记录了医生总体 VAS、医生评估的发作、肿胀和压痛关节计数（TJC）以及临床疾病活动指数（CDAI）。比较了患者报告和医生报告的发作类别之间的 AmE-FLARE-RA 和疾病活动测量值。
患者均为女性（89%），平均年龄（SD）为 51.1（±15.3）岁，平均病程（SD）为 11.9（±10.1）年，有 26%的患者处于缓解/低疾病活动期。与非发作患者相比，无论通过患者自我报告还是医生报告，AmE-FLARE-RA 的总评分、RAPID3、CDAI 和患者总体 VAS 均在患者报告的发作和医生报告的发作时显著升高（p<0.05）。AmE-FLARE-RA 的总评分与 RAPID3 显著相关（相关系数=0.50，p<0.0001），与 CDAI 显著相关（相关系数=0.45，p<0.0001）。在“无发作”、“一次发作”和“多次发作”组中，AmE-FLARE-RA 评分呈非显著升高（p=0.07）。
英国英语 FLARE-RA 成功适用于讲美式英语的 RA 患者。AmE-FLARE-RA 与 RAPID3 和 CDAI 显著相关，能区分患者报告和医生报告的发作，因此可用于检测美国 RA 患者的发作情况。关键点• 美式英语 FLARE-RA（AmE-FLARE-RA）问卷是使用经验证的法国 FLARE-RA 的英式英语版本对美国 RA 患者进行认知性访谈的结果，并纳入了患者推荐的语言修改。..• 与就诊时无发作的患者相比，自我报告发作的患者的 AmE-FLARE-RA 评分明显更高。AmE-FLARE-RA 评分与 RAPID3 和 CDAI 相关。• 使用 AmE-FLARE-RA 评分检查无发作、一次发作或多次发作的患者时，存在非统计学意义的趋势。• 无论患者和 MD 在就诊时对发作的评估是否存在差异，AmE-FLARE-RA 的总评分均均匀升高（在 0-10 分的量表上约为 6.0）。
