van der Meulen Coen, van de Stadt Lotte A, Kroon Féline P B, Niesters Marieke, Rosendaal Frits R, Kloppenburg Margreet
Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Rheumatology, Reade, Amsterdam Rheumatology and Immunology Center, The Netherlands, Amsterdam.
Rheumatology (Oxford). 2025 Jun 1;64(6):3492-3499. doi: 10.1093/rheumatology/keaf029.
Pain in hand osteoarthritis (OA) is evaluated with repeated pain questionnaires. It is unclear whether these questionnaires adequately capture changes in pain recalled by patients. This study investigated whether changes on pain questionnaires (real-time evaluation) correspond to recalled pain.
Data from hand OA patients from the HOSTAS cohort (four one-yearly) and HOPE trial (one six-week interval) were used. Pain was measured with the Australian/Canadian hand Osteoarthritis Index (AUSCAN, range 0-20) and a recall question (how is the pain compared with your last visit). Changes in AUSCAN pain were categorized into improved (≤-1), stable or worsened pain (≥1) and compared with the recall question using Cohen's kappa and percentage agreement. We determined concordance between measurement methods, and investigated associations of mental well-being and illness perceptions with concordance using generalized estimating equations (GEE).
Of 708 intervals from HOSTAS (307 patients, 82% women, mean age 61.0 years, mean AUSCAN 9.1), AUSCAN changes and recall were concordant in 42% (Cohen's kappa 0.13). There was concordance in 47% of 86 intervals (Cohen's kappa 0.14) from the HOPE trial (86 patients, 80% women, mean age 63.5, mean AUSCAN 10.7). The most frequent recall answer was worsened pain in the HOSTAS (60%), improved pain in the HOPE trial (76%). In both studies, AUSCAN pain most frequently improved. Depression and anxiety showed no association with concordance.
Changes in repeatedly measured AUSCAN pain often differ from the recalled course of pain over the same period. This has profound implications for evaluating patient-reported pain in clinical trials.
采用重复疼痛问卷对手部骨关节炎（OA）的疼痛进行评估。目前尚不清楚这些问卷是否能充分反映患者回忆起的疼痛变化。本研究调查了疼痛问卷上的变化（实时评估）是否与回忆起的疼痛相符。
使用来自HOSTAS队列研究（每一年一次，共四次）和HOPE试验（间隔六周一次）的手部OA患者数据。采用澳大利亚/加拿大手部骨关节炎指数（AUSCAN，范围0 - 20）和一个回忆问题（与上次就诊相比，疼痛情况如何）来测量疼痛。将AUSCAN疼痛的变化分为改善（≤ -1）、稳定或疼痛加重（≥1），并使用Cohen's kappa系数和百分比一致性与回忆问题进行比较。我们确定了测量方法之间的一致性，并使用广义估计方程（GEE）研究心理健康和疾病认知与一致性之间的关联。
在HOSTAS研究的708个时间间隔中（307例患者，82%为女性，平均年龄61.0岁，平均AUSCAN为9.1），AUSCAN变化与回忆结果的一致性为42%（Cohen's kappa系数为0.13）。在HOPE试验的86个时间间隔中（86例患者，80%为女性，平均年龄63.5岁，平均AUSCAN为10.7），一致性为47%（Cohen's kappa系数为0.14）。HOSTAS研究中最常见的回忆答案是疼痛加重（60%），而HOPE试验中最常见的是疼痛改善（76%）。在两项研究中，AUSCAN疼痛最常见的情况是改善。抑郁和焦虑与一致性无关联。
重复测量的AUSCAN疼痛变化通常与同一时期回忆起的疼痛过程不同。这对在临床试验中评估患者报告的疼痛具有深远影响。
