Wells G A, Tugwell P, Kraag G R, Baker P R, Groh J, Redelmeier D A
Department of Medicine, Ottawa General Hospital, ON, Canada.
J Rheumatol. 1993 Mar;20(3):557-60.
To determine the point at which differences in clinical assessment scores on physical ability, pain and overall condition are sufficiently large to correspond to a subjective perception of a meaningful difference from the perspective of the patient.
Forty patients with a diagnosis of rheumatoid arthritis participated in an evening of clinical assessment and one-on-one conversations with each other regarding their arthritic condition. The assessments included tender and swollen joint counts, clinician and patient global assessments, participant assessment of pain and the Health Assessment Questionnaire (HAQ) on physical ability. After each conversation, participants rated themselves relative to their conversational partner on physical ability, pain and overall condition. These subjective comparative ratings were compared to the differences of the individual clinical assessments.
In total there were 120 conversations. Generally participants judged themselves as less disabled than others. They rated themselves as "somewhat better" than their conversation partner when they had a (mean) 7% better score on the HAQ, 6% less pain, and 9% better global assessment. In contrast, they rated themselves as "somewhat worse" when they had a (mean) 16% worse score on the HAQ, 16% more pain, and 29% worse global assessment.
Patients view clinically important differences in an asymmetric manner. These results can provide guidance in interpreting results and planning clinical trials.
确定身体能力、疼痛及整体状况的临床评估分数差异达到何种程度时，才足以在患者视角下对应有意义差异的主观感受。
40名诊断为类风湿性关节炎的患者参与了一个晚间临床评估活动，并就其关节炎状况进行了一对一交流。评估包括压痛和肿胀关节计数、临床医生和患者的整体评估、参与者的疼痛评估以及身体能力方面的健康评估问卷（HAQ）。每次交流后，参与者就身体能力、疼痛和整体状况对自己相对于交流伙伴进行评分。将这些主观比较评分与个体临床评估的差异进行比较。
总共进行了120次交流。总体而言，参与者认为自己的残疾程度低于他人。当他们在HAQ上的得分（平均）高出7%、疼痛程度低6%、整体评估好9%时，他们将自己评为比交流伙伴“稍好”。相反，当他们在HAQ上的得分（平均）低16%、疼痛程度高16%、整体评估差29%时，他们将自己评为“稍差”。
患者以不对称的方式看待临床上的重要差异。这些结果可为解释结果和规划临床试验提供指导。
