Guest guest Posted January 10, 2008 Report Share Posted January 10, 2008 Agreement between physicians and parents in rating functional ability of children with juvenile idiopathic arthritis Pediatric Rheumatology 2007, 5:23doi:10.1186/1546-0096-5-23 http://www.ped-rheum.com/content/5/1/23/abstract Abstract (provisional) Objective To investigate concordance between physicians and parents in rating the degree of functional ability of children with juvenile idiopathic arthritis (JIA). Methods The attending physician and a parent were asked to rate independently the level of physical functioning of 155 patients with disease duration > or = to 5 years on a 6-point scale ranging from 1=no disability (i.e. the child can do without difficulty all activities that children of his/her age can do) to 6=severe disability (i.e. all activities are difficult for the child). At study visit, measures of JIA activity and damage were assessed. Agreement was evaluated with weighted kappa (<0.40=poor agreement; 0.41-0.60=moderate agreement; 0.61-0.80=substantial agreement; >0.80 excellent agreement). Physician/parent evaluations were divided in 3 groups: 1) concordance; 2) parent over-rating= parent assessment over-rated relative to physician assessment; 3) physician over-rating= physician assessment over-rated relative to parent assessment. Factors affecting concordance/discordance were evaluated by means of Kruskal-Wallis or Chi-square/Fisher exact test. Results Concordance, parent over-rating and physician over-rating were observed in 107 (69%), 29 (18.7%) and 19 (12.3%) evaluations, respectively. Kappa value was 0.69. Parent over-rating was associated with greater intensity of pain and higher Childhood Health Assessment Questionnaire (C-HAQ) score, whereas physician over-rating was associated with more severe joint disease, higher C-reactive protein higher frequency of Steinbrocker functional class > or = to II, and greater articular damage, as measured with the Juvenile Arthritis Damage Index. Conclusion Physicians and parents revealed fair concordance in rating functional ability of children with JIA. Parent over-rating was associated with greater child's pain and worse C-HAQ score, whereas physician over-rating was associated with greater severity of joint inflammation and damage. Quote Link to comment Share on other sites More sharing options...
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