REVIEW - Patient self-report versus trained assessor joint counts in RA

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Journal of Rheumatology

Dec 2009

Systematic Review and Metaanalysis of Patient Self-Report versus

Trained Assessor Joint Counts in Rheumatoid Arthritis

JENNIFER L. BARTON, LINDSEY A. CRISWELL, RACHEL KAISER, YEA-HUNG CHEN

and DEAN SCHILLINGER

From the Department of Medicine, University of California, San

Francisco, and the San Francisco Department of Public Health, San

Francisco, California, USA.

J.L. Barton, MD, Assistant Professor; L.A. Criswell, MD, MPH,

Professor; R. Kaiser, MD, MPH, Assistant Professor; D. Schillinger,

MD, Professor, Department of Medicine, University of California, San

Francisco; Y. Chen, MS, San Francisco Department of Public Health.

Abstract

Objective. Patient self-report outcomes and physician-performed joint

counts are important measures of disease activity and treatment

response. This metaanalysis examines the degree of concordance in

joint counts between trained assessors and patients with rheumatoid

arthritis (RA).

Methods. Studies eligible for inclusion met the following criteria:

English language; compared patient with trained assessor joint counts;

peer-reviewed; and RA diagnosis determined by board-certified or

board-eligible specialist or met 1987 American College of Rheumatology

criteria. We searched PubMed and Embase to identify articles between

1966 and January 1, 2008. We compared measures of correlation between

patients and assessors for either tender/painful or swollen joint

counts. We used metaanalysis methods to calculate summary correlation

estimates.

Results. We retrieved 462 articles and 18 were included. Self-report

joint counts were obtained by a text and/or mannequin (picture)

format. The summary estimates for the Pearson correlation coefficients

for tender joint counts were 0.61 (0.47 lower, 0.75 upper) and for

swollen joint counts 0.44 (0.15, 0.73). Summary results for the

Spearman correlation coefficients were 0.60 (0.30, 0.90) for tender

joint counts and 0.54 (0.35, 0.73) for swollen joint counts.

Conclusion. A self-report tender joint count has moderate to marked

correlation with those performed by a trained assessor. In contrast,

swollen joint counts demonstrate lower levels of correlation. Future

research should explore whether integrating self-report tender joint

counts into routine care can improve efficiency and quality of care,

while directly involving patients in assessment of RA disease

activity.

http://www.jrheum.org/content/36/12/2635.abstract

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