Abstract
While the validity and reliability of many newer health status instruments have been reported, few data are available regarding the sensitivity of these instruments to clinically discernible changes in patient status. We studied this feature of the Sickness Impact Profile (SIP) in a group of patients with rheumatoid arthritis, comparing it with more traditional measures of functional status (the American Rheumatism Association (ARA) functional classification and a patient self-rating scale). Four different approaches were devised to measure "sensitivity to clinical change." These involved comparisons of functional score changes with clinical changes in patient status which were independently agreed upon by both clinician and patient, and also comparisons with several clinical disease severity indicators. When applied to groups of patients, the SIP and the patient self-rating scale were modestly superior to the ARA scale, but neither the SIP nor the self-rating scale was clearly superior to the other. For considering individual patients, all of the scales were relatively insensitive, and predictive accuracy for clinically estimated change was low. New strategies for assessing sensitivity to small changes should be developed and applied to health status and functional scales. Attention to this characteristic should allow refinement of existing scales and may enhance their clinical usefulness.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bergner M., Bobbitt R. A., Carter W. B., Gilson B. S. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981 Aug;19(8):787–805. doi: 10.1097/00005650-198108000-00001. [DOI] [PubMed] [Google Scholar]
- Bergner M., Bobbitt R. A., Pollard W. E., Martin D. P., Gilson B. S. The sickness impact profile: validation of a health status measure. Med Care. 1976 Jan;14(1):57–67. doi: 10.1097/00005650-197601000-00006. [DOI] [PubMed] [Google Scholar]
- Carter W. B., Bobbitt R. A., Bergner M., Gilson B. S. Validation of an interval scaling: the sickness impact profile. Health Serv Res. 1976 Winter;11(4):516–528. [PMC free article] [PubMed] [Google Scholar]
- Deyo R. A., Inui T. S., Leininger J. D., Overman S. S. Measuring functional outcomes in chronic disease: a comparison of traditional scales and a self-administered health status questionnaire in patients with rheumatoid arthritis. Med Care. 1983 Feb;21(2):180–192. doi: 10.1097/00005650-198302000-00006. [DOI] [PubMed] [Google Scholar]
- Gilson B. S., Gilson J. S., Bergner M., Bobbit R. A., Kressel S., Pollard W. E., Vesselago M. The sickness impact profile. Development of an outcome measure of health care. Am J Public Health. 1975 Dec;65(12):1304–1310. doi: 10.2105/ajph.65.12.1304. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kotzin B. L., Strober S., Engleman E. G., Calin A., Hoppe R. T., Kansas G. S., Terrell C. P., Kaplan H. S. Treatment of intractable rheumatoid arthritis with total lymphoid irradiation. N Engl J Med. 1981 Oct 22;305(17):969–976. doi: 10.1056/NEJM198110223051702. [DOI] [PubMed] [Google Scholar]
- Parkerson G. R., Jr, Gehlbach S. H., Wagner E. H., James S. A., Clapp N. E., Muhlbaier L. H. The Duke-UNC Health Profile: an adult health status instrument for primary care. Med Care. 1981 Aug;19(8):806–828. doi: 10.1097/00005650-198108000-00002. [DOI] [PubMed] [Google Scholar]
- Patrick D. L., Bush J. W., Chen M. M. Toward an operational definition of health. J Health Soc Behav. 1973 Mar;14(1):6–23. [PubMed] [Google Scholar]
- ROPES M. W., BENNETT G. A., COBB S., JACOX R., JESSAR R. A. 1958 Revision of diagnostic criteria for rheumatoid arthritis. Bull Rheum Dis. 1958 Dec;9(4):175–176. [PubMed] [Google Scholar]
- Sackett D. L., Chambers L. W., MacPherson A. S., Goldsmith C. H., Mcauley R. G. The development and application of indices of health: general methods and a summary of results. Am J Public Health. 1977 May;67(5):423–428. doi: 10.2105/ajph.67.5.423. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ware J. E., Jr, Brook R. H., Davies A. R., Lohr K. N. Choosing measures of health status for individuals in general populations. Am J Public Health. 1981 Jun;71(6):620–625. doi: 10.2105/ajph.71.6.620. [DOI] [PMC free article] [PubMed] [Google Scholar]