HAQ-DI, PROMIS-PF highly agreeable in psoriatic arthritis
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The Health Assessment Questionnaire-Disability Index and the Patient-Reported Outcomes Measurement Information System-Physical Function had excellent agreement in finding psoriatic arthritis minimal disease activity, according to findings.
“PROMIS measures are available in electronic medical records and can be administered remotely, representing a flexible and precise method to collect health information from patients,” Ana-Maria Orbai, MD, MHS, director of the Psoriatic Arthritis Program at the Johns Hopkins Arthritis Center, told Healio Rheumatology. “PROMIS thresholds for linking scores with older questionnaires are available for physical function for the general population from Schalet BD. et al. We wanted to validate the use of PROMIS physical function in the calculation of minimal disease activity in psoriatic arthritis.”
“Specifically, our objective was to evaluate if PROMIS-Physical Function can replace the Health Assessment Questionnaire-Disability Index, which is an older 20-item paper questionnaire measuring disability and a current component of the minimal disease activity criteria,” she added. “If we were able to demonstrate good agreement — kappa of 0.6 or greater — then the scoring systems would be interchangeable and we could use PROMIS in the future instead of having to also collect the HAQ-DI to calculate treat-to-target state in psoriatic arthritis.”
To examine the interchangeability of HAQ-DI with PROMISPF in calculating minimal disease activity (MDA) in PsA, Orbai and colleagues collected and analyzed data from the Johns Hopkins Psoriatic Arthritis cohort. In all, the researchers included 352 observations from 100 adult patients with PsA who completed up to five visits. Among the included patients, 43% were in MDA at baseline.
The researchers developed PROMIS-based MDA definitions using the existing crosswalk between the scores — the HAQ-DI≤0.5 equivalent to a PROMIS-PF T-score of at least 41.3. In addition, they analyzed agreement between MDA — which the researchers labeled MDA HAQ-DI — and PROMIS-PF MDA definitions — MDA PROMIS-PF4a and MDA PROMIS-PF Bank — at each visit, as well as longitudinally using MDA state changes between consecutive visits, through the kappa statistic. Lastly, Orbai and colleagues assessed the predictive value of MDA PROMIS-PF for MDA HAQ-DI using ROC curve analysis.
According to the researchers, the kappa statistic for PROMIS-PF-based MDA demonstrated excellent agreement with HAQ-DI MDA. Specifically the kappa statistic was 0.94 (95% CI, 0.90.97) for MDA PROMIS-PF Bank and 0.9 (95% CI, 0.80.95) for MDA PROMISPF4a. The researchers also reported higher longitudinal agreement between MDA HAQ-DI and MDA PROMIS-PF Bank, compared with MDA PROMISPF4a between consecutive visits. Here, kappa ranged between 0.81 and 0.94, compared with 0.72 and 0.84, respectively.
The area under the ROC curve for predicting MDA HAQ-DI was 0.97 for MDA PROMIS-PF Bank and 0.95 for MDA PROMISPF4a.
“The impact of our study is a demonstration that we can move on to the now widely available PROMIS measurement system for two reasons,” Orbai sand. “First, we will continue to be able to calculate MDA using a PROMIS Physical Function score threshold of 41.3 or better. Second, at the same time we will have collected a measure of physical function that is population normed, adaptable, and precise.”
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