Agreement Between Patient And Clinician Ratings Of Disease Severity In Hidradenitis Suppurativa, Rheumatoid Arthritis, And Chronic Plaque Psoriasis

Abstract

There are often discrepancies among patient and clinician ratings of disease severity. This study investigated the level of agreement between patient- and clinician-reported disease severity ratings and explored demographic factors that may further explain discordance across three diseases (hidradenitis suppurativa [HS], rheumatoid arthritis [RA], and chronic plaque psoriasis [Ps]). Patient and clinician global assessments of disease severity (encompassing: 0-10 numeric rating scales and seven- or five-point categorical scales) from five quantitative and qualitative studies were pooled within HS (n=2), RA (n=2), and Ps (n=1). When necessary, scales were collapsed (e.g., combining very mild and mild categories) for consistency across patient and clinician ratings. Statistical analyses included: cross-tabulations of patient and clinician severity ratings and calculation of intraclass correlation coefficients (ICCs; for continuous variables) or weighted kappa coefficients (κw; for categorical variables) to assess the level of patient-clinician agreement within each disease. These analyses were repeated among patient demographic subgroups (i.e., sex, race, level of education). Data from 190 HS (mean age=41.8, [standard deviation=13.1 years]; 65.3% female), 240 RA (mean age=61.2 [12.9]; 62.1% female), and 200 Ps (mean age=61.3 [13.2]; 50.0% female) patients were analyzed. Percentage of matched patient-clinician disease severity ratings ranged from 73.5% to 79.9% in HS, 61.0% to 80.3% in RA, and 57.8 to 78.0% in Ps, and the level of agreement ranged from 0.69 to 0.71, 0.61 to 0.79, and 0.43 to 0.75 in HS, RA, and Ps, respectively. Lower agreement levels were found in the following demographic subgroups: females (HS), non-Caucasians (HS), and patients with lower education levels (HS, RA, Ps). Overall, clinicians and patients report high levels of agreement, demonstrating some level of consistency in disease rating across the three researched diseases. Less agreement in demographic subpopulations indicate that sex, race, and education are potential factors in patient reported severity of disease.