Abstract
IntroductionAnkylosing Spondylitis (AS) is characterised by limitations in physical function. The Bath Ankylosing Spondylitis Functional Index (BASFI) is considered to be the gold-standard to assess physical function in AS patients. However, the BASFI questionnaire is a self-reported outcome measure and susceptible to subjective interpretation (under- or over-estimation). More objective outcome measures, like performance-based tests, could provide an objective outcome measurement for the evaluation of limitations in physical function. Therefore, the primary aim of this study was to determine the association between performance-based measures and the BASFI questionnaire.MethodsIn this cross-sectional study 126 AS patients completed the BASFI questionnaire and eight performance-based tests based on BASFI-items. Each test received three scores: one for performance (time or points) and a score for exertion and pain experienced during performance (using modified Borg-scale and VAS 0-100 mm, respectively). Linear regression analyses were used to assess the associations between the BASFI questionnaire and performance-based tests.ResultsThe univariable association between performance and BASFI-score was moderate with a R-square of 0.31 and Beta of 0.56 (p's < 0.05). In a multivariable analysis, the association between performance, exertion and pain on the one hand and BASFI-score on the other was assessed; R-square increased to 0.54: the Beta's for exertion and pain during performance were 0.38 and 0.26, respectively; the Beta for performance decreased to 0.19 (p's < 0.05).ConclusionsThis study demonstrates that alongside actual performance, patients seem to incorporate exertion and pain in their assessment of perceived physical function on the BASFI questionnaire. Performance-based tests could provide an objective outcome measurement for the evaluation of physical function and give relevant new information in addition to the BASFI questionnaire.
Highlights
Ankylosing Spondylitis (AS) is characterised by limitations in physical function
Medication was used by 80% of the study population and only 4% was treated with tumour necrosis factor (TNF)-blockers at the time of the study
The present study shows that the association between performance-based tests of physical function and the Bath Ankylosing Spondylitis Functional Index (BASFI) questionnaire was moderate
Summary
Ankylosing Spondylitis (AS) is characterised by limitations in physical function. The Bath Ankylosing Spondylitis Functional Index (BASFI) is considered to be the gold-standard to assess physical function in AS patients. An alternative method for assessing limitations in physical function is the use of performance-based tests In these measures an individual has to perform one or more specific activities that are evaluated in a standardised manner, mostly time to complete the activity [9,10]. Self-reported and performance-based measures both claim to assess the physical function domain, numerous studies have reported only moderate relations between both measurements. These moderate relations were found, among others, in elderly patients, and those with chronic low back pain and osteoarthritis [9,11,12,13,14]. Discordance between observed and perceived physical function measured with a self-reported questionnaire has been reported in patients with AS, rheumatoid arthritis and fibromyalgia [20,21]
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