Patient perceptions of foot disability in Juvenile Idiopathic Arthritis: a comparison of the juvenile arthritis foot disability index and the Oxford ankle foot questionnaire for children.

Jill Ferrari

doi:10.1186/s13047-015-0106-5

Abstract

BackgroundThe Juvenile Arthritis Foot Disability Index (JAFI) and the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) are two region-specific paediatric outcome tools that measure the impact on well-being in children with foot pathology. The aim of this study was to establish the level of agreement between the JAFI and the OxAFQ-C in a group of children diagnosed with Juvenile Idiopathic Arthritis (JIA).MethodsChildren with JIA accessed the questionnaire via a website. The OxAFQ-C questionnaire and the JAFI questionnaire were combined into one document consisting of 42 statements with Likert-scale responses. A further question regarding duration of disease was added. On completion, the web-linked questionnaire was returned by e-mail.ResultsThirty five participants were included. Individual domain and composite score analysis was undertaken. The JAFI participation domain was compared to the OxAFQ-C school domain and showed no significant difference between the median scores of each participant (z = -1.33, p = 0.181). The JAFI activity and the OxAFQ-C physical domains were compared and showed that a significant difference between the median scores existed (z = -4.29, p < 0.001). Agreement between the two PROMs was tested using Bland Altman Levels of Agreement based upon the percentage summed composite scores. Levels of agreement between the scores were considered to be poor based on the Bland Altman plot, despite a low mean difference in scores (mean difference = -3.88, SD of difference = 9.93, p = 0.027). Pearson correlation was undertaken to measure the relationship between the summed composite score and disease duration. No relationship was found (JAFI: r = -0.08, p = 0.672; OxAFQ-C: r = 0.037, p = 0.871).ConclusionsThis study has shown that despite some agreement between the individual domains, overall there is poor agreement between the OxAFQ-C and the JAFI percentage summed composite scores. The study is not able to determine if one score is superior to the other but both scores could be of value when used in this population.

Highlights

The Juvenile Arthritis Foot Disability Index (JAFI) and the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) are two region-specific paediatric outcome tools that measure the impact on well-being in children with foot pathology
Validated patient reported outcome measures (PROMs) provide quantifiable data as well as the potential to identify a meaningful change in the condition of the patient
Regional PROMs such as the Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ) and the Manchester Oxford Foot Questionnaire (MOXFQ) are well known, but these are tools designed to be used with adult patients; children will need outcomes that relate to their daily activities, such as attending school and being able to play

Summary

Introduction

The Juvenile Arthritis Foot Disability Index (JAFI) and the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) are two region-specific paediatric outcome tools that measure the impact on well-being in children with foot pathology. The podiatrist is likely to encounter arthritic conditions that impact on the feet Those practitioners treating paediatric foot problems on a regular basis will be familiar with Juvenile Idiopathic Arthritis (JIA) which has a prevalence of approximately 1 in 1000 children in the UK [1]. Validated patient reported outcome measures (PROMs) provide quantifiable data as well as the potential to identify a meaningful change in the condition of the patient Such PROMs determine the patient’s perception of their foot problems across various aspects of their life. The authors note that the translation of the questionnaire from the original Swedish language has not been validated and sensitivity to change has not been tested

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