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Same question, different answers: a comparison of global health assessments using visual analogue scales

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Abstract

Purpose

To compare responses to two global health VAS of patients with rheumatoid arthritis at the same assessment within the same questionnaire.

Methods

Secondary analysis of randomised controlled trial data. Patients completed the patient global assessment VAS (PG-VAS) (horizontal 10 cm scale, left (0), right (100), no incremental markers) and EQ-5D-VAS (EQ-VAS) (vertical 20 cm scale, 100 at the top, markers at each increment of 10). Both asked “how good or bad is your health today, in your opinion, from 100 ‘Best imaginable health state’ to 0 ‘Worst imaginable health state’.” Agreement was assessed using intra-class correlation co-efficients (ICC) and Bland–Altman plots.

Results

Four hundred and forty-eight patients reported median PG-VAS 66 (IQR 51, 77) and EQ-VAS 65 (IQR 50, 80) scores. Correlation of the VAS scales was moderate at baseline (ICC 0.564) and longitudinally (ICC 0.503). Bland–Altman plots suggested poor concordance of the PG-VAS and EQ-VAS; the limits of agreement were ±32.3 on a 0–100 scale. PG-VAS scores were evenly distributed; EQ-VAS scores clustered at increments of 10; rounding did not improve agreement.

Conclusions

The EQ-VAS and PG-VAS scores are not interchangeable at the individual level. The EQ-VAS correlated more strongly with disease-specific and health-related quality of life measures, therefore, appears preferable.

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Abbreviations

VAS:

Visual analogue scales

EQ-VAS:

EuroQol visual analogue scales

PG-VAS:

Patient global assessment visual analogue scale

ICC:

Intra-class correlation co-efficients

IQR:

Interquartile range

SD:

Standard deviation

OMERACT:

Outcome measures for rheumatology

QALYs:

Quality-adjusted life years

RA:

Rheumatoid arthritis

BROSG:

British rheumatoid outcome study group

RCT:

Randomised controlled trial

ACR:

American College of Rheumatology

HAQ:

Health assessment questionnaire

DAS28:

Disease activity score based on 28 swollen joint counts

ESR:

Erythrocyte sedimentation rate

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Acknowledgements

The BROSG project was funded by the NHS Executive, UK (NHS HTA project number 94/45/02). The views and opinions expressed within do not necessarily reflect those of the NHS Executive. The NHS Executive commissioned this work, but played no part in the design, data collection, analysis, interpretation, report writing or decision to publish this paper. The BROSG Study Group: Dr. D. Mulherin (Cannock), Dr. S. Knight (Macclesfield), Prof D. Scott (King’s College, London), Dr. P. Dawes (Stoke-on-Trent), Dr. M. Davis (Truro). All participants of the OMERACT QALY sub-group.

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Correspondence to Deborah P. M. Symmons.

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Harrison, M.J., Boonen, A., Tugwell, P. et al. Same question, different answers: a comparison of global health assessments using visual analogue scales. Qual Life Res 18, 1285–1292 (2009). https://doi.org/10.1007/s11136-009-9546-3

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