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Research ArticleAccepted Articles

Assessment of orofacial symptoms in juvenile idiopathic arthritis: Validation of a consensus-based short patient questionnaire

Peter Stoustrup, Hanna Rahimi, Marinka Twilt, Y. Ingrid Goh, Thomas Klit Pedersen, Troels Herlin and Lynn Spiegel on Behalf of the Temporomandibular joint Juvenile Arthritis Work group (TMJaw)
The Journal of Rheumatology December 2022, jrheum.220667; DOI: https://doi.org/10.3899/jrheum.220667
Peter Stoustrup
Peter Stoustrup: DDS, PhD. Associate Professor of Orthodontics, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Hanna Rahimi: MD, Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Marinka Twilt: MD, MSCE, PhD, Associate professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Y. Ingrid Goh: PhD, Division of Rheumatology, The Hospital for Sick Children; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Thomas Klit Pedersen: Consultant Orthodontist, Professor, PhD. Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Denmark; Troels Herlin: Professor, MD, DMSci, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; Lynn Spiegel: MD, FRCPC, Associate Professor, Department of Pediatrics, University of Toronto, Division of Rheumatology, The Hospital of Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada. Corresponding author: pstoustrup@dent.au.dk, Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9-11, 8000, Aarhus C.
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Hanna Rahimi
Peter Stoustrup: DDS, PhD. Associate Professor of Orthodontics, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Hanna Rahimi: MD, Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Marinka Twilt: MD, MSCE, PhD, Associate professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Y. Ingrid Goh: PhD, Division of Rheumatology, The Hospital for Sick Children; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Thomas Klit Pedersen: Consultant Orthodontist, Professor, PhD. Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Denmark; Troels Herlin: Professor, MD, DMSci, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; Lynn Spiegel: MD, FRCPC, Associate Professor, Department of Pediatrics, University of Toronto, Division of Rheumatology, The Hospital of Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada. Corresponding author: pstoustrup@dent.au.dk, Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9-11, 8000, Aarhus C.
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Marinka Twilt
Peter Stoustrup: DDS, PhD. Associate Professor of Orthodontics, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Hanna Rahimi: MD, Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Marinka Twilt: MD, MSCE, PhD, Associate professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Y. Ingrid Goh: PhD, Division of Rheumatology, The Hospital for Sick Children; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Thomas Klit Pedersen: Consultant Orthodontist, Professor, PhD. Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Denmark; Troels Herlin: Professor, MD, DMSci, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; Lynn Spiegel: MD, FRCPC, Associate Professor, Department of Pediatrics, University of Toronto, Division of Rheumatology, The Hospital of Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada. Corresponding author: pstoustrup@dent.au.dk, Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9-11, 8000, Aarhus C.
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Y. Ingrid Goh
Peter Stoustrup: DDS, PhD. Associate Professor of Orthodontics, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Hanna Rahimi: MD, Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Marinka Twilt: MD, MSCE, PhD, Associate professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Y. Ingrid Goh: PhD, Division of Rheumatology, The Hospital for Sick Children; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Thomas Klit Pedersen: Consultant Orthodontist, Professor, PhD. Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Denmark; Troels Herlin: Professor, MD, DMSci, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; Lynn Spiegel: MD, FRCPC, Associate Professor, Department of Pediatrics, University of Toronto, Division of Rheumatology, The Hospital of Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada. Corresponding author: pstoustrup@dent.au.dk, Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9-11, 8000, Aarhus C.
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Thomas Klit Pedersen
Peter Stoustrup: DDS, PhD. Associate Professor of Orthodontics, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Hanna Rahimi: MD, Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Marinka Twilt: MD, MSCE, PhD, Associate professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Y. Ingrid Goh: PhD, Division of Rheumatology, The Hospital for Sick Children; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Thomas Klit Pedersen: Consultant Orthodontist, Professor, PhD. Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Denmark; Troels Herlin: Professor, MD, DMSci, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; Lynn Spiegel: MD, FRCPC, Associate Professor, Department of Pediatrics, University of Toronto, Division of Rheumatology, The Hospital of Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada. Corresponding author: pstoustrup@dent.au.dk, Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9-11, 8000, Aarhus C.
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Troels Herlin
Peter Stoustrup: DDS, PhD. Associate Professor of Orthodontics, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Hanna Rahimi: MD, Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Marinka Twilt: MD, MSCE, PhD, Associate professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Y. Ingrid Goh: PhD, Division of Rheumatology, The Hospital for Sick Children; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Thomas Klit Pedersen: Consultant Orthodontist, Professor, PhD. Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Denmark; Troels Herlin: Professor, MD, DMSci, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; Lynn Spiegel: MD, FRCPC, Associate Professor, Department of Pediatrics, University of Toronto, Division of Rheumatology, The Hospital of Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada. Corresponding author: pstoustrup@dent.au.dk, Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9-11, 8000, Aarhus C.
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Lynn Spiegel
Peter Stoustrup: DDS, PhD. Associate Professor of Orthodontics, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Hanna Rahimi: MD, Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Marinka Twilt: MD, MSCE, PhD, Associate professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Y. Ingrid Goh: PhD, Division of Rheumatology, The Hospital for Sick Children; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Thomas Klit Pedersen: Consultant Orthodontist, Professor, PhD. Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Denmark; Troels Herlin: Professor, MD, DMSci, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; Lynn Spiegel: MD, FRCPC, Associate Professor, Department of Pediatrics, University of Toronto, Division of Rheumatology, The Hospital of Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada. Corresponding author: pstoustrup@dent.au.dk, Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9-11, 8000, Aarhus C.
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Peter Stoustrup: DDS, PhD. Associate Professor of Orthodontics, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Hanna Rahimi: MD, Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Marinka Twilt: MD, MSCE, PhD, Associate professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Y. Ingrid Goh: PhD, Division of Rheumatology, The Hospital for Sick Children; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Thomas Klit Pedersen: Consultant Orthodontist, Professor, PhD. Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Denmark; Troels Herlin: Professor, MD, DMSci, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; Lynn Spiegel: MD, FRCPC, Associate Professor, Department of Pediatrics, University of Toronto, Division of Rheumatology, The Hospital of Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada. Corresponding author: pstoustrup@dent.au.dk, Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9-11, 8000, Aarhus C.
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Abstract

Objective To develop, validate and test the performance of patient reported outcomes (PROs) in a short patient questionnaire (<5 min) to assess the multidimensional aspects of orofacial symptoms related to juvenile idiopathic arthritis (JIA) from ≥10 years.

Methods The study was conducted by an interdisciplinary task force from the Temporomandibular joint Juvenile Arthritis Working Group (TMJaw). The project consisted of a multi-phased approach including: 1) Conceptual phase with online international survey of 167 healthcare workers, 2) item generation and drafting of preliminary questionnaire(s) (face validity), 3) cognitive script interview and probing (content validity, n=16 patients with JIA), 4) assessment of construct validity (convergence and divergence, n=53 patients with JIA), 5) test of reliability, 6) test of clinical performance and psychometric characteristics (n=95 patients with JIA).

Results Seven PROs were included in the final patient questionnaire: (1) pain frequency, (2) pain intensity, 3) pain location, 4) jaw function, 5) specific questions related to symptoms and dysfunction, 6) changes in face and jaw pain since last visit, 7) changes in jaw function since last visit. Eighty percent of the patients were able to complete the questionnaire in less than 5 minutes.

Conclusion We have developed and validated a short patient questionnaire to assess the multidimensional aspects of JIA-related orofacial symptoms. The PROs included in our questionnaire show acceptable validity and reliability. The questionnaire is applicable to routine monitoring of subjects with JIA, as well as future research studies.

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The Journal of Rheumatology
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1 Jan 2023
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Accepted manuscript
Assessment of orofacial symptoms in juvenile idiopathic arthritis: Validation of a consensus-based short patient questionnaire
Peter Stoustrup, Hanna Rahimi, Marinka Twilt, Y. Ingrid Goh, Thomas Klit Pedersen, Troels Herlin, Lynn Spiegel
The Journal of Rheumatology Dec 2022, jrheum.220667; DOI: 10.3899/jrheum.220667

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Accepted manuscript
Assessment of orofacial symptoms in juvenile idiopathic arthritis: Validation of a consensus-based short patient questionnaire
Peter Stoustrup, Hanna Rahimi, Marinka Twilt, Y. Ingrid Goh, Thomas Klit Pedersen, Troels Herlin, Lynn Spiegel
The Journal of Rheumatology Dec 2022, jrheum.220667; DOI: 10.3899/jrheum.220667
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