title: Clinical responsiveness of self-report functional assessment measures for children with juvenile idiopathic arthritis undergoing intraarticular corticosteroid injections.
abstract: OBJECTIVE
  The Childhood Health Assessment Questionnaire (CHAQ), Juvenile Arthritis Functional Assessment Report (JAFAR), and Juvenile Arthritis Functional Status Index (JASI) are widely used functional measures for juvenile idiopathic arthritis (JIA) that differ in content, format, and completion time. We compared the responsiveness and child-parent agreement of the JAFAR, CHAQ, and JASI in a prospective, multicenter study.
  
  
  METHODS
  Children and adolescents from 5 rheumatology centers were enrolled. Subjects were about to undergo therapy (intraarticular corticosteroid injections [IAS] and methotrexate or hip surgery (MTX/hip]) expected to produce a functional improvement. All subjects were studied before the intervention and at 6 weeks and 6 months posttreatment. At each study visit, the 3 measures were administered in randomized, balanced order to both parents and children.
  
  
  RESULTS
  A total of 92 subjects (mean age 12.8 years) were enrolled in the study, 74 of which were in the IAS group. The responsiveness of all 3 measures was moderate to strong. The standardized response mean at 6 weeks for the IAS group on the JAFAR, CHAQ, and JASI was 0.41 (95% confidence interval [95% CI] 0.18, 0.64), 0.70 (95% CI 0.47, 0.93), and 0.36 (95% CI 0.13, 0.59), respectively. The CHAQ was somewhat more responsive to change at 6 weeks (IAS group: relative efficiency 0.34 [JAFAR], 0.27 [JASI]), but less responsive at 6 months (MTX/hip group: relative efficiency 5.1 [JAFAR], 3.9 [JASI]). All 3 questionnaires showed acceptable parent-child agreement, and overall, there were few differences between the 3 questionnaires.
  
  
  CONCLUSIONS
  The functional outcome measures currently used for JIA are all adequately responsive for use in trials or in the clinic setting. The choice of which measure to use should therefore be based on the time available for completion, the intended clinical/research use, and the depth of content required.
authors.affiliation: Monash University, Frankston, Victoria, Australia.
authors.forename: G Ted
authors.initials: GT
authors.lastname: Brown
authors.forename: F Virginia
authors.initials: FV
authors.lastname: Wright
authors.forename: Bianca A
authors.initials: BA
authors.lastname: Lang
authors.forename: Nina
authors.initials: N
authors.lastname: Birdi
authors.forename: Kim
authors.initials: K
authors.lastname: Oen
authors.forename: Derek
authors.initials: D
authors.lastname: Stephens
authors.forename: Joan
authors.initials: J
authors.lastname: McComas
authors.forename: Brian M
authors.initials: BM
authors.lastname: Feldman
mesh_terms: D000293:Adolescent; D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006304:Health Status; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D010290:Parents; D011446:Prospective Studies; D015203:Reproducibility of Results; D016353:Self-Examination; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D008727:Methotrexate