title: Validation of patient-reported joint counts in rheumatoid arthritis and the role of training.
abstract: OBJECTIVE
  To demonstrate the effectiveness of simple training on improving the ability of patients with rheumatoid arthritis (RA) to assess joint swelling, and to validate the use of a computerized questionnaire, the Health Assessment Questionnaire (HAQ-ulous), to collect patient-reported tender and swollen joint counts.
  
  
  METHODS
  Sixty patients completed the HAQ-ulous, reporting pain and swelling of the 28 joints included in the Disease Activity Score-28. A rheumatologist blinded to the patients' responses assessed each joint for the presence of tenderness and swelling. At followup visits, 30 patients received training in distinguishing a swollen joint from a chronically enlarged joint, completed the HAQ-ulous again, and were reassessed by the physician.
  
  
  RESULTS
  At the initial visit, a strong correlation was shown between patient- and clinician-reported tender joints [Pearson correlation coefficient (r(p)) = 0.79; p < 0.0001]. Correlation between patient- and clinician-reported swollen joints was less robust (r(p) = 0.41; p = 0.001). Following training at the second visit, agreement between patients and the clinician improved for both tender joints (r(p) = 0.94; p < 0.0001) and swollen joints (r(p) = 0.93; p < 0.0001).
  
  
  CONCLUSIONS
  With simple training in distinguishing swollen joints from chronically enlarged joints, the majority of patients are able to accurately assess joint swelling. Objective tools, such as the HAQ-ulous, that incorporate patient-reported outcomes are a valuable and reliable addition to standard clinical practice for monitoring patients with RA.
authors: Department of Rheumatology, Southern California Kaiser Permanente, Bellflower, California 90242, USA. gerald.d.levy@kp.org
authors: Gerald
authors: G
authors: Levy
authors: Craig
authors: C
authors: Cheetham
authors: Allison
authors: A
authors: Cheatwood
authors: Raoul
authors: R
authors: Burchette
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000473:pathology*; D003194:Computer-Assisted Instruction; D005260:Female; D006306:Health Surveys; D006801:Humans; D007596:Joints / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010817:Physician-Patient Relations; D015203:Reproducibility of Results; D012219:Rheumatology / Q000193:education; D016353:Self-Examination; D012720:Severity of Illness Index