title: Comparison of internal and external responsiveness of the generic Medical Outcome Study Short Form-36 (SF-36) with disease-specific measures in rheumatoid arthritis.
abstract: OBJECTIVE
  To examine the comparative internal and external responsiveness of the generic Medical Outcome Study Short Form-36 Health Survey (SF-36) and disease-specific measures in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  Data were collected from 280 RA patients starting anti-tumor necrosis factor treatment. A total of 168 patients completed a questionnaire including the SF-36, the Arthritis Impact Measurement Scales 2 (AIMS2), the Health Assessment Questionnaire (HAQ), a visual analog scale for general health (VAS-GH), and an 11-point numerical rating scale for pain (NRS pain) at baseline and after 12 months. Internal responsiveness was evaluated with paired samples t-tests and standardized response means (SRM). External responsiveness was investigated with receiver-operating characteristic statistics and Spearman rank-order correlation coefficients. A health transition item was used as the external indicator of change.
  
  
  RESULTS
  No significant differences in internal and external responsiveness were found between the SF-36 and disease-specific measures within the domains physical function, pain, and psychological function. In the domain social function, the SF-36 was more responsive than the AIMS2. In the domain general health, the SF-36 was less responsive (only internal) than the AIMS2 and VAS-GH.
  
  
  CONCLUSIONS
  Our study showed comparable internal and external responsiveness of the SF-36 compared with disease-specific measures (AIMS2, HAQ, NRS pain) in all health domains, except social function and general health domains. The assumption that disease-specific measures are more responsive to detect intervention-related changes over time is not confirmed by our data.
authors.affiliation: Institute for Behavioral Research, University of Twente, Enschede, The Netherlands. m.m.veehof@utwente.nl
authors.forename: Martine M
authors.initials: MM
authors.lastname: Veehof
authors.forename: Peter M
authors.initials: PM
authors.lastname: ten Klooster
authors.forename: Erik
authors.initials: E
authors.lastname: Taal
authors.forename: Piet L C M
authors.initials: PL
authors.lastname: van Riel
authors.forename: Mart A F J
authors.initials: MA
authors.lastname: van de Laar
mesh_terms: D001172:Arthritis, Rheumatoid / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011594:Psychometrics / Q000295:instrumentation*; D011788:Quality of Life; D012372:ROC Curve; D015203:Reproducibility of Results; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires