title: Reliability and validity of the myositis disease activity assessment tool.
abstract: OBJECTIVE
  To test the interrater reliability and validity of the Myositis Disease Activity Assessment Tool, which consists of the Myositis Intention-to-Treat Activity Index and the Myositis Disease Activity Assessment Visual Analog Scales.
  
  
  METHODS
  Two phases of the study were conducted to assess the reliability and validity of the tool, which was modified following the first phase. In the first phase of the reliability study, 123 adult myositis patients were evaluated in 7 centers, and in the second phase 40 patients were evaluated in 2 centers. The validity study included 294 patients in 5 centers in the first phase and 65 patients in 3 centers in the second phase. The interrater reliability was assessed using intraclass correlation coefficients. The criterion validity was calculated using sensitivity, specificity, and positive predictive value (PPV) of a grade of A in any system. Spearman's rank correlation coefficient was used to measure the convergent validity of cross-sectional scores between the 2 instruments.
  
  
  RESULTS
  There was a 2:1 ratio of female to male patients. There was no significant difference in mean age at diagnosis (46.3 versus 46.8 years) and mean disease duration (7.7 versus 10 years) between the 2 groups recruited for the different phases of the study. There was an improvement in interrater reliability in the second phase of the study. There was a significant improvement in the validity of the assessment tool following modification of the tool. The sensitivity, specificity, and PPV of a grade of A in any system improved from 86%, 92%, and 67% in the first phase to 96%, 94%, and 83%, respectively, in the second phase. Convergent validity between the 2 activity tools showed good correlation, ranging from 0.8 to 0.94, for the individual organ systems.
  
  
  CONCLUSIONS
  This is the first major attempt to assess the reliability and validity of a disease activity index in myositis. Our findings indicate that, following within-study modification, the tool appears to be a reliable and valid instrument to assess myositis disease activity.
authors.affiliation: University College London Hospitals, London, UK. ssultan@doctors.org.uk
authors.forename: Shabina M
authors.initials: SM
authors.lastname: Sultan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Allen
authors.forename: Chester V
authors.initials: CV
authors.lastname: Oddis
authors.forename: Patrick
authors.initials: P
authors.lastname: Kiely
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cooper
authors.forename: Ingrid E
authors.initials: IE
authors.lastname: Lundberg
authors.forename: Jiri
authors.initials: J
authors.lastname: Vencovsky
authors.forename: David A
authors.initials: DA
authors.lastname: Isenberg
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009220:Myositis / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index