Parent and child acceptable symptom state in juvenile idiopathic arthritis.
OBJECTIVE
To explore the parent and child acceptable symptom state in juvenile arthritis (JA-PASS and JA-CASS, respectively) and estimate the JA-PASS and JA-CASS cutoff values for outcome measures.


METHODS
Children with juvenile idiopathic arthritis (JIA) and their parents completed a multi-dimensional questionnaire that included parent-reported and child-reported outcomes and a question about whether they considered the disease state as satisfactory. Additional assessments included demographic data, physician-reported outcomes, and acute-phase reactant levels. Stepwise logistic regression was used to assess contributors to JA-PASS and JA-CASS. Cutoff values of outcome measures that defined JA-PASS and JA-CASS were determined using both 75th percentile and receiver-operating characteristic (ROC) curve methods. Testing procedures included evaluation of discriminative and construct validity of the satisfaction question and assessment of reliability of JA-PASS and JA-PASS cutoffs.


RESULTS
Of 584 parents, 385 (65.9%) considered their child in JA-PASS. Of 343 children, 236 (68.8%) considered themselves in JA-CASS. Significant contributors to being in either JA-PASS or JA-CASS were absence of active joints, better rating of overall well-being, and better physical function or health. Cutoff values yielded by 75th percentile and ROC curve methods were similar. Parent, child, and physician global ratings yielded the lowest percentage of false-positive misclassification and the best tradeoff between sensitivity and specificity. The satisfaction question showed good discriminative and construct validity and the JA-PASS and JA-PASS cutoffs were found to be stable over time.


CONCLUSIONS
The acceptable symptom state is a relevant concept for children with JIA and their parents and constitutes a valid outcome measure that is potentially applicable in routine practice and clinical trials.
Pediatria II, Istituto G. Gaslini, Largo G. Gaslini 5, 16147 Genoa, Italy.
Giovanni
G
Filocamo
Alessandro
A
Consolaro
Benedetta
B
Schiappapietra
Nicolino
N
Ruperto
Angela
A
Pistorio
Nicoletta
N
Solari
Silvia
S
Pederzoli
Sara
S
Verazza
Alberto
A
Martini
Angelo
A
Ravelli
D000223:Adaptation, Psychological; D000293:Adolescent; D001171:Arthritis, Juvenile / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010287:Parent-Child Relations; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011788:Quality of Life; D016896:Treatment Outcome