title: Development of the patient Harvey Bradshaw index and a comparison with a clinician-based Harvey Bradshaw index assessment of Crohn's disease activity.
abstract: OBJECTIVE
  The objective is to develop a patient-based Harvey Bradshaw Index (P-HBI) of Crohn's Disease (CD) activity and to compare it with the clinician-based HBI of CD activity in CD outpatients.
  
  
  METHODS
  Consecutive patients with CD randomly completed the P-HBI either before or after the consultation. The gastroenterologist assessed patient's CD activity on the same day. Overall agreement between HBI and P-HBI was calculated with Spearman's ρ and Mann-Whitney U test. Agreement regarding active disease versus remission and agreement at item level was calculated by percent agreement and Cohen's κ.
  
  
  RESULTS
  One hundred eighty-one (response rate 88.3%) CD patients participated. P-HBI and HBI showed a large correlation (rs=0.82). The medians (interquartile range) of the total HBI (2; 0 to 4) and P-HBI (4; 1 to 7) were statistically significantly different (z=-8.411; P<0.001). Fortunately, in 82.6% of the cases this difference between clinicians and patients was not clinically significant (<3.2). The percentage agreement between clinician and patient, judging CD as active or as in remission, was 77%, rs=0.56, κ=0.52, indicating a moderate agreement. P-HBI and HBI on frequent extraintestinal manifestations in CD varied from less than chance (κ=-0.02) to a perfect agreement (κ=1). Patients tended to report more symptoms while completing the patient-based questionnaire compared to what they reported to the clinician during consultation.
  
  
  CONCLUSIONS
  The P-HBI is the first step in developing a potential promising tool given its adequate agreement with the original HBI and its feasibility, especially in patients with low scores. Future research is necessary to develop a validated patient-based version studied in several patient populations.
authors: Departments of *Medical Psychology ‡Gastroenterology, Academic Medical Center, Amsterdam †Department of Gastroenterology, Saint Lucas Andreas Hospital, Amsterdam §Department of Clinical Psychology, University of Groningen ∥Health Psychology Section, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Floor
authors: F
authors: Bennebroek Evertsz'
authors: Céline C M Q
authors: CC
authors: Hoeks
authors: Pythia T
authors: PT
authors: Nieuwkerk
authors: Pieter C F
authors: PC
authors: Stokkers
authors: Cyriel Y
authors: CY
authors: Ponsioen
authors: Claudi L H
authors: CL
authors: Bockting
authors: Robbert
authors: R
authors: Sanderman
authors: Mirjam A G
authors: MA
authors: Sprangers
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000175:diagnosis* / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires