title: Reliability and sensitivity to change of the Bristol Rheumatoid Arthritis Fatigue scales.
abstract: OBJECTIVE
  To examine the reliability (stability) and sensitivity of the Bristol Rheumatoid Arthritis Fatigue scales (BRAFs) and patient-reported outcome measures (PROMs) developed to capture the fatigue experience. The Multi-Dimensional Questionnaire (BRAF-MDQ) has a global score and four subscales (Physical Fatigue, Living with Fatigue, Cognitive Fatigue and Emotional Fatigue), while three numerical rating scales (BRAF-NRS) measure fatigue Severity, Effect and Coping.
  
  
  METHODS
  RA patients completed the BRAFs plus comparator PROMs. Reliability (study 1): 50 patients completed questionnaires twice. A same-day test-retest interval (minimum 60 min) ensured both time points related to the same 7 days, minimizing the capture of fatigue fluctuations. Reliability (study 2): 50 patients completed the same procedure with a re-worded BRAF-NRS Coping. Sensitivity to change (study 3): 42 patients being given clinically a single high dose of i.m. glucocorticoids completed questionnaires at weeks 0 and 2.
  
  
  RESULTS
  The BRAF-MDQ, its subscales and the BRAF-NRS showed very strong reliability (r = 0.82-0.95). BRAF-NRS Coping had lower moderate reliability in both wording formats (r = 0.62, 0.60). The BRAF-MDQ, its subscales and the BRAF-NRS Severity and Effect were sensitive to change, with effect sizes (ESs) of 0.33-0.56. As hypothesized, the BRF-NRS Coping was not responsive to the pharmaceutical intervention (ES 0.05). Preliminary exploration suggests a minimum clinically important difference of 17.5% for improvement and 6.1% for fatigue worsening.
  
  
  CONCLUSIONS
  The BRAF scales show good reliability and sensitivity to change. The lack of BRAF-NRS Coping responsiveness to medication supports the theory that coping with fatigue is a concept distinct from severity and effect that is worth measuring separately.
authors.affiliation: Academic Rheumatology, Bristol Royal Infirmary, Bristol BS2 8HW, UK. emma2.dures@uwe.ac.uk.
authors.forename: Emma K
authors.initials: EK
authors.lastname: Dures
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hewlett
authors.forename: Fiona A
authors.initials: FA
authors.lastname: Cramp
authors.forename: Rosemary
authors.initials: R
authors.lastname: Greenwood
authors.forename: Joanna K
authors.initials: JK
authors.lastname: Nicklin
authors.forename: Marie
authors.initials: M
authors.lastname: Urban
authors.forename: John R
authors.initials: JR
authors.lastname: Kirwan
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D005221:Fatigue / Q000175:diagnosis* / Q000209:etiology* / Q000523:psychology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D005938:Glucocorticoids
keywords: MCID; fatigue; patient-reported outcome; reliability; rheumatoid arthritis; sensitivity