Agreement between physicians & parents in rating functional ability of children with juvenile idiopathic arthritis

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Agreement between physicians and parents in rating functional ability of

children with juvenile idiopathic arthritis

Pediatric Rheumatology 2007, 5:23doi:10.1186/1546-0096-5-23

http://www.ped-rheum.com/content/5/1/23/abstract

Abstract (provisional)

Objective

To investigate concordance between physicians and parents in rating the

degree of functional ability of children with juvenile idiopathic arthritis

(JIA).

Methods

The attending physician and a parent were asked to rate independently the

level of physical functioning of 155 patients with disease duration > or =

to 5 years on a 6-point scale ranging from 1=no disability (i.e. the child

can do without difficulty all activities that children of his/her age can

do) to 6=severe disability (i.e. all activities are difficult for the

child).

At study visit, measures of JIA activity and damage were assessed. Agreement

was evaluated with weighted kappa (<0.40=poor agreement; 0.41-0.60=moderate

agreement; 0.61-0.80=substantial agreement; >0.80 excellent agreement).

Physician/parent evaluations were divided in 3 groups: 1) concordance; 2)

parent over-rating= parent assessment over-rated relative to physician

assessment; 3) physician over-rating= physician assessment over-rated

relative to parent assessment. Factors affecting concordance/discordance

were evaluated by means of Kruskal-Wallis or Chi-square/Fisher exact test.

Results

Concordance, parent over-rating and physician over-rating were observed in

107 (69%), 29 (18.7%) and 19 (12.3%) evaluations, respectively. Kappa value

was 0.69. Parent over-rating was associated with greater intensity of pain

and higher Childhood Health Assessment Questionnaire (C-HAQ) score, whereas

physician over-rating was associated with more severe joint disease, higher

C-reactive protein higher frequency of Steinbrocker functional class > or =

to II, and greater articular damage, as measured with the Juvenile Arthritis

Damage Index.

Conclusion

Physicians and parents revealed fair concordance in rating functional

ability of children with JIA. Parent over-rating was associated with greater

child's pain and worse C-HAQ score, whereas physician over-rating was

associated with greater severity of joint inflammation and damage.