Rheumatology Advance Access originally published online on January 30, 2007
Rheumatology 2007 46(5):849-855; doi:10.1093/rheumatology/kel445
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The overall status in rheumatoid arthritis (OSRA) measure—further evidence to support its use in clinical practice
arc Epidemiology Unit, The University of Manchester, 1Department of Rheumatology, University Hospital of North Staffordshire NHS Trust, 2Academic Rheumatology Unit, King's College Hospital NHS Trust, 3Department of Rheumatology, East Cheshire NHS Trust, 4Department of Rheumatology, Royal Cornwall Hospitals NHS Trust and 5Department of Rheumatology, Mid Staffordshire General Hospitals NHS Trust.
Correspondence to: D. P. M. Symmons, Professor of Rheumatology and Musculoskeletal Epidemiology, arc Epidemiology Unit, Stopford Building, The University of Manchester, Oxford Road Manchester, M13 9PT, UK. E-mail: deborah.symmons{at}manchester.ac.uk
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Abstract |
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Objectives. The overall status in rheumatoid arthritis (OSRA) instrument is a simple summary of health status, including disease activity (OSRA-A) and damage (OSRA-D) scores. Despite evidence of the validity of the OSRA, uptake has been low. This study aimed to assess the responsiveness and re-examine the validity of the OSRA using the measures from the British Rheumatoid Outcome Study Group (BROSG) randomized controlled trial of aggressive vs symptomatic treatment of rheumatoid arthritis (RA) patients.
Methods. 466 patients were recruited. Outcome measures included the OSRA, the OMERACT core set and the DAS28, and were collected at baseline and annually for the 3 yrs of the trial. X-rays of the hands and feet were taken at baseline and 3 yrs. Patients were assigned a Townsend score (a measure of social deprivation) according to area of residence. Construct validity was assessed by correlating the OSRA with a range of outcome measures, and testing for the known inequality in RA outcome between patients classified by social deprivation. Responsiveness to change was assessed against self-reported change over the first year of the trial.
Results. The OSRA-A and OSRA-D measures demonstrated construct validity, performing as hypothesized. The OSRA-A was the most responsive measure in the BROSG trial in detecting patient reported improvement and deterioration. The OSRA-D demonstrated similar responsiveness to alternative measures.
Conclusions. Our results demonstrate the validity and responsiveness of the OSRA, and its potential for inclusion in clinical trials. More important, as the OSRA is quick and easily calculated, uses routinely collected information, and provides useful quantitative information about a patient's status and progress it is suitable for use in the routine clinic.
KEY WORDS: Rheumatoid arthritis, Health status, Validity (epidemiology), Quality of life, Socioeconomic factors, Randomized controlled trial
Submitted 17 August 2006;
revised version accepted 12 December 2006.
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