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Preliminary validation of a self-reported screening questionnaire for inflammatory back pain
Stephanie O Keeling1, Sumit R Majumdar, Barbara Conner-Spady
1Department of Medicine, University of Alberta, 562 Heritage Medical Research Center, Edmonton, Alberta T6G 2S2, Canada. stephanie.keeling@ualberta.ca
The Journal of Rheumatology
|February 17, 2012
Summary
A single question about diurnal variation in pain shows high accuracy for identifying inflammatory back pain (IBP), a key feature of axial spondyloarthritis (SpA). This simple assessment can aid in earlier SpA diagnosis.
Area of Science:
- Rheumatology
- Clinical Diagnostics
- Patient-Reported Outcomes
Background:
- Inflammatory back pain (IBP) is a hallmark of axial spondyloarthritis (SpA).
- IBP is often underrecognized in primary care, potentially delaying SpA diagnosis.
- Existing diagnostic criteria may not fully capture key patient experiences of IBP.
Purpose of the Study:
- To develop and validate a patient-reported questionnaire for IBP.
- To identify key domains of IBP that are predictive of axial spondyloarthritis.
- To improve the early recognition of SpA in clinical practice.
Main Methods:
- A 6-item questionnaire was developed, focusing on symptoms like stiffness, pain patterns, and peripheral joint involvement.
- The questionnaire was validated against established criteria (Calin, ASAS) in patients with axial SpA and mechanical back pain.
- Classification utility was assessed using sensitivity, specificity, and likelihood ratios, with logistic regression for scoring systems.
Main Results:
- The single item "diurnal variation" demonstrated the highest classification utility for IBP (Sensitivity 49%, Specificity 92%, LR+ 5.95).
- This item outperformed existing Calin and ASAS IBP criteria in distinguishing IBP.
- Its utility was particularly high in early SpA (disease duration < 6 years).
Conclusions:
- A single self-reported item, "diurnal variation," possesses significant classification utility for IBP.
- This crucial domain is currently absent from established IBP criteria.
- Incorporating "diurnal variation" could enhance the early detection of axial spondyloarthritis.
