Development of START, a novel multimedia-based symptom appraisal tool for autoimmune rheumatic diseases

To facilitate earlier diagnosis of autoimmune rheumatic diseases (ARDs), we aimed to (i) develop Symptom Testing for Autoimmune RheumaTic diseases (START), a novel multimedia-based symptom appraisal tool for ARDs and (ii) pilot test START among established ARD cases and non-ARD controls.

We developed START using a social cognitive theory-based theoretical framework and consensus-based lists of ARDs and manifestations from our previous work. START was revised through reviews by an expert panel of rheumatologists and cognitive debriefing interviews (CDIs) with patients newly referred for assessment of ARDs. We pilot tested START to evaluate its sensitivity, specificity and test-retest reliability in detecting patients with known ARDs.

Of the 59 manifestations of ARDs identified from our previous work, 33 reached expert consensus for content validity, 26 were removed because they were non-specific or late features of ARDs. Similar manifestations were grouped, resulting in 19 items. The phrasing and formatting of items in START were revised based on findings from the CDIs with 36 patients and expert panel review. Visual illustrations such as photos and drawings were included to improve comprehension of items in START, using an online platform for implementation. Pilot testing in 145 patients with ARDs, 133 patients with non-ARDs and 155 healthy controls found that the sensitivity, specificity and test-retest reliability in detecting patients with any ARDs were 86.2%, 80.9% and 0.789, respectively.

A novel multimedia-based symptom appraisal tool for ARDs was developed, which addresses the limitations of existing tools and exhibited promising sensitivity and specificity in detecting patients with known ARDs.