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The Juvenile Arthritis Functional Status Index (JASI): a validation study
F V Wright1, J L Kimber, M Law
1Arthritis and Orthopaedic Programme, Hugh MacMillan Rehabilitation Centre, Toronto, Ontario, Canada.
Insights
The Juvenile Arthritis Functional Status Index (JASI) Part I is a reliable and valid tool for assessing daily living and mobility in children with juvenile rheumatoid arthritis (JRA). It accurately captures functional status in young patients.
Area of Science:
- Pediatric Rheumatology
- Rehabilitation Medicine
- Health Outcomes Measurement
Background:
- Juvenile rheumatoid arthritis (JRA) significantly impacts children's daily living and functional mobility.
- A validated instrument is needed to comprehensively assess functional status in pediatric patients with JRA.
- The Juvenile Arthritis Functional Status Index (JASI) was developed to address this need.
Purpose of the Study:
- To evaluate the reliability and validity of the Juvenile Arthritis Functional Status Index (JASI) in children with JRA.
- To assess the JASI's ability to measure functional tasks across various domains of daily life.
- To determine if children aged 8 and older can provide realistic self-reports on functional abilities.
Main Methods:
- The JASI was administered to 30 children (ages 8-19) with JRA at three time points (baseline, 3 weeks, 3 months) to assess test-retest reliability.
- Construct validity was evaluated using established rheumatology measures (e.g., joint count, grip strength, functional class).
- Child self-reports were compared with therapist observations for agreement.
Main Results:
- JASI Part I demonstrated excellent test-retest reliability (ICC > 0.95) for both retest intervals.
- JASI Part I scores showed strong correlations with multiple rheumatology measures (r > 0.50), confirming construct validity.
- There was fair to good agreement between child self-reports and therapist observations, supporting realistic reporting from age 8.
Conclusions:
- JASI Part I is a reliable and valid functional measure for school-aged children and adolescents with JRA.
- The self-report feature of JASI Part I is considered realistic for children as young as 8 years old.
- Further research is ongoing to evaluate JASI's responsiveness to change and compare its sensitivity with other JRA functional measures.
Objective:
To evaluate aspects of reliability and validity of the Juvenile Arthritis Functional Status Index (JASI). We developed this questionnaire to assess a variety of daily living and functional mobility tasks in children with juvenile rheumatoid arthritis (JRA). JASI part I consists of 100 functional items divided into 5 activity categories (self-care, domestic, mobility, school, extracurricular). A 7 point degree of difficulty rating scale is used for responses. JASI Part II is a priority function section within which the child identifies and scores important activities for improvement.
Methods:
The JASI was administered to 30 children with JRA 8 to 19 years of age at baseline, 3 weeks, and 3 months to determine test-retest reliability. Various rheumatology measures were used to evaluate the JASI construct validity.
Results:
Reliability of JASI Part I was excellent (intraclass correlation coefficients > or = 0.95) for both retest intervals. Reliability was lower for respondents with mild disease than those with polyarticular disease. JASI Part I scores correlated strongly with rheumatology measures including joint count, grip strength, hip synovitis, timed walk and run. ACR functional class, and range of motion (r > 0.50), indicating construct validity. There was fair to good agreement between scores from the child's self-report and those from therapist observation of the child's abilities on the same activities. This provides evidence that children as young as 8 years of age can realistically report on function on their own. In JASI Part II, respondents identified a mean of 5.9 functional items in the baseline priority activity list. Test-retest reliability for JASI Part II was fair (kappa = 0.57). Further work is needed to determine the most reliable and sensitive response sequence for evaluating change in priority functions with JASI Part II.
Conclusion:
JASI Part I is a reliable and valid functional measure for school age children and adolescents with JRA. Research is under way to evaluate responsiveness to change. Comparisons will be made with shorter JRA functional measures to determine differences in sensitivity.