Comparison of the Recent-Onset Arthritis Disability questionnaire with the Health Assessment Questionnaire disability index in patients with rheumatoid arthritis.

BACKGROUND: Physical disability in patients with rheumatoid arthritis (RA) is often assessed by questionnaires. We compared the Recent-Onset Arthritis Disability (ROAD) questionnaire with the Health Assessment Questionnaire (HAQ) disability index (DI) in a cohort of RA patients. The aim of this study was to obtain information on several aspects of construct validity of these measures. METHODS: A cross-sectional multicentre study was carried out among patients with RA who were attending hospital outpatient clinics. The patient group included 196 patients partially or not responding to disease modifying anti-rheumatic drugs. For the evaluation of the psychometric properties of the ROAD in comparison with HAQ-DI this population has been compared to another cohort of 247 outpatients with RA who were participating in a long-term observational study. All patients completed the ROAD and HAQ-DI. Additional comparator composite indices of disease activity were analysed. The ROAD structural validity was first assessed using exploratory factor analysis. Concurrent validity was analysed by Spearman's correlations and cross-tabulations. Discriminant validity to distinguish patients with active and non-active disease was assessed with receiver operating characteristic (ROC) curve analysis. For agreement analysis Bland and Altman plots were calculated. RESULTS: Factor analysis yielded a two-factor ROAD score that accounted for 68.74% of the explained variance in the questionnaire. The first factor, namely upper extremity function/activity daily living and work (ROAD-upper) accounted for 55.6% of the explained variance. The second factor, namely lower extremity function (ROAD-lower) accounted for 13.1% of the explained variance. Significant correlations were found between the scores of the ROAD and the other clinical variables with a high ability to measure pain and disease activity, supporting the concept of convergent construct validity. The discriminatory power of both questionnaires to assess inactive and active RA patients was good, without significant difference. CONCLUSIONS: ROAD is a good alternative to the HAQ-DI for the assessment of physical disability in RA. Use of the ROAD makes it easier and less costly to collect data and reduces the burden on RA patients and should be applied in both clinical trials and routine clinical care settings.

On-line information sources on chemical substances.

Information technology has brought about changes in the work patterns of researchers and scientists. After some hints on the on-line facilities needed to be connected to the international host computers, an analysis is made of some of the main automated sources available to retrieve information on chemical substances. Special emphasis is given to textual-numeric data banks, first reviewing the main chemical dictionaries, like Registry and Chemline, and then focusing on those sources that offer immediate information in case of emergency. Among the Toxnet files, produced and managed within the US National Library of Medicine Toxicology Information Program, play a very important role in offering publicly available data on toxicology and on hazardous chemicals. Therefore, the Hazardous Substances Data Bank (HSDB) and the Registry of Toxic Effects of Chemical Substances (RTECS) are described for their relevance thereon. Other data banks produced in Europe, like the Environmental Chemicals Data Information Network (ECDIN) and the very specialized Major Hazard Incident Data Service (MHIDAS) are also briefly outlined. To integrate this overview on online information, the attention is then shifted on sources having the characteristic of reference databases: prestigious files covering the international scientific literature, as CA/Chemabs, Toxline/Toxlit, Embase, Medline are introduced. Implications of on-line technology in enhancing information access in the next future are discussed, pointing out the new tools created to meet the information needs of end-users.