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Development of a screening tool to identify patients with axial spondyloarthritis: a cognitive interview study

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Abstract

Objective

To further refine the wording of screening questions and examine their face validity through cognitive interviews with axial spondyloarthritis (axSpA) and chronic mechanical back pain patients.

Methods

In-depth, semi-structured cognitive interviews were conducted with 30 patients (10 axSpA; 20 chronic mechanical back pain patients) to assess the face validity and comprehensibility of the screening questions. The interview protocol focused on 12 questions/domains including participants’ feedback/thoughts on the duration of suffering from back pain, age at onset of back pain, pace of back pain development, improvement of pain with movement or rest, nocturnal back pain improving upon awakening, pain in other parts of the body, responsiveness of pain to nonsteroidal anti-inflammatory drug (NSAID) use, history of autoimmune conditions, and domains such as sleep, sitting, and stiffness. The Flesch-Kincaid grade level and Flesch reading ease scores were then analyzed for the revised versions of screening questions.

Results

Participants preferred questions that allowed them to provide more details regarding the frequency of their symptoms. Questions were refined for clarity and eliminated if participants considered them to be irrelevant (e.g., NSAIDs). Two sample screeners were derived from twelve questions each with an overall reading grade of 7.5 and reading ease of 65.7%.

Conclusions

It is feasible to design a screening tool that is accessible to most (e.g., reading level) and clear to individuals with back pain. An evidence-based approach to demonstrate the validity of the screening tool will be critical for it to be implemented widely into clinical practice.

Key Points

• Our study developed two sample screeners that are clear to individuals with back pain and accessible to most with an overall Flesch-Kincaid reading grade of 7.5 and Flesch reading ease of 65.7%.

• Questions that were considered irrelevant to participants were eliminated such as responsiveness of pain to nonsteroidal anti-inflammatory drug (NSAID).

• It is feasible to design a screening tool that is accessible to most (e.g., reading level) and clear to individuals with back pain.

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Data availability

The data analyzed during the current study are not publicly available due to the nature of the qualitative data.

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Acknowledgements

We thank all the patients who participated in this study.

Funding

Funding for this project was provided by Novartis Pharmaceuticals Corporation. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR000161. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. This work was also supported by a charitable contribution to the UMass Memorial Foundation from Timothy S. and Elaine L. Peterson.

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Author notes

  1. Divya Shridharmurthy and Sara Khan contributed equally to the work.

Authors and Affiliations

  1. Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA

    Divya Shridharmurthy, Sara Khan, Kate L. Lapane, Jonathan Kay & Shao-Hsien Liu

  2. Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA

    Divya Shridharmurthy & Kate L. Lapane

  3. Novartis Pharmaceuticals Corporation, East Hanover, NJ, 07936, USA

    Esther Yi

  4. Division of Rheumatology, Department of Medicine, UMass Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA

    Jonathan Kay & Shao-Hsien Liu

Authors
  1. Divya Shridharmurthy
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  2. Sara Khan
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  4. Esther Yi
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Corresponding author

Correspondence to Shao-Hsien Liu.

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Ethics approval

The study was approved by the UMass Chan Medical School Institutional Review Board. All participants provided informed consent. Authors Sara Khan, Divya Shridharmurthy, Kate L. Lapane PhD, Jonathan Kay, MD, and Shao-Hsien Liu, MPH, PhD, have no competing interests directly related to this study.

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Conflict of interest

Dr. Yi is an employee of Novartis. The other authors have disclosed no conflicts of interest.

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Shridharmurthy, D., Khan, S., Lapane, K.L. et al. Development of a screening tool to identify patients with axial spondyloarthritis: a cognitive interview study. Clin Rheumatol 41, 1391–1402 (2022). https://doi.org/10.1007/s10067-022-06072-8

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  • DOI: https://doi.org/10.1007/s10067-022-06072-8

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