In the Journals

Cutoff values for symptom state acceptability vary widely in patients with OA

Elien A.M. Mahler

Patient Acceptable Symptom State values do not appear consistent across dimensions and rheumatic conditions, suggesting that their use among patients with osteoarthritis and other rheumatic diseases may not be justifiable, according to findings published in the Journal of Rheumatology.

“This is the first study that examined and confirmed the robustness of the patient acceptable symptom state (PASS) values for physical functioning measured with the [Knee Injury and Osteoarthritis Outcome Score], [Lequesne Algofunctional Index], [ Lower Extremity Functional Scale] and [Western Ontario and McMaster Universities Osteoarthritis Index] at the same time, in patients with knee OA,” Elien A.M. Mahler, MD, MSc, of the Radboud University Medical Center, in the Netherlands, told Healio Rheumatology.

To determine PASS cutoff values for various patient-reported outcome measures of physical function among those with OA, and to estimate the effects of age, sex, symptom duration and depression on PASS, Mahler and colleagues recruited a cohort of 161 individuals in the Netherlands. Participants completed various questionnaires analyzing physical function at baseline and 3 months. They were all patients with OA with a mean age of 59 years who received standard nonsurgical treatment.

Researchers found that PASS values were inconsistent across dimensions and rheumatic diseases, and that the use of a nonspecific PASS value for patients with osteoarthritis would not be advised.
Source: Shutterstock

The questionnaires included in the study were the Knee Injury and Osteoarthritis Outcome Score, Lequesne Algofunctional Index, Lower Extremity Functional Scale, numerical rating scale, and the physical function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index.

According to the researchers, standardized PASS values for various questionnaires ranged between 48 (95% CI, 44-54) and 54 (95% CI, 50-56).

“Our results show that these PASS cutoff values are relatively robust across different questionnaires measuring physical function,” Mahler said. “Also, in our knee OA cohort, and in line with previous results for OA, patients consider a higher level of symptoms acceptable than the multinational PASS value reported previously, applicable for different rheumatic conditions and domains.”

Mahler added that the researchers also observed that women and patients with depression have a lower chance of reaching the estimated PASS value, with OR varying from 0.45 (95% CI, 0.23-0.91) to 0.5 (95% CI, 0.26-0.97) for women, and from 0.27 (95% CI, 0.14-0.55) to 0.38 (95% CI, 0.19-0.77) for those with depression.

“Our results indicate that PASS values are not consistent across dimensions and rheumatic diseases, and that the use of a generic PASS value for patients with OA or even patients with other rheumatic diseases might not be justifiable,” Mahler said. “We discuss that this may indicate that a PASS value is only generalizable to one outcome domain in a specific rheumatic disease.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures. 

Elien A.M. Mahler

Patient Acceptable Symptom State values do not appear consistent across dimensions and rheumatic conditions, suggesting that their use among patients with osteoarthritis and other rheumatic diseases may not be justifiable, according to findings published in the Journal of Rheumatology.

“This is the first study that examined and confirmed the robustness of the patient acceptable symptom state (PASS) values for physical functioning measured with the [Knee Injury and Osteoarthritis Outcome Score], [Lequesne Algofunctional Index], [ Lower Extremity Functional Scale] and [Western Ontario and McMaster Universities Osteoarthritis Index] at the same time, in patients with knee OA,” Elien A.M. Mahler, MD, MSc, of the Radboud University Medical Center, in the Netherlands, told Healio Rheumatology.

To determine PASS cutoff values for various patient-reported outcome measures of physical function among those with OA, and to estimate the effects of age, sex, symptom duration and depression on PASS, Mahler and colleagues recruited a cohort of 161 individuals in the Netherlands. Participants completed various questionnaires analyzing physical function at baseline and 3 months. They were all patients with OA with a mean age of 59 years who received standard nonsurgical treatment.

Researchers found that PASS values were inconsistent across dimensions and rheumatic diseases, and that the use of a nonspecific PASS value for patients with osteoarthritis would not be advised.
Source: Shutterstock

The questionnaires included in the study were the Knee Injury and Osteoarthritis Outcome Score, Lequesne Algofunctional Index, Lower Extremity Functional Scale, numerical rating scale, and the physical function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index.

According to the researchers, standardized PASS values for various questionnaires ranged between 48 (95% CI, 44-54) and 54 (95% CI, 50-56).

“Our results show that these PASS cutoff values are relatively robust across different questionnaires measuring physical function,” Mahler said. “Also, in our knee OA cohort, and in line with previous results for OA, patients consider a higher level of symptoms acceptable than the multinational PASS value reported previously, applicable for different rheumatic conditions and domains.”

Mahler added that the researchers also observed that women and patients with depression have a lower chance of reaching the estimated PASS value, with OR varying from 0.45 (95% CI, 0.23-0.91) to 0.5 (95% CI, 0.26-0.97) for women, and from 0.27 (95% CI, 0.14-0.55) to 0.38 (95% CI, 0.19-0.77) for those with depression.

“Our results indicate that PASS values are not consistent across dimensions and rheumatic diseases, and that the use of a generic PASS value for patients with OA or even patients with other rheumatic diseases might not be justifiable,” Mahler said. “We discuss that this may indicate that a PASS value is only generalizable to one outcome domain in a specific rheumatic disease.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.