Skip to main content

Advertisement

SpringerLink
Log in

Assessing Health Status in Inflammatory Bowel Disease Using a Novel Single-Item Numeric Rating Scale

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Current instruments used to measure disease activity and health-related quality of life in patients with Crohn’s disease (CD) and ulcerative colitis (UC) are often cumbersome, time-consuming, and expensive; although used in clinical trials, they are not convenient for clinical practice. A numeric rating scale (NRS) is a quick, inexpensive, and convenient patient-reported outcome that can capture the patient’s overall perception of health.

Aims

The aim of this study was to assess the validity, reliability, and responsiveness of an NRS and evaluate its use in clinical practice in patients with CD and UC.

Methods

We prospectively evaluated patient-reported NRS scores and measured correlations between NRS and a range of severity measures, including physician-reported NRS, Crohn’s disease activity index (CDAI), Harvey-Bradshaw index (HBI), inflammatory bowel disease questionnaire (IBDQ), and C-reactive protein (CRP) in patients with CD. Subsequently, we evaluated the correlation between the NRS and standard measures of health status (HBI or simple colitis clinical activity index [SCCAI]) and laboratory tests (sedimentation rate [ESR], CRP, and fecal calprotectin) in patients with CD and UC.

Results

The patient-reported NRS showed excellent correlation with CDAI (R 2 = 0.59, p < 0.0001), IBDQ (R 2 = 0.66, p < 0.0001), and HBI (R 2 = 0.32, p < 0.0001) in patients with CD. The NRS showed poor, but statistically significant correlation with SCCAI (R 2 = 0.25, p < 0.0001) in patients with UC. The NRS did not correlate with CRP, ESR, or calprotectin. The NRS was reliable and responsive to change.

Conclusions

The NRS is a valid, reliable, and responsive measure that may be useful to evaluate patients with CD and possibly UC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Magasi S, Ryan G, Revicki D, et al. Content validity of patient-reported outcome measures: perspectives from a PROMIS meeting. Qual Life Res. 2011;21:739–746.

    Google Scholar 

  2. Fiscella K, Ransom S, Jean-Pierre P, et al. Patient-reported outcome measures suitable to assessment of patient navigation. Cancer. 2011;117:3601–3615.

    Article  Google Scholar 

  3. Marshall S, Haywood K, Fitzpatrick R. Impact of patient-reported outcome measures on routine practice: a structured review. J Eval Clin Pract. 2006;12:559–568.

    Article  PubMed  Google Scholar 

  4. Velikova G, Booth L, Smith AB, et al. Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial. J Clin Oncol. 2004;22:714–724.

    Article  PubMed  Google Scholar 

  5. Detmar SB, Muller MJ, Schornagel JH, et al. Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial. JAMA. 2002;288:3027–3034.

    Article  PubMed  Google Scholar 

  6. Sandborn WJ, Feagan BG, Hanauer SB, et al. A review of activity indices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn’s disease. Gastroenterology. 2002;122:512–530.

    Article  PubMed  Google Scholar 

  7. Salaffi F, Stancati A, Silvestri CA, et al. Minimally clinically important changes in chronic musculoskeletal pain intensity measured on a numeric rating scale. Eur J Pain. 2004;8:283–291.

    Article  PubMed  Google Scholar 

  8. Samulak D, Michalska M, Gaca M, et al. Efficiency of postoperative pain management after gynecologic oncological surgeries with the use of morphine + acetaminophen + ketoprofen versus morphine + metamizol + ketoprofen. Eur J Gynaecol Oncol. 2001;32:168–170.

    Google Scholar 

  9. Van Seventer R, Serpell M, Bach FW, et al. Relationships between changes in pain severity and other patient-reported outcomes: an analysis in patients with posttraumatic peripheral neuropathic pain. Health Qual Life Outcomes. 2011;9:17.

    Article  PubMed  Google Scholar 

  10. Eckmann MS, Ramamurthy S, Griffin JG. Intravenous regional ketorolac and lidocaine in the treatment of complex regional pain syndrome of the lower extremity: a randomized, double-blinded, crossover study. Clin J Pain. 2011;27:203–206.

    Article  PubMed  Google Scholar 

  11. Simpson DM, Schifitto G, 1066 HIV Neuropathy Study Group, et al. Pregabalin for painful HIV neuropathy: a randomized, double-blind, placebo-controlled trial. Neurology. 2010;74:413–420.

    Article  PubMed  CAS  Google Scholar 

  12. Birnbaum J, Kip M, Spies CD, et al. The effect of stimulation versus nonstimulating catheters for continuous interscalene plexus blocks in short-term pain management. J Clin Anesth. 2007;19:434–439.

    Article  PubMed  Google Scholar 

  13. Funk W, Podmelle F, Guiol C, et al. Aesthetic satisfaction scoring- introducing an aesthetic numeric analogue scale (ANA-scale). J Craniomaxillofac Surg. 2011;40:439–442.

    Google Scholar 

  14. Gossec L, Paternotte S, Aanerud GJ, et al. Finalisation and validation of the rheumatoid arthritis impact of disease score, a patient-derived composite measure of impact of rheumatoid arthritis: a EULAR initiative. Ann Rheum Dis. 2011;70:935–942.

    Article  PubMed  CAS  Google Scholar 

  15. Wig J, Chandrashekharappa KN, Yaddanapudi LN, et al. Effect of prophylactic odansetron on postoperative nausea and vomiting in patients on preoperative steroids undergoing craniotomy for supratnetorial tumors. J Neurosurg Anesthesiol. 2007;19:239–242.

    Article  PubMed  Google Scholar 

  16. Rabin R, De Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–343.

    Article  PubMed  CAS  Google Scholar 

  17. Stermer E, Gaitini L, Yudashkin M, et al. Patient-controlled analgesia for conscious sedation during colonoscopy: a randomized controlled study. Gastrointest Endosc. 2000;5:278–281.

    Article  Google Scholar 

  18. Spiegel B, Bolus R, Harris LA, et al. Measuring irritable bowel syndrome patient-reported outcomes with an abdominal pain numeric rating scale. Aliment Pharmacol Ther. 2009;30:1159–1170.

    Article  PubMed  CAS  Google Scholar 

  19. Livingston PM, Craike MJ, White VM, et al. A nurse-assisted screening and referral program for depression among survivors of colorectal cancer: feasibility study. Med J Aust. 2010;193:S83–S87.

    PubMed  Google Scholar 

  20. Wilcox AR, Dragnev MCC, Darcey CJ, et al. A new tool to measure burden of Crohn’s disease and its treatment: do patient and physician perceptions match? Inflamm Bowel Dis. 2010;16:645–650.

    Article  PubMed  Google Scholar 

  21. Torrance GW. Measurement of health state utilities for economic appraisal. J Health Econ. 1986;5:1–30.

    Article  PubMed  CAS  Google Scholar 

  22. Best WR, Becktel JM, Singleton JW, et al. Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology. 1976;70:439–444.

    PubMed  CAS  Google Scholar 

  23. Harvey RF, Bradshaw JM. A simple index of Crohn’s disease activity. Lancet. 1980;1:514.

    Article  PubMed  CAS  Google Scholar 

  24. Hlavaty T, Persoons P, Vermeire S, et al. Evaluation of short-term responsiveness and cutoff values for inflammatory bowel disease questionnaire in Crohn’s Disease. Inflamm Bowel Dis. 2006;12:199–204.

    Article  PubMed  Google Scholar 

  25. Guyatt G, Mitchell A, Irvine EJ, et al. A new measure of health status for clinical trials in inflammatory bowel disease. Gastroenterology. 1989;96:804–810.

    PubMed  CAS  Google Scholar 

  26. Pallis AG, Mouzas IA, Vlachonikolis IG, et al. The inflammatory bowel disease questionnaire. A review of its national validation studies. Inflamm Bowel Dis. 2004;10:261–269.

    Article  PubMed  CAS  Google Scholar 

  27. Walmsley RS, Ayres RC, Pounder RE, et al. A simple clinical colitis activity index. Gut. 1998;43:29–32.

    Article  PubMed  CAS  Google Scholar 

  28. Cohen J. A power primer. Psychol Bull. 1992;112:155–159.

    Article  PubMed  CAS  Google Scholar 

  29. Irvine EJ, Feagan B, Rochon J, et al. Quality of life: a valid and reliable measure of therapeutic efficacy in the treatment of inflammatory bowel disease. Canadian Crohn’s relapse prevention trial study group. Gastroenterology. 1994;106:287–296.

    PubMed  CAS  Google Scholar 

  30. Gray WN, Denson LA, Baldassano RN, et al. Disease activity, behavioral dysfunction, and health-related quality of life in adolescents with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:1581–1586.

    Article  PubMed  Google Scholar 

  31. Banovic I, Gilibert D, Cosnes J. Crohn’s disease and fatigue: constancy and co-variations of activity of the disease, depression, anxiety, and subjective quality of life. Psychol Health Med.. 2010;15:394–405.

    Article  PubMed  Google Scholar 

  32. Kanwal F, Hays RD, Kilbourne AM, et al. Are physician-derived disease severity indices associated with health-related quality of life in patients with end-stage liver disease? Am J Gastroenterol. 2004;99:1726–1732.

    Article  PubMed  Google Scholar 

  33. Borstlap M, van de Laar M, Zant J, et al. Components of health: an analysis in rheumatoid arthritis using quality of life questionnaires and clinical and laboratory variables. Ann Rheum Dis. 1993;52:650–654.

    Article  PubMed  CAS  Google Scholar 

  34. Bardsley MJ, Astell S, McCallum A, et al. The performance of three measures of health status in an outpatient diabetes population. Diabet Med. 1993;10:619–626.

    Article  PubMed  CAS  Google Scholar 

  35. Beto JA, Bansal VK. Quality of life in treatment of hypertension: a metaanalysis of clinical trials. Am J Hypertens. 1992;5:125–133.

    Article  PubMed  CAS  Google Scholar 

  36. Laupacis A, Wong C, Churchill D. The use of generic and specific quality of life measures in hemodialysis patients treated with erythropoietin. The Canadian Erythropoietin Study Group. Control Clin Trials. 1991;12:168S–179S.

    Article  PubMed  CAS  Google Scholar 

  37. Hjortswang H, Almer S, Strom M. The network: a strategy to describe the relationship between quality of life and disease activity. The case of inflammatory bowel disease. Eur J Gastroenterol Hepatol. 1999;11:1099–1104.

    Article  PubMed  CAS  Google Scholar 

  38. Drossman DA, Leserman J, Li Z, et al. The rating form of IBD patient concerns: a new measure of health status. Psychosom Med. 1991;53:701–712.

    PubMed  CAS  Google Scholar 

  39. Denis MA, Reenaers C, Fontaine F, et al. Assessment of endoscopic activity index and biological inflammatory markers in clinically active Crohn’s disease with normal C-reactive protein serum level. Inflam Bowel Dis. 2007;13:1100–1105.

    Article  Google Scholar 

  40. Lewis JD. The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease. Gastroenterology. 2011;140:1817–1826.

    Article  PubMed  CAS  Google Scholar 

  41. Cakal B, Akoz AG, Ustundag Y, et al. Red cell distribution width for assessment of activity of inflammatory bowel disease. Dig Dis Sci. 2009;54:842–847.

    Article  PubMed  Google Scholar 

  42. Rodgers AD, Cummins AG. CRP correlated with clinical score in ulcerative colitis but no in Crohn’s disease. Dig Dis Sci. 2007;52:2063–2068.

    Article  PubMed  Google Scholar 

  43. Drossman DA, Patrick DL, Mitchell CM, et al. Health related quality of life in inflammatory bowel disease: functional status and patient worries and concerns. Dig Dis Sci. 1989;34:1379–1386.

    Article  PubMed  CAS  Google Scholar 

  44. Rubin DT, Siegel CA, Kane SV, et al. Impact of ulcerative colitis from patients’ and physicians’ perspectives: results from the UC: NORMAL survey. Inflamm Bowel Dis. 2009;15:581–588.

    Article  PubMed  Google Scholar 

  45. Sewitch MJ, Abrahamowicz M, Dobkin PL, et al. Measuring differences between patients’ and physicians’ health perceptions: the patient-physician discordance scale. J Behav Med. 2003;26:245–264.

    Article  PubMed  Google Scholar 

  46. Westwood N, Travis SPL. Review article: what do patients with inflammatory bowel disease want for their clinical management? Aliment Pharmacol Ther. 2008;27:1–8.

    Article  PubMed  Google Scholar 

  47. Wolfe BJ, Sirois FM. Beyond standard quality of life measures: the subjective experiences of living with inflammatory bowel disease. Qual Life Res. 2009;17:877–886.

    Article  Google Scholar 

  48. Leeb BF, Sautner J, Leeb BA, et al. Lack of agreement between patients’ and physicians’ perspectives of rheumatoid arthritis disease activity changes. Scand J Rheumatol. 2006;35:441–446.

    Article  PubMed  CAS  Google Scholar 

  49. Rothwell PM, MacDowell Z, Wong CK, et al. Doctors and patients don’t agree: cross sectional study of patients’ and doctors’ perceptions and assessments of disability in multiple sclerosis. Br Med J. 1997;314:1580–1583.

    Article  CAS  Google Scholar 

  50. Leong KP, Chong EY, Kong KO, et al. Discordant assessment of lupus activity between patients and their physicians: the Singapore experience. Lupus. 2010;19:100–106.

    Article  PubMed  CAS  Google Scholar 

  51. Slevin ML, Plant H, Lynch D, et al. Who should measure quality of life, the doctor or the patient? Br J Cancer. 1988;57:109–112.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was funded in part by an unrestricted Investigator-Initiated grant from Centocor, Inc. The authors gratefully acknowledge Dr Fasiha Kanwal and Dr Ron Hays (UCLA) for methodologic input and Dr Patricio Ibanez (Cedars-Sinai) for assistance with patient recruitment. IBD Research at Cedars-Sinai that contributed to this study is supported by USPHS grant PO1DK046763, DK062413 and the Cedars-Sinai F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute Research Funds. Project investigators are support by The Helmsley Foundation, The European Union and the Crohn's and Colitis Foundation of America (D.P.B.M.), The Feintech Family Chair in IBD (S.R.T.), The Joshua L. and Lisa Z. Greer Chair in IBD Genetics (D.P.B.M.).

Conflict of interest

G.Y.M: Consultant (Amgen, Celgene, Janssen (formerly Centrocor), Given Imaging), non-CME speaker (Prometheus, Abbott), research support (Centocor).

Author information

Authors and Affiliations

  1. F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, 8635 W. 3rd St. #960-Wv, Los Angeles, CA, 90048, USA

    Bijal Surti, Andrew Ippoliti, Eric A. Vasiliauskas, Peter Simpson, David Q. Shih, Stephan R. Targan, Dermot P.B. McGovern & Gil Y. Melmed

  2. Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Bijal Surti & Brennan Spiegel

  3. Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Brennan Spiegel

  4. Center for Outcomes Research Digestive Disease Research Center, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Brennan Spiegel

Authors
  1. Bijal Surti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brennan Spiegel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew Ippoliti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eric A. Vasiliauskas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter Simpson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David Q. Shih
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stephan R. Targan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dermot P.B. McGovern
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gil Y. Melmed
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gil Y. Melmed.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 171 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Surti, B., Spiegel, B., Ippoliti, A. et al. Assessing Health Status in Inflammatory Bowel Disease Using a Novel Single-Item Numeric Rating Scale. Dig Dis Sci 58, 1313–1321 (2013). https://doi.org/10.1007/s10620-012-2500-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-012-2500-1

Keywords

Search

Navigation