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As disease-specifi c assessments are more common in RA and SpA, studies
predominantly address these patient groups. Examples are briefl y summarized in
chronological order: Ryan et al. showed that 44 % of RA patients were more likely
to skip a question or mark more than one answer to the given question in paper-
based questionnaires when comparing a paper-based and an electronic version of
the SF-36 General Health Questionnaire [ 36 ]. In patients with systemic lupus ery-
thematosus and vasculitis, an electronic version of the SF-36 correlated well with
the paper version [ 18 ]. Schaeren et al. validated the North American Spine Society
outcome-assessment instrument for the lumbar spine (a valid and reliable tool for
measuring the outcome in patients with low back pain) in a touchscreen format. The
computerized version was as reliable as the paper–pencil version and nearly two-
thirds of the patients preferred the computerized version [ 40 ]. Evaluations by Bent
et al. not only showed a high degree of agreement between paper and computer-
administered versions of the Quebec Scale, the Bath Ankylosing Spondylitis
Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional
Index (BASFI), and the Bath AS Patient Global Score (BAS-G) on a computerized
touchscreen system but also noticed small systematic differences for the Quebec
Scale and in the BAS-G results [ 48 ].
A comparison of self-reported health status measures (pain, fatigue, and global
health on visual analogue scales [VAS]; rheumatoid arthritis disease activity index;
modifi ed health assessment questionnaire; SF-36) of paper-based questionnaires
and electronic versions on a personal digital assistant (PDA) in RA patients was
published in 2005 [ 73 ]. The authors reported acceptable agreement between the
scores and patients’ preferences of the PDA version [ 73 ]. A study with touchscreen
computers showed that assessment via computer was as fast as paper-based versions
[ 32 ]. The authors investigated the Rheumatoid Arthritis Quality of Life Questionnaire
(RAQol); the Stanford Health Assessment Questionnaire (HAQ); VAS for pain,
fatigue, and global arthritis activity; as well as a joint assessment. Their touchscreen
questionnaires produced similar results to the applied paper–pencil versions; age
and computer experiences did not infl uence the results [ 32 ].
Thumboo et al. also reported that patients preferred computerized versions of the
PROMs evaluated (EQ5D, the Health Utilities Index Mark 2 [HUI2] & 3 [HUI3],
and the Family Functioning Measure [FFM]) [ 74 ]. They showed that differences in
the mean scores (interviewer versus touchscreen) did not reach statistical signifi -
cance with the exception of the EQ-VAS. The authors concluded that computerized
PROMs may have great advantages for the conduction of clinical trials and cohort
studies as they may lead to smaller sample size requirements as well as reductions
in cost and recruitment time [ 74 ]. Richter et al. published data on the evaluation of
the feasibility of electronic data capture of Hannover Functional Ability
Questionnaire (FFbH)/HAQ, BASDAI, and SF-36 using a tablet PC connected to a
patient documentation system [ 33 ]. The study showed no signifi cant differences
between the electronic and the paper-based assessments [ 33 ].
In patients from the DANBIO register, PROMs on a touchscreen were investi-
gated. The ePROMs (BASDAI, BASFI, HAQ, and VAS for pain, fatigue, and global
health) generated valid results in ankylosing spondylitis and rheumatoid arthritis
J. Richter et al.