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THE BATH AS DISEASE
ACTIVITY INDEX (BASDAI)
..............................................................................(Garrett
et al, 1994)
The research team identified that no gold standard was available
for measuring disease activity in AS. The authors acknowledged
research, from the Royal National Hospital for the Rheumatic
diseases, that identified fatigue as a major component of AS.
It was therefore suggested that this should be incorporated
into measures of disease activity. The BASDAI was subsequently
developed. As with the functional index, the research team included
major input from patients with AS, to enhance clinical relevance
and disease specifity.
Like the BASFI, the BASDAI consists of 10cm visual analog
scales used to answer 6 questions pertaining to the 5 major
symptoms of AS:
- Fatigue
- Spinal pain
- Joint pain / swelling
- Areas of localized tenderness
- Morning stiffness.
To give each symptom equal weighting, the mean of the two scores
relating to morning stiffness is taken. The resulting 0 to 50
score is divided by 5 to give a final 0 – 10 BASDAI score
(refer to page).
When clinically tested, results showed:
- 1) BASDAI to be a quick and simple index (taking between
30 secs and 2 mins to complete)
- BASDAI demonstrated statistically significant (p<0.001)
reliability.
- The individual symptoms and the index as a whole demonstrated
good score distribution, using 95% of the scale.
-
Following a 3 week physiotherapy course,
the BASDAI showed a significant (p=0.009) 16.4% score improvement,
therefore demonstrating a sensitivity to change.
..........................................................................(Garrett
et al, 1994)
By comparison, a previous disease activity index did demonstrate
greater sensitivity to change (22.8% improvement being shown)
(Garrett et al, 1994). However, the authors recognised that
the previous index had a bias towards pain and included a
scale measuring patient’s sense of well being. It is
felt that the BASDAI is superior in terms of symptoms considered
and their weighting. This may be due to the input from patients
with AS when the index was developed. The BASDAI was also
found to be superior in all aspects to the Newcastle Enthesis
index (Garrett et al, 1994).
Calin et al (1999) have further assessed the validity of
the BASDAI. With a sample size of 473, a double-blind, placebo-controlled
study of 6 weeks duration was conducted. Subjects were divided
into two groups. One group received a placebo. The other group
received an active NSAID. Disease activity was assessed with
the BASDAI and by analysing a wide range of individual symptom
components. The authors concluded that BASDAI has excellent
content validity.
The BASFI and BASDAI have also been translated into Swedish
for use in Sweden. Cronstedt et al (1999) and Waldner et al
(1999) have assessed the Swedish version of these two indices.
In agreement with the studies at Bath, the Swedish versions
of the BASFI and BASDAI proved to be reliable, valid, and
sensitive to change following a course of inpatient therapy.
To conclude, the BASDAI is user friendly, highly reliable,
reflects the entire spectrum of the disease, and is sensitive
to clinical changes (Garrett et al, 1994).
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