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Development and validation of the Edmonton Ankylosing Spondylitis Metrology Index

  1. Walter P. Maksymowych1,†,*,
  2. Cathy Mallon1,
  3. Rhonda Richardson1,
  4. Barbara Conner-Spady1,
  5. Edwin JaureguI2,
  6. Cecilia Chung1,
  7. Lisa Zappala3,
  8. Kevin Pile3,
  9. Anthony S. Russell1

Article first published online: 27 JUL 2006

DOI: 10.1002/art.22103

Issue

Arthritis Care & Research

Arthritis Care & Research

Volume 55, Issue 4, pages 575–582, 15 August 2006

Additional Information

How to Cite

Maksymowych, W. P., Mallon, C., Richardson, R., Conner-Spady, B., JaureguI, E., Chung, C., Zappala, L., Pile, K. and Russell, A. S. (2006), Development and validation of the Edmonton Ankylosing Spondylitis Metrology Index. Arthritis & Rheumatism, 55: 575–582. doi: 10.1002/art.22103

Author Information

  1. 1

    University of Alberta, Edmonton, Alberta, Canada

  2. 2

    CAYRE Arthritis and Rehabilitation Clinic, Bogota, Colombia

  3. 3

    James Cook University, Queensland, Australia

  1. †

    Dr. Maksymowych is a Senior Scholar of the Alberta Heritage Foundation for Medical Research.

*562 Heritage Medical Research Building, University of Alberta, Edmonton, Alberta T6G 2S2, Canada

  1. †

    Dr. Maksymowych is a Senior Scholar of the Alberta Heritage Foundation for Medical Research.

Publication History

  1. Issue published online: 27 JUL 2006
  2. Article first published online: 27 JUL 2006
  3. Manuscript Accepted: 22 DEC 2005
  4. Manuscript Received: 30 JUL 2005

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Keywords:

  • Spinal and hip mobility;
  • Ankylosing spondylitis;
  • Index;
  • Validation

Abstract

Objective

Assessment of spinal and hip mobility has been recommended by the Assessments in Ankylosing Spondylitis (AS) Working Group for clinical trials and record keeping, although suggested measures primarily reflect structural damage. Our objective was to validate a simple, 4-item composite measure of spinal and hip mobility, the Edmonton AS Metrology Index (EDASMI).

Methods

We assessed the EDASMI and the Bath AS Metrology Index (BASMI) using a total of 263 patients from 3 countries: Canada (n = 205), Australia (n = 29), and Colombia (n = 29). Intra- and interobserver reliability were assessed in a subset of 44 patients. Construct validity with respect to disease activity (Bath AS Disease Activity Index [BASDAI]), function (Bath AS Functional Index [BASFI]), and structural damage (modified Stoke AS Spinal Score [mSASSS]) was analyzed using correlation and hierarchical regression. Responsiveness was assessed in a subset of 33 patients who received either anti–tumor necrosis factor α therapy (n = 26) or pamidronate (n = 7) over 24 weeks.

Results

In contrast to the EDASMI, BASMI scores covered a limited range, with 70% of patients demonstrating a score ≤3 (range 0–10) and 4 of 5 individual measures demonstrating substantial floor effects. Both measures were highly reliable (intraclass correlation coefficient >0.90) and demonstrated similar construct validity (EDASMI correlated with disease duration [0.52], BASDAI [0.24], BASFI [0.61], Bath Ankylosing Spondylitis Radiology Index [0.79], mSASSS [0.75]; P < 0.001 for all). The change in EDASMI score was significant after 24 weeks of therapy (standardized response mean 0.40; P = 0.03), but change in the BASMI was not significant.

Conclusion

The EDASMI is a simple, rapid, and reliable tool for the assessment of spinal mobility in AS that is responsive to therapeutic intervention.

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