Nurse-Guided Completion of the BASDAI Questionnaire in Ankylosing Spondylitis Patients with Low Literacy

The objective of this study was to assess nurse-guided patient completion of the Bath Ankylosing Spondylitis Activity Index (BASDAI). Between April and June 2008, all consecutive patients diagnosed with ankylosing spondylitis in a university clinic who were over 18 years old were enrolled in this study. Demographic data and socioeconomic status were collected by a questionnaire. First, the BASDAI forms were completed by the patient (self-report). The forms were completed again by the patient, this time with the guidance of an experienced study nurse (nurse-guided). If the absolute value of difference of self-reported and nurse-guided BASDAI was $ 1 cm (the minimum clinically important difference), these patients were defined as discordant. One hundred sixty-two patients (101 male, 62%; 61 female, 38%); mean age 35.6 years (standard deviation [SD] 11.4); and with a mean disease duration of 12.7 years (SD 7.8), were enrolled in the study. Mean BASDAI scores were no different between self-reported (3.07, SD 2.31) and nurse-guided (2.89, SD 2.31) scores. Thirty-eight patients (23.4%) had discordant results. Comparing the discordant to non-discordant patients, the discordant patients had more active disease (53% versus 27%, P = 0.004); were older (39 years, SD 11, versus 34 years, SD 11, P = 0.029); were more frequently female (58% versus 32%, P = 0.003); had # 8 years' education (55% versus 22%, P < 0.001); and read the newspaper less (24% versus 50%, P = 0.005), respectively. After logistic regression analysis, the main factors explaining the discordance were: length of education, 3.1 (range 1.21-7.88); age, 1.19 (range 0.97-1.46); and frequency of newspaper reading, 2.63 (0.96-7.18). The BASDAI should be carefully evaluated in older patients with low literacy, and nurse-guided questionnaire completion may be an alternative approach in this subgroup.