628 TheJournalofRheumatology2010;37:3;doi:10.3899/jrheum.090548 Personal non-commercial use only. The Journal of Rheumatology Copyright © 2010. All rights reserved. VisualAssessmentoftheSpineBruckelInstrument,a NovelStatusTooltoReflectAppearanceoftheSpinein PatientswithAnkylosingSpondylitis DOMINIK W. PODBIELSKI, JANE BRUCKEL, EMMAPOMEROY, ROBERT D. INMAN, ROBERTW. WARREN, LAURIE M. SAVAGE, JENNY RICHARDSON,ANGELO PAPACHRISTOS, REBECCAJ. MOGG, and MILLICENT A. STONE ABSTRACT. Objective. The Visual Assessment of the Spine Bruckel Instrument (VASBI) is a new status tool developed by the Spondylitis Association of America and the University of Toronto to reflect spinal appearance in patients with ankylosing spondylitis (AS). Our objective was to validate the VASBI according to the Outcome Measures in Rheumatoid Arthritis Clinical Trials filter (truth, discrimina- tion, and feasibility). Methods. Three hundred patients with AS were asked to rate their degree of perceived spinal defor- mity using the VASBI. To evaluate construct validity, VASBI scores were compared with function- al outcome, spinal mobility, and radiographic spinal damage. Test-retest reliability was evaluated using kappa statistic (κ). Results. Patient VASBI demonstrated strong correlation with spinal mobility (r = 0.543) and mod- erate correlation with functional impairment (r = 0.490) and structural damage (r = 0.309). Reliability for VASBI was very good (κ = 0.973, p < 0.001). Conclusion. The VASBI is a novel tool with practical applications in a busy clinical setting as it sim- plifies assessment ofAS spinal deformity. Our study demonstrates that the VASBI has good feasi- bility, construct validity, and reliability. (First Release Feb 15 2010; J Rheumatol 2010;37:628–32; doi:10.3899/jrheum.090548) KeyIndexingTerms: SPINE BRUCKEL INSTRUMENT ANKYLOSING SPONDYLITIS SELF-ASSESSMENT FromtheOphthalmologyandVisionSciences,UniversityofToronto; TorontoWesternHospital;St.Michael’sHospital,Toronto,Canada; SpondylitisAssociationofAmerica,ShermanOaks,California,USA; RoyalNationalHospitalforRheumaticDiseases,BathInstitutefor RheumaticDiseases,UniversityofBath,Bath,UK;Departmentof Pediatrics,BaylorCollegeofMedicine;RheumatologyCenter,Texas Children’sHospital,Houston,Texas;andtheHospitalforSpecialSurgery, NewYork,NewYork,USA. SupportedbyajointawardfromtheSpondylitisAssociationofAmerica andtheNationalAnkylosingSpondylitisSocietyoftheUK;andbythe donatedfundsawardfromtheRoyalNationalHospitalforRheumatic Diseases,Bath.Dr.PodbielskiistherecipientofaCanadianArthritis NetworkSummerResearchProgramStudentship,theSpondylitis AssociationofAmerica(SAA)Studentship,andtheSt.Michael’sHospital SummerResearchStudentScholarship.Dr.Stoneistherecipientofthe CummingVisitingProfessorAwardandSAAaward. D.W.Podbielski,MD,OphthalmologyandVisionSciences,Universityof Toronto;J.Bruckel,BSN,RN;L.M.Savage,BA,SpondylitisAssociation ofAmerica;E.Pomeroy,MA;J.Richardson,MCSP;R.J.Mogg,BSc, RoyalNationalHospitalforRheumaticDiseases,BathInstitutefor RheumaticDiseases;R.D.Inman,MD,TorontoWesternHospital; R.W.Warren,MD,DepartmentofPediatrics,BaylorCollegeofMedicine, RheumatologyCenter,TexasChildren’sHospital;A.Papachristos,BSc, BScPT,MBA,St.Michael’sHospital;M.A.Stone,MB,MRCP,MSc,St. Michael’sHospital,HospitalforSpecialSurgery,UniversityofBath. AddresscorrespondencetoDr.M.A.Stone,St.Michael’sHospital, 30BondStreet,Toronto,OntarioM5B1W8,Canada. E-mail:stonem@smh.toronto.on.ca AcceptedforpublicationOctober9,2009. One of the earliest features of ankylosing spondylitis (AS) is loss of spinal mobility 1 . Evaluation of spinal mobility is an important part of patient subgroup stratification. Further, it provides a baseline at the commencement of appropriate therapy and determination of clinical out- comes 2,3 . To this end, the Assessment in AS (ASAS) Study Group has identified spinal mobility as one of the core domains for the evaluation of disease-controlling therapies and for clinical recordkeeping in AS 4 . Based on the ASAS Study Group recommendation, spinal assessment should be incorporated into routine clinical and research prac- tice 4,5 . Spinal deformity is also a common feature of AS, and at present, rheumatologists rely on clinical and radio- graphic examination to assess the degree of spinal defor- mity in patients with AS. Measurements of spinal involve- ment (mobility/deformity) in the clinical setting can be assessed using the Bath Ankylosing Spondylitis Metrology Index (BASMI) 6 , which consists of 5 clinical measures to assess axial spine status in patients with AS. Radiographic damage is measured using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), which is considered superior to the other radiographic scoring systems 7,8 . However, these measurements can be time-consuming, requiring a metrologist for accuracy and appropriate resources that are often lacking in physicians’ offices. Other spinal measurement tools have been developed 9,10 , but few have undergone validation according to the Outcome Measures in Rheumatoid Arthritis Clinical Trials www.jrheum.org Downloaded on October 14, 2022 from