Extended report
Values for function in rheumatoid arthritis: patients,
professionals, and public
S Hewletta, A P Smithb, J R Kirwana
a University of
Bristol Rheumatology Academic, Division of Medicine, Bristol Royal
Infirmary, UK, b School of Psychology, Cardiff University, UK
Correspondence to: Dr S Hewlett, University of Bristol Rheumatology Academic, Bristol Royal Infirmary, Bristol BS2 8HW, UK Sarah.Hewlett{at}bristol.ac.uk
Accepted for publication 4 April 2001
BACKGROUND
Although
many disability questionnaires measure fact very efficiently, they do
not allow for consideration of the relevance of that disability to the
patient. Data suggest that professionals misinterpret the relevance of
disability for the patient and thus, also, the outcome of treatment.
OBJECTIVESFirstly, to
examine agreement on levels of importance for the items on a validated
disability scale (Health Assessment Questionnaire (HAQ) and Modified
HAQ (MHAQ)), within groups of patients with rheumatoid arthritis,
health professionals, and controls. Secondly, to see if functional
items important to patients are included in the HAQ, and whether the
HAQ items are important to patients.
METHODS25 patients
with RA, 25 rheumatology health professionals, and 25 healthy controls
were asked to rate the importance of the HAQ (20 items) and MHAQ (eight
domains). Before seeing the HAQ, patients were asked to generate items
of function important to them.
RESULTSOnly a
slight-fair agreement within each group was found for the level of
importance of the HAQ and MHAQ, and also within any combination of the
groups (
values <0.38). Most of the functional items valued by
patients were contained on the HAQ (70%), and no HAQ items were
consistently rated as unimportant.
CONCLUSIONPatients,
professionals, and healthy controls do not agree on the importance of
disabilities. These data support the need to assess the personal impact
of disability, as well as disability itself. Individual importance of
disability weighted by level of disability is proposed as a model for
calculating the personal impact of disability. A new tool to assess the
personal impact of disability is being developed.
© 2001 by Annals of the Rheumatic Diseases
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