Extended report
Does the Stanford Health Assessment Questionnaire have potential
as a monitoring tool for subjects with rheumatoid arthritis?
M C Greenwood, D V Doyle, M Ensor
Rheumatology
Department, Whipps Cross Hospital, Leytonstone, London E11 1NR, UK
Correspondence to: Dr Doyle Mandy.Greenwood{at}Forhc-tr.nthames.nhs.uk
Accepted for publication 29 August
2000
OBJECTIVE
To assist in
the interpretation of the Stanford Health Assessment Questionnaire
(HAQ) score changes for individual patients with rheumatoid arthritis
(RA), by determining the minimum size of score change that can
confidently be considered to reflect a significant change in disability
from the patient's perspective.
METHODHAQ score
changes were calculated for 40 clinic patients with RA who had reported
no change to health in general over two months. These were considered
to reflect both inconsistencies in questionnaire completion and any
true but minor changes not considered significant enough by the
patients to represent a change to their health in general. HAQ score
changes over one year were also calculated for 207 clinic patients with RA.
RESULTSThe range
within which 95% of score changes would be expected to lie in the
absence of significant change was estimated as ±0.48 points (±2SD
of the score changes) and 80% within ±0.31 points (±1.29SD). A
2 test showed no significant association between an HAQ
score increase of >0.31 over one year and decline in health related to
arthritis reported by the patient over the same period.
CONCLUSIONAs a
general guideline, an HAQ score needs to change by 0.48 points or more
for 95% confidence that it reflects significant change (0.31 for 80%
confidence). Although the value of HAQ as a group outcome measure is
well established, this study questions the usefulness of monitoring
individual HAQ scores in a clinical setting.
© 2001 by Annals of the Rheumatic Diseases
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