Extended report
Health Assessment Questionnaire modifications: is standardisation
needed?
M M Zandbelt, P M J Welsing, A M van Gestel, P L C M van Riel
Department of
Rheumatology, University Medical Centre St Radboud, Nijmegen, The
Netherlands
Correspondence to: Dr M M Zandbelt, Department of Rheumatology, UMC St Radboud Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands M.Zandbelt{at}reuma.azn.nl
Accepted for publication 9 February
2000
BACKGROUND
Physical
disability is part of the end point measures in rheumatoid arthritis
clinical trials. The Stanford Health Assessment Questionnaire
Disability Index (HAQ DI) is often used for this purpose but lacks
international uniformity owing to variations in the translated and
adapted questionnaires and variations in its calculation. To study the
consequences of these variations the previous Dutch HAQ (HAQ90) was
revised, resulting in a new Dutch HAQ (HAQ99).
OBJECTIVETo compare
DI scores from the two versions, and to study the consequences of
applying different calculation methods for the DI score.
METHODS78 patients
completed both the HAQ99 and the HAQ90. To compare the use of different
category score calculation methods a post hoc analysis on prospectively
collected data obtained in clinical trials was performed.
RESULTSNo
statistically significant differences were observed between the DI
scores of the HAQ90 and the HAQ99 using the alternative method (that
is, without correcting for aid and devices). However, correcting for
the use of aid or devices or not did result in statistically
significant different DI scores. The systematic shift when using the
maximum or mean item score for calculation of the category score
resulted in non-comparable absolute DI scores.
CONCLUSIONThe use of
HAQ DI questionnaires with different numbers of items and/or categories
does not hinder international comparability, except when these
variations interfere with the calculation method of the DI (as in the
case of questionnaires without a section correcting for devices). For
the sake of international uniformity the HAQ or any validated
translation should be used and calculated in a standard way, including
correcting for the use of aid and devices, and taking the maximum
within each category as the category score.
© 2001 by Annals of the Rheumatic Diseases
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