Does removal of aids/devices and help make a difference in the Childhood Health Assessment Questionnaire disability index?
- C Saad-Magalhães1,
- A Pistorio2,
- A Ravelli3,
- G Filocamo1,
- S Viola1,
- R Brik4,
- D Mihaylova5,
- R ten Cate6,
- B Andersson-Gare7,
- V Ferriani8,
- K Minden9,
- P Hashkes10,
- M Rygg11,
- M-J Sauvain12,
- H Venning13,
- A Martini3,
- N Ruperto1
- 1IRCCS G Gaslini, Pediatria II, Reumatologia, PRINTO, Genova, Italy
- 2IRCCS G Gaslini, Servizio di Epidemiologia e Biostatistica, Genova, Italy
- 3IRCCS G Gaslini, Pediatria II, Reumatologia and Dipartimento di Pediatria, Università degli Studi di Genova, Genova, Italy
- 4Rambam Medical Center, Haifa, Israel
- 5University Children Hospital, Sofia, Bulgaria
- 6Academisch Ziekenhuis Leiden, Leiden, The Netherlands
- 7Ryhov’s County Hospital, Jonkoping, Sweden
- 8Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto, Brazil
- 9Charite University Hospital Berlin, Berlin, Germany
- 10Cleveland Clinic Foundation, Cleveland, Ohio, USA
- 11Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, and Department of Pediatrics, St Olavs Hospital, Trondheim, Norway
- 12Policlinique de Pediatrie Hopital Universitaire, Bern, Switzerland
- 13Paediatric and Adolescent Rheumatology, Nottingham University Hospital, Nottingham, UK
- Correspondence to Dr N Ruperto, Pædiatric Rheumatology International Trials Organisation (PRINTO), IRCCS G Gaslini, Università di Genova, Pediatria II – Reumatologia, Largo Gaslini, 5, 16147 Genova Italy; nicolaruperto{at}ospedale-gaslini.ge.it
- Accepted 23 January 2009
- Published Online First 16 February 2009
Abstract
Objective: To assess whether the removal of aids/devices and/or help from another person in the Childhood Health Assessment Questionnaire (C-HAQ) leads to a significant change in the disability index (DI) score and responsiveness in juvenile idiopathic arthritis (JIA).
Methods: Changes in the C-HAQ DI score in a cross-sectional sample of 2663 children with JIA and in 530 active patients with JIA in a trial of methotrexate (MTX) were compared.
Results: Patients in the MTX trial had higher disease activity and disability than the cross-sectional sample. The frequency of aids/devices (range 1.2–10.2%) was similar between the two samples, while help (range 5.3–38.1%) was more frequently used in the MTX group. Correlation between disease severity variables and the two different C-HAQ DI scoring methods did not change substantially. There was a decrease in the C-HAQ DI score for both the cross-sectional (mean score from 0.64 with the original method to 0.54 without aids/devices and help, p<0.0001) and the MTX sample (mean score from 1.23 to 1.07, p<0.0001). A linear regression analysis of the original C-HAQ DI score versus the score without aids/devices and help demonstrated the substantial overlap of the different scoring methods. Responsiveness in the responders to MTX treatment did not change with the different C-HAQ DI scoring methods (range 0.86–0.82).
Conclusion: The removal of aids/devices and help from the C-HAQ does not alter the interpretation of disability at a group level. The simplified C-HAQ is a more feasible and valid alternative for the evaluation of disability in patients with JIA.
Footnotes
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Funding The project was supported by the European Union (Contract No. BMH4-983531 CA) and the IRCCS Istituto G Gaslini. CS-M was the recipient of a post-doctoral scholarship from The São Paulo State University (UNESP) for this project. CS-M and VF were recipients of a scholarship from the European Union ALFA program (Contract AML/B7-311/97/0666/II-0246-FI).
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Competing interests None.
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Ethics approval In each of the centres, written or verbal informed consent was obtained from a parent or legal guardian and the patient assent, if age-appropriate, according to the requirements of each local ethics committee.
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Provenance and Peer review Not commissioned; externally peer reviewed.
