Background Patients with rheumatoid arthritis (RA) are significantly better in recent years than in previous decades.1 Health assessment questionnaire (HAQ) scores were almost always elevated in 1980 when the HAQ2 was reported; in 1999, 16% of patients had HAQ scores of zero, suggesting “no difficulty” in function, but most nonetheless reported problems with function as well as psychosocial issues, reflecting “floor effects.”3 Therefore, a multidimensional HAQ (MDHAQ) was developed to include 13 queries in the user-friendly HAQ format, 8 simple activities of daily living (ADL) from (and identical to) the HAQ, and 5 not on the HAQ: 2 complex activities – “walk 2 miles or 3 kilometers” and “participate in recreation and sports as you would like”; and 3 “psychological” queries – sleep quality, anxiety and depression.
Objectives To analyze mean scores for each of 13 MDHAQ items in 3 rheumatology settings, 2 in the USA and one in Australia, to recognize their capacity to document improved clinical status.
Methods All patients at 3 settings in Ridley Park, PA USA, Baltimore, MD USA and Liverpool, NSW, Australia complete an MDHAQ at each visit in the reception area before seeing the physician. The MDHAQ queries 13 items (Table) in the patient-friendly HAQ format, all scored 0-3, with 4 response options: without any difficulty=0, with some difficulty=1, with much difficulty=2 and unable to do=3. Mean scores were analyzed in 224 RA patients in PA USA, 432 visits of 72 RA patients in MD USA, and 228 patients with all rheumatic diseases (RD) in Australia. Statistical significance was evaluated using Wilcoxon signed rank tests.
Results Mean scores >0.88 (0-3 scale) were seen at all 3 sites for 3 of the 13 items in all patient groups, “walk 2 miles/3 kilometers,” “participate in recreation/sports as you would like” and “poor sleep”, 3 of the 5 MDHAQ items not found on the HAQ. Scores varied at the 3 sites, but patterns were similar.
Conclusions The MDHAQ identifies patient problems that are not captured by the HAQ, similarly in USA and Australia, which may be valuable in clinical management and documentation of improvement over time, not possible when baseline scores are zero. The MDHAQ might be included in usual clinical care and in clinical trials.
Arthritis Rheum 2005;52:1009.
Arthritis Rheum 1980;23:137.
Arthritis Rheum 1999;42:2220.
Disclosure of Interest None declared