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Musculoskeletal disorders in the community
  1. H A CAPELL,
  1. Centre for Rheumatic Diseases
  2. Royal Infirmary, 84 Castle Street
  3. Glasgow G4 0SF
  1. Dr McEntegart.

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We noted with interest the recent findings of Urwinet al.1 We have previously reported higher HAQ scores (poorer function) in rheumatoid arthritis (RA) patients from more deprived areas.2 We subsequently wished to determine whether this difference in functional ability was a true difference or one of patient perception. A cross sectional study of 37 female RA patients was conducted in an outpatient rheumatology clinic. Patients were asked to complete a HAQ (self reported HAQ) and thereafter observed performing the tasks delineated in the HAQ excluding bathing, toileting, and outdoor activities (observed HAQ). Observed HAQ scores were completed by the same observer in a room equipped for the assessment. The observer was blinded to the self reported HAQ and no discussion took place between observer and patient. Self reported and observed scores were calculated as described by Fries et al.3 Observed scores had maximum score of 21 (seven categories). Social deprivation was determined using the Carstairs Index, which is derived from the patients’ postcode and is based on overcrowding, social class, male unemployment, car ownership.4 Deprivation category 1—most affluent; deprivation category 7—most deprived. Discordance in HAQ was calculated by subtracting self reported HAQ from observed HAQ. Table 1lists the results. Because of the small sample size previous differences observed in HAQ between deprivation categories were not found.

Table 1

Observed and self reported HAQ scores in 37 RA patients

Thus self reported HAQ correlated well with observed HAQ in each group. Self reported HAQ was accurate and equally valid regardless of level of social deprivation. The important influence of social deprivation on functional ability is not one of patient perception and requires further investigation.