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Greenwood et al have questioned the usefulness of the Stanford Health Assessment Questionnaire (HAQ) in the clinic.1 Using Bland and Altman's limits of agreement procedure,2 they report that an HAQ score change of at least 0.48 units is required to confidently reflect significant change. We have used the HAQ in the care of our patients for many years and think that their conclusions about the extent of change required and the non-usefulness of the HAQ in clinical care is not correct.
We have replicated the authors' study in paired visits of 443 patients with rheumatoid arthritis (RA) followed up in the clinic by of one of us (FW), and in a survey databank of 2720 patients. Our data are in general agreement with the authors' data.
Using the limits of agreement procedure, we found that the 95% confidence intervals (CI) for the HAQ were approximately 0.9 for clinic data and 0.6 for survey data. But we also found the following. To exceed 95% CI, changes in excess of 40 mm/1st h for the erythrocyte sedimentation rate (ESR), 70 mm Hg for grip strength, 10 joints for a joint count, and four units on 0–10 VAS scales …
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