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Does removal of aids/devices and help make a difference in the Childhood Health Assessment Questionnaire disability index?
  1. C Saad-Magalhães1,
  2. A Pistorio2,
  3. A Ravelli3,
  4. G Filocamo1,
  5. S Viola1,
  6. R Brik4,
  7. D Mihaylova5,
  8. R ten Cate6,
  9. B Andersson-Gare7,
  10. V Ferriani8,
  11. K Minden9,
  12. P Hashkes10,
  13. M Rygg11,
  14. M-J Sauvain12,
  15. H Venning13,
  16. A Martini3,
  17. N Ruperto1
  1. 1
    IRCCS G Gaslini, Pediatria II, Reumatologia, PRINTO, Genova, Italy
  2. 2
    IRCCS G Gaslini, Servizio di Epidemiologia e Biostatistica, Genova, Italy
  3. 3
    IRCCS G Gaslini, Pediatria II, Reumatologia and Dipartimento di Pediatria, Università degli Studi di Genova, Genova, Italy
  4. 4
    Rambam Medical Center, Haifa, Israel
  5. 5
    University Children Hospital, Sofia, Bulgaria
  6. 6
    Academisch Ziekenhuis Leiden, Leiden, The Netherlands
  7. 7
    Ryhov’s County Hospital, Jonkoping, Sweden
  8. 8
    Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto, Brazil
  9. 9
    Charite University Hospital Berlin, Berlin, Germany
  10. 10
    Cleveland Clinic Foundation, Cleveland, Ohio, USA
  11. 11
    Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, and Department of Pediatrics, St Olavs Hospital, Trondheim, Norway
  12. 12
    Policlinique de Pediatrie Hopital Universitaire, Bern, Switzerland
  13. 13
    Paediatric and Adolescent Rheumatology, Nottingham University Hospital, Nottingham, UK
  1. 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}


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.

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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).

  • Competing interests None.

  • 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.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

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