Childhood Health Assessment Questionnaire Score Research Articles

Discordance between proxy-reported and observed assessment of functional ability of children with juvenile idiopathic arthritis.

To determine the level of agreement between parents and clinicians in rating dysfunction in children with juvenile idiopathic arthritis (JIA). A parent of each patient completed the Italian version of the Childhood Health Assessment Questionnaire (CHAQ). Subsequently, an examiner assessed, in a specially equipped room, the child's performance of tasks as described by the CHAQ. Demographic and clinical variables were recorded for all patients. Seventy consecutive JIA patients and their parents were included. The mean proxy-reported and observed CHAQ score was 0.64+/-0.53 and 0.47+/-0.62 respectively, the difference ranging from -1.75 to 1.5. There were 30 cases (43%) of agreement (difference < or =0.25 CHAQ units) between the parent's and clinician's ratings, whereas in 40 cases (57%) there was discordance (difference >0.25 CHAQ units). In 30 cases the parent rated the child's functional ability as worse than that observed by the clinician (i.e. the parent underestimated the child's function), whereas in 10 cases the parent rated the child's functional ability as better than that observed by the clinician (i.e. overestimated the child's function). Multivariate regression analysis showed that children's functional ability was overestimated by parents with increasing erythrocyte sedimentation rate and global articular severity score and underestimated with increasing level of pain. Among the functional areas of the CHAQ, the level of agreement was poorest in the areas of eating and hygiene and was best for activities. Discordance between proxy-reported and observed functional ability was frequent in our patients with JIA. The children's functional ability was overestimated by parents as the severity of arthritis increased and underestimated as the level of pain increased.

Medium- and long-term functional outcomes in a multicenter cohort of children with juvenile dermatomyositis.

To evaluate functional outcomes in a cohort of patients with juvenile dermatomyositis (DM). A retrospective inception cohort of patients diagnosed as having juvenile DM between January 1, 1984 and January 1, 1995 was established at 4 Canadian tertiary care pediatric centers. Informed consent was obtained. Each subject was interviewed by telephone or in person. The primary outcome was physical function, as measured by the Childhood Health Assessment Questionnaire (CHAQ). Additional outcomes were educational and vocational achievement, growth, development of calcinosis, patient satisfaction with outcome, and development of other illnesses. Data regarding illness presentation, treatment, and disease course were obtained through chart review. Sixty-five of 80 patients (81%; 46 females and 19 males) could be contacted. The median followup time was 7.2 years (range 3.2-13.9 years), with a median age at followup of 13 years (range 7-26 years). Twenty-four patients (37%) had a monocyclic course, while the remaining 41 (63%) had a chronic continuous or polycyclic course. Sixty-two patients (95%) were treated with corticosteroids, while 41 (63%) received a second-line agent. Physical function was excellent, with a median CHAQ score of 0 (range 0-2.50). Eighteen patients had scores >0, and only 5 had moderate-to-severe disability, as defined by a CHAQ score >1.0. Females had higher CHAQ scores, and all but 1 of the patients with scores >0 were female (range 0-2.50; P = 0.015). Patients with a chronic continuous course also had higher CHAQ scores. Sixteen patients in the chronic continuous group had CHAQ scores >0 (range 0-2.50; P = 0.0009). Calcinosis developed in 22 patients (34%) and persisted to followup in 14. Development of calcinosis was not related to initial therapy, sex, or disease course, but was significantly associated with higher CHAQ scores (range 0-1.0 versus 0-2.5; P = 0.01). At the time of followup, 26 patients (40%) still had rash, 15 (23%) still reported weakness, and 23 (35%) continued taking medications, despite the fact that all were at least 3 years postdiagnosis. There was 1 death. In general, patients in this cohort had favorable outcomes. Most had CHAQ scores of 0, and only 8% met our definition of moderate-to-severe disability. However, many patients continued to have chronic disease, persistent rash, and continued taking medications >3 years after diagnosis. Further research is needed to improve outcomes for patients with juvenile DM.

Measurement properties of the Activities Scale for Kids

The Activities Scale for Kids (ASK) is a self-report measure of childhood physical disability, that has excellent reliability (ICC=0.97). The purpose of this study was to assess further the ASK's measurement properties. ASK questionnaires were completed by 200 children with musculoskeletal limitations (mean age, 10.1 years). Rasch analyses confirmed that all items measured the same construct and supported aggregation of a summary score. Validity of the ASK was demonstrated by a correlation of 0.81 (P < 0.0001) with parent-reported Childhood Health Assessment Questionnaire scores; a significant difference in scores according to clinicians' global ratings of disability (P < 0.0001), and a correlation of 0.92 (P < 0.0001) with clinician-observation. The ASK showed minimal ceiling effects, no floor effects, and changed by 1.73 standard deviation units after clinically important change. The ASK is a valid and responsive outcome measure that permits 5- to 15-year-old childrens' physical functioning in the community to be assessed accurately by mail. The quality of this measure will enable clinical studies to measure outcome not only in a way that is relevant to patients, but also in a way that is sensitive to small amounts of change and is practical and inexpensive.

Assessing Functional Ability In Children With Juvenile Chronic Arthritis: An Arthritis-Specific Measure Versus A General Measure Of Children's Health Status 1981

Objective: In order to determine the utility of functional outcome measures in children with chronic arthritis, we compared the results of two well-validated measures, the Childhood Health Assessment Questionnaire(CHAQ) and the Functional Status II (FSII[R]). Methods: Sixty-eight mothers of children with chronic arthritis, ages 1 to 16 years, completed the CHAQ, an arthritis-specific measure that includes two visual analog scales to assess pain and global well-being and the FSII(R), a general instrument used in children with chronic physical conditions, that assesses general health, locomotion and interpersonal functioning. At the same visit, a pediatric rheumatologist examined each child for number of active joints and number of joints with limited range of motion, and completed a visual analog scale of global disease activity. Results: Both measures had significant associations with the physician's assessment (r=0.60 for the CHAQ and 0.50 for the FSII[R]), and with each other (r=0.67). CHAQ scores were most strongly associated with the number of limited joints (r=0.62), followed by the parent's assessment of global well-being (r=0.49), the number of active joints(r=0.48), and the parent's assessment of overall pain (r=0.48). In contrast, the FSII(R) scores were most strongly associated with the parent's assessment of pain (r=0.63), followed by the parents assessment of global well-being(r=0.59), and less strongly with the number of active and limited joints(r=0.42 for each). All had p<0.02. Conclusion: We conclude that both an arthritis-specific measure (CHAQ) and a general measure of functional status (FSII[R]) are good measures of function in children with chronic arthritis. The CHAQ is more strongly associated with physician's global assessment, and the number of active and limited joints, while the FSII(R) is most strongly associated with parent's assessment of pain and global well-being. Because these measures provide complementary information, they are both useful tools in assessing children's functioning.

Hermann von Helmholtz.

<h3>Objective.</h3> To describe a clinical practice with leflunomide (LEF) in juvenile idiopathic arthritis (JIA). <h3>Methods.</h3> Patients with JIA seen between May 2008 and May 2012 and considered nonresponsive to methotrexate (MTX) were given LEF and prospectively followed. Primary outcome was a 28-joint Disease Activity Score (DAS28) of low disease activity (&lt; 3.2) in less than 6 months. Childhood Health Assessment Questionnaire (CHAQ) scores and safety data were recorded. <h3>Results.</h3> Forty-three patients (33 female) were included with 25 (58.1%) polyarticular, 10 oligoarticular (7 extended; 3 persistent), 6 systemic, and 2 enthesitis-related. Ten (23.2%) were rheumatoid factor–positive and 7 (16.3%) had antinuclear antibodies. Prior drugs other than MTX: 11 (25.5%) chloroquine diphosphate + MTX and 2 (4.6%) sulfasalazine + MTX; mean prednisone dose was 6.4 ± 9.3 mg. The MTX dose prior to LEF was 14.5 ± 4.5 mg/m²/week. LEF dose and duration of therapy were 16.6 ± 5.2 mg/d and 3.6 ± 2.2 years, respectively. Nineteen patients (44.2%) interrupted LEF: 1 entered remission, 11 were nonresponsive, and 7 were intolerant (16.2%). Baseline DAS28 (5.57 ± 0.7) dropped to 3.7 ± 1.2 at final analysis (p &lt; 0.001) and 16 patients (37.2%) had a low DAS28 [&lt; 3.2; 12 (27.9%) while taking LEF + MTX and 4 (9.3%) while taking monotherapy]. At last followup, the number of patients with DAS28 &gt; 5.1 dropped from 34 (79%) to 9 (20.9%) and CHAQ scores from 0.86 ± 0.7 to 0.44 ± 0.5 (p &lt; 0.001). <h3>Conclusion.</h3> LEF isolated or combined with MTX is effective and safe to treat JIA in patients refractory to MTX.