Multidimensional Health Assessment Questionnaire Research Articles

Validation of RAPID3 using a Japanese version of Multidimensional Health Assessment Questionnaire with Japanese rheumatoid arthritis patients: Characteristics of RAPID3 compared to DAS28 and CDAI

Objectives. To validate Routine Assessment of Patient Index Data 3 (RAPID3) using a Japanese version of Multidimensional Health Assessment Questionnaire (MDHAQ) with Japanese rheumatoid arthritis (RA) patients and to describe the characteristics of RAPID3 by comparison with Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI).Methods. The original MDHAQ was translated into Japanese with minor cultural modifications and was translated back in English. Test–retest reliability was evaluated in 50 Japanese RA patients and further validation was performed in 350 Japanese RA patients recruited by seven rheumatologists. RAPID3, CDAI, and DAS28 were assessed on two consecutive visits.Results. The test–retest reliability and the internal reliability of RAPID3 were excellent. Spearman's correlation coefficients between RAPID3 score versus CDAI score and DAS28 score were 0.761and 0.555. However, the agreement measured by kappa (weighted) for RAPID3 category versus CDAI category and for RAPID3 category versus DA28 category were 0.225 (0.382) and 0.187 (0.336). The sensitivity and specificity of “RAPID3 ≤ 3 and swollen joint ≤ 1” for predicting Boolean remission were 90.0% and 93.4%, respectively.Conclusions. RAPID3 obtained by Japanese MDHAQ was validated with Japanese RA patients and the remission criteria were found to have excellent clinical utility in usual care.

SAT0155 Scores on the MDHAQ for “Walk 2 Miles or 3 Kilometers,” “Poor Sleep” and “Participate in Recreation,” Which Are not on the Haq, Indicate Poorer Status than Scores from the Haq: Data from the United States and Australia

BackgroundPatients 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...

FRI0189 Assessment of Exercise Status in Routine Care Using Mdhaq: Evidence That Initiating Exercise is Associated with Substantially Better Outcomes than NO Exercise

BackgroundExtensive evidence indicates major benefits of exercise in rheumatoid arthritis1 and many rheumatic diseases,2 not only for cardiovascular and general fitness, but also for better rheumatologic clinical status. Most reported...

AB0863 A Proposed Simple 3-Variable Cumulative Score for Identification of Fibromyalgia, Analogous to Classification Criteria for RA and SLE

BackgroundA cumulative quantitative score is implemented for classification criteria in various rheumatic diseases, including rheumatoid arthritis (RA)1 and systemic lupus erythematosus (SLE).2 Previous reports indicate that self-report patient scores on...

FRI0218 Patient Self-Reported Fatigue as A Differentiator in SLE Flares

BackgroundPatient reported outcome (PRO) tools are uniquely informative for management of systemic lupus erythematosus (SLE) patients. Fatigue is an important component of PRO. Patients with SLE experience significant fatigue and...

AB1080 Comparison of Physical Function in SLE and RA Using Mdhaq

BackgroundThe rheumatic diseases have significant impact on patients' physical function. Patient reported outcome (PRO) tools provide insight into physical function, and are the most significant clinical predictor of work disability...

THU0089 A Patient Reported Outcome Measures-Based Composite Index (RAPID3) for the Assessment of Disease Activity in Ankylosing Spondylitis

BackgroundThere are disease-specific activity measures for almost each rheumatic disease. Disease-specific questionnaires may be optimal for clinical trials and other research studies, but it is not feasible to have patients...

FRI0204 Patient Global Estimates of Status Vary More than Physician Global Estimates, and Estimates Become Increasingly Discordant from ONE Another at Both High and Low Extremes of Disease Activity

BackgroundGlobal estimates by both patient (PATGL) and physician (DOCGL) are concordant within 2 units on a 0-10 visual analog scale (VAS) in about 40-65% of encounters, while discordance of PATGL>DOCGL...

AB0255 Delay in Diagnosis from Onset of Symptoms by More than One Year in 48% of 177 Patients with Rheumatic Diseases, Including 36% in Patients with Rheumatoid Arthritis in Australia

BackgroundDelayed diagnosis is recognized in many rheumatic diseases. Early treatment is regarded as critical for optimal clinical outcomes in patients with inflammatory rheumatic diseases. We studied possible delay in diagnosis...

FRI0176 Group Clinics for Rheumatoid Arthritis: A New Model of Care

BackgroundGroup clinics are an alternative model of care to 1:1 clinic appointments. They have been used extensively in the United States for diverse conditions, including diabetes & hypertension, but have...

Discordance of Global Estimates by Patients and Their Physicians in Usual Care of Many Rheumatic Diseases: Association With 5 Scores on a Multidimensional Health Assessment Questionnaire (MDHAQ) That Are Not Found on the Health Assessment Questionnaire (HAQ)

To analyze discordance between global estimates by patients (PATGL) and their physicians (DOCGL) according to demographic and self-report variables on a Multidimensional Health Assessment Questionnaire (MDHAQ) in patients with many rheumatic diseases seen in usual care. Each patient completed an MDHAQ at each visit, which includes scores for physical function, pain, and PATGL, each found on the traditional Health Assessment Questionnaire (HAQ), and scores for sleep quality, anxiety, depression, self-report joint count, and fatigue, which are not found on the HAQ. A random visit of 980 patients with any rheumatic diagnosis was analyzed in 3 categories: PATGL=DOCGL (within 2 of 10 units), PATGL>DOCGL (by ≥2 of 10 units), and DOCGL>PATGL (by ≥2 of 10 units), using descriptive statistics and multinomial logistic regression models. Patients included 145 with rheumatoid arthritis, 57 with systemic lupus erythematosus, 173 with osteoarthritis, 348 with other inflammatory diseases, and 257 with other noninflammatory diseases. Overall, PATGL=DOCGL in 509 (52%), PATGL>DOCGL in 371 (38%), and DOCGL>PATGL in 100 (10%). PATGL>DOCGL was associated significantly with older age, female sex, low formal education, Hispanic ethnicity, not working, high MDHAQ physical function and pain scores, and high scores for fatigue, poor sleep, anxiety, depression, and self-report joint count, which are not available on the HAQ. Pain and fatigue were significant in a final multinomial logistic regression; the other variables may raise awareness of discordance to clinicians. Global estimates of patients indicated significantly poorer status than estimates of their physicians in 38% of 980 patients with rheumatic conditions, and were associated with demographic and MDHAQ scores, 5 of which are not available on the HAQ.

Multi-dimensional health assessment questionnaire in China: reliability, validity and clinical value in patients with rheumatoid arthritis.

ObjectiveTo evaluate the psychometric properties and clinical utility of Chinese Multidimensional Health Assessment Questionnaire (MDHAQ-C) in patients with rheumatoid arthritis (RA) in China.Methods162 RA patients were recruited in the evaluation process. The reliability of the questionnaire was tested by internal consistency and item analysis. Convergent validity was assessed by correlations of MDHAQ-C with Health Assessment Questionnaire (HAQ), the 36-item Short-Form Health Survey (SF-36) and the Hospital anxiety and depression scales (HAD). Discriminant validity was tested in groups of patients with varied disease activities and functional classes. To evaluate the clinical values, correlations were calculated between MDHAQ-C and indices of clinical relevance and disease activity. Agreement with the Disease Activity Score (DAS28) and Clinical Disease Activity Index (CDAI) was estimated.ResultsThe Cronbach's alpha was 0.944 in the Function scale (FN) and 0.768 in the scale of psychological status (PS). The item analysis indicated all the items of FN and PS are correlated at an acceptable level. MDHAQ-C correlated with the questionnaires significantly in most scales and scores of scales differed significantly in groups of different disease activity and functional status. MDHAQ-C has moderate to high correlation with most clinical indices and high correlation with a spearman coefficient of 0.701 for DAS 28 and 0.843 for CDAI. The overall agreement of categories was satisfying.ConclusionMDHAQ-C is a reliable, valid instrument for functional measurement and a feasible, informative quantitative index for busy clinical settings in Chinese RA patients.

Do inpatient multidisciplinary rehabilitation programmes improve health status in people with long-term musculoskeletal conditions? A service evaluation.

Long-term musculoskeletal (MSK) conditions impair health and function. Guidelines recommend a multidisciplinary team (MDT) approach for the optimum management of people with long-term MSK conditions, but there is limited evidence for MDT care. This service evaluation investigates the short-term effectiveness of an inpatient MDT rehabilitation programme on self-reported function and disease status in people with long-term MSK conditions. A convenience sample of adults with rheumatoid arthritis (RA), osteoarthritis (OA), low back pain (LBP) and chronic widespread pain (CWP) participated in an inpatient MDT rehabilitation programme, consisting of needs assessment, collaborative goal setting and planning, exercise and self-management. The Routine Assessment of Patient Index Data (RAPID3) (primary outcome), the Multi-Dimensional Health Assessment Questionnaire (MDHAQ), Pain Visual Analogue Scale (VAS) and global well-being VAS were assessed at baseline and immediately following MDT rehabilitation. A total of 183 people [mean age 62 (standard deviation, 14.5) years, 145 females] with RA, OA, LBP or CWP were evaluated before and after inpatient MDT rehabilitation (median duration, ten days). Overall, there was a 28% improvement in RAPID3 (mean difference [95% confidence intervals] in effect size, 5.0 [4.3, 5.8], d=-0.98, p<0.05). Clinically relevant changes were found in people with RA (5.7 [4.4, 6.9], d=-1.08, p<0.05, 32%), OA 6.1 [3.4, 8.7], d=-1.07, p<0.05, 35%), LBP 4.0 [2.8, 5.2], d=-0.91, p<0.05, 22%), CWP 4.6 [2.7, 6.6], d=-0.84, p<0.05, 25%). These changes were reflected in all secondary outcomes. This inpatient MDT rehabilitation programme provides short-term evidence of improved function and disease status in people with long term MSK conditions.

The relationship between body composition, disease activity, and functional status in adults with rheumatoid arthritis (1031.15)

Rheumatoid arthritis (RA) is a chronic disease causing pain, stiffness, swelling, and disability. The purpose of this study was to examine the relationship between body composition, disease activity, and functional status in adults with RA (n=84; age 53 ± 14 y; BMI 29.3 ± 7.3 kg/m2; duration of disease 13.4 ± 9.3 y). Height, weight, waist circumference, grip strength, and body composition (bioelectrical impedance assessment) were measured. Waist‐to‐height ratio (WHtR), fat mass index (FMI; kg/m2), and fat‐free mass index (FFMI; kg/m2) were calculated for each participant. C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), duration of morning stiffness, and the Multidimensional Health Assessment Questionnaire (MDHAQ) determined disease activity and functional status. Partial correlations (controlling for age) examined relationships between variables. Body fat % and FMI were positively associated with CRP, ESR, physical function, pain score, and global status (p&lt;0.05). WHtR was positively associated with CRP, physical function, pain score, and global status (p&lt;0.05). Grip strength was positively correlated with FFMI (p&lt;0.01) and negatively correlated with body fat % (p&lt;0.05). In this study, higher body adiposity was associated with greater disease activity and poorer functional status. Interventions promoting a healthy body composition in individuals with RA may improve quality of life.Grant Funding Source: Supported by NYU Steinhardt Faculty Challenge Grant

Increased Prevalence of Metabolic Syndrome in Patients with Psoriatic Arthritis

The increased incidence of cardiovascular disease (CVD) in patients with psoriatic arthritis (PsA) has been reported previously. We aimed to evaluate the presence of metabolic syndrome and to assess the insulin resistance associated with chronic inflammation in patients with PsA. Fifty-nine (34 females, 25 males) consecutive PsA patients were enrolled in this study. The control group consisted of 82 (46 females, 36 males) healthy volunteers. All subjects were questioned about criteria of National Cholesterol Education Program Adult Panel III (NCEP ATP III) and also the modified World Health Organization (WHO) definition. Disease activity, damage, and functional activity were assessed by using functional indices [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index (PASI), Disease Activity Score in 28 joints (DAS28), The Multi-Dimensional Health Assessment Questionnaire-function (MDHAQ-function), The Multi-Dimensional Health Assessment Questionnaire-Routine Assessment of Patient Index Data scores (MDHAQ-RAPID-3)]. Fasting blood samples were collected for complete biochemical analysis. According to the NCEP criteria, 21 (35.5%) of PsA patients and 12 (14.6%) of healthy controls were classified as having metabolic syndrome (P=0.004). According to the NCEP criteria, hypertension and hyperglycemia were more common in the PsA group than the healthy controls (P=0.000 and P=0.043, respectively). According to the WHO criteria, 14 (23.7%) of the patients and 14 (17%) of the healthy controls had metabolic syndrome (P=0.328). No correlation was observed between functional indices and cardiovascular risks factors that were among the metabolic syndrome components. This study demonstrated an increase in the frequency of metabolic syndrome, which is a major risk factor for atherosclerosis in patients with PsA. Patients with PsA should be closely followed in terms of cardiovascular events, and aggressive treatment should be performed for both cardiovascular risk factors and the disease itself.

Swedish version of the multi dimensional health assessment questionnaire – translation and psychometric evaluation

BackgroundHealth assessment measurements for patients with Rheumatoid arthritis (RA) have to be meaningful, valid and relevant. A commonly used questionnaire for patients with RA is the Stanford Health Assessment Questionnaire Disability Index (HAQ), which has been available in Swedish since 1988. The HAQ has been revised and improved several times and the latest version is the Multi Dimensional Health Assessment Questionnaire (MDHAQ). The aim of this study was to translate the MDHAQ to Swedish conditions and to test the validity and reliability of this version for persons with RA.MethodsTranslation and adaption of the MDHAQ were performed according to guidelines by Guillemin et al. The translated version was tested for face validity and test-retest in a group of 30 patients with RA. Content validity, criterion validity and internal consistency were tested in a larger study group of 83 patients with RA. Reliability was tested with test-retest and Cronbach´s alpha for internal consistency. Two aspects of validity were explored: content and criterion validity. Content validity was tested with a content validity index.Criterion validity was tested with concurrent validity by exploring the correlation between the MDHAQ-S and the AIMS2-SF. Floor and ceiling effects were explored.ResultsTest-retest with intra-class correlation coefficient (ICC) gave a coefficient of 0.85 for physical function and 0.79 for psychological properties. Reliability test with Cronbach´s alpha gave an alpha of 0.65 for the psychological dimension and an alpha of 0.88 for the physical dimension of the MDHAQ-S.The average sum of the content validity index for each item was of the MDHAQ-S was 0.94. The MDHAQ-S had mainly a moderate correlation with the AIMS2-SF, except for the social dimension of the AIMS2-SF, which had a very low correlation with the MDHAQ-S.ConclusionsThe MDHAQ-S was considered to be reliable and valid, but further research is needed concerning sensitivity to change.

SAT0460 Patient self-report joint count, rheumatoid arthritis disease activity index (RADAI), on a multidimensional health assessment questionnaire (MDHAQ) is informative in patients with rheumatic diseases other than rheumatoid arthritis

BackgroundA patient self-report joint count, rheumatoid arthritis disease activity index (RADAI),1 is correlated significantly with tender and swollen joint counts performed by a health professional in rheumatoid arthritis (RA) patients2....

FRI0588-HPR Are multidisciplinary inpatient rehabilitation programmes effective for chronic musculoskeletal conditions?: a service evaluation

BackgroundChronic musculoskeletal (MSK) conditions impair health and function. Clinical guidelines recommend a Multidisciplinary Team (MDT) approach for the optimum management of chronic MSK conditions. The efficacy of inpatient MDT care...

SAT0094 Superior results in the guepard tight-control versus ESPOIR routine care cohorts are documented similarly according to disease activity score (DAS28), clinical disease activity index (CDAI), and routine assessment of patient index data (RAPID3)

BackgroundTreat-to-target with intensification of therapy according to DAS28 is documented to be an effective strategy to manage rheumatoid arthritis (RA)1. However, DAS28 and CDAI require formal joint counts, which are...

MDHAQ/RAPID3 to Recognize Improvement Over 2 Months in Usual Care of Patients With Osteoarthritis, Systemic Lupus Erythematosus, Spondyloarthropathy, and Gout, as Well as Rheumatoid Arthritis

To analyze whether MDHAQ (Multidimensional Health Assessment Questionnaire) scores for physical function (FN), pain, Patient Global Estimate (PATGL), and RAPID3 (Routine Assessment of Patient Index Data, a composite of these 3 measures) document improvement in patients with osteoarthritis, systemic lupus erythematosus, spondyloarthropathy, and gout, similarly to rheumatoid arthritis. In a solo rheumatology practice, every patient completes an MDHAQ/RAPID3 and is assigned a Physician Global Estimate (DOCGL) at every visit. Mean and median FN (0-10 scale), pain (0-10), PATGL (0-10), RAPID3 (0-30), and DOCGL (0-10) were computed at first visit and 2 months later in 141 new patients with 5 diagnoses. Proportions with RAPID3 high (>12), moderate (6.1-12), and low (3.1-6) severity and remission (≤3) were computed. Differences between baseline and 2-month follow-up for each diagnosis were analyzed using paired t tests. Mean changes over 2 months across 5 diagnoses were compared using analysis of variance. Mean baseline scores for all measures were in narrow ranges for all 5 diagnoses: FN 1.5 to 2.5, pain 4.2 to 5.9, PATGL 4.3 to 5.6, RAPID3 10.1 to 13.7, and DOCGL 2.4 to 4.0. Improvement for FN was 9.4% to 26.8% in all diagnoses but osteoarthritis, for pain 20.2% to 35.3% in all diagnoses, PATGL 11.3% to 30.4%, RAPID3 16.8% to 27.5%, and for DOCGL 23.8% to 36.4%, similar in 5 diagnostic groups. MDHAQ, RAPID3, and DOCGL document similar baseline and improvement scores in patients with 5 diagnoses. These quantitative data may supplement traditional narrative, "gestalt" descriptions in usual care of patients with any rheumatic disease.