A practical guide to scoring a Multi-Dimensional Health Assessment Questionnaire (MDHAQ) and Routine Assessment of Patient Index Data (RAPID) scores in 10–20seconds for use in standard clinical care, without rulers, calculators, websites or computers

2007 ◽  
Vol 21 (4) ◽  
pp. 755-787 ◽  
Author(s):  
Theodore Pincus ◽  
Yusuf Yazici ◽  
Martin Bergman
Keyword(s):  
Health Assessment Questionnaire ◽  
Clinical Care ◽  
Health Assessment ◽  
Index Data ◽  
Practical Guide ◽  
Routine Assessment ◽  
Assessment Questionnaire

The Minimally Important Difference for the Health Assessment Questionnaire in Rheumatoid Arthritis Clinical Practice Is Smaller Than in Randomized Controlled Trials

2009 ◽  
Vol 36 (2) ◽  
pp. 254-259 ◽  
Author(s):  
JANET E. POPE ◽  
DINESH KHANNA ◽  
DEBORAH NORRIE ◽  
JANINE M. OUIMET
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Practice ◽  
Health Assessment Questionnaire ◽  
Clinical Care ◽  
Damage Index ◽  
Health Assessment ◽  
Change Score ◽  
Minimally Important Difference ◽  
Patient Reported ◽  
Assessment Questionnaire

Objective.Patient-reported outcomes are used in clinical practice and trials. We studied a large clinical practice to determine the minimally important difference (MID) estimates for (1) the Health Assessment Questionnaire–Damage Index (HAQ-DI): improvement and worsening using patient global assessment anchor; and (2) pain using a patient-reported pain anchor.Methods.Patients with rheumatoid arthritis (RA; N = 225) had clinic visits at 2 timepoints within 1 year, completed the HAQ-DI and pain visual analog scale (VAS; 0–100 mm), and answered the question, “How would you describe your overall status/overall pain since the last visit?”, as much worsened, somewhat worsened, the same, somewhat improved, or much improved. If rated as somewhat improved or worsened, they were defined as the minimally changed subgroups.Results.Eighty-three percent were women, mean age 60 years, with disease duration 11.7 ± 10.7 years. The baseline HAQ-DI was 0.97 ± SD 0.76, and at followup 1.0 ± 0.77 (mean change +0.03 ± 0.40). The baseline pain VAS was 42.3 ± 28.8, and at followup 38.5 ± 27.9 (mean change −2.8 ± 25.9). The mean (SD) HAQ-DI change score was −0.09 (0.42) for somewhat improved and 0.15 (0.33) for somewhat worsened. The HAQ-DI change for somewhat/much better was −0.20 ± 0.52, and for somewhat/much worse +0.21 ± 0.33. For pain, somewhat improved changed by −11.9 mm on the VAS, and somewhat worsened by 6.8 mm. Estimates for HAQ-DI and pain were larger than the for no-change group, 0.03 (0.32) and −3.2 (20.9).Conclusion.The MID for HAQ-DI in clinical practice is smaller than it is in trials. This may have implications for observational studies and clinical care.

scholarly journals Use of a “critical difference” statistical criterion improves the predictive utility of the Health Assessment Questionnaire-Disability Index score in patients with rheumatoid arthritis

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Frank Behrens ◽  
Michaela Koehm ◽  
Eva C. Schwaneck ◽  
Marc Schmalzing ◽  
Holger Gnann ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Health Assessment Questionnaire ◽  
Clinical Care ◽  
Health Assessment ◽  
Critical Difference ◽  
Routine Clinical Care ◽  
Therapeutic Outcomes ◽  
Assessment Questionnaire ◽  
Questionnaire Disability

Abstract Background The Health Assessment Questionnaire-Disability Index (HAQ-DI) is used to assess functional status in rheumatoid arthritis (RA), but the change required for meaningful improvements remains unclear. A minimum clinically important difference (MCID) of 0.22 is frequently used in RA trials. The aim of this study was to determine a statistically defined critical difference for HAQ-DI (HAQ-DI-dcrit) and evaluate its association with therapeutic outcomes. Methods We retrospectively analyzed data from adult German patients with RA enrolled in a multicenter observational trial in which they received adalimumab therapy at the decision of the treating clinician during routine clinical care. The HAQ-DI-dcrit, defined as the minimum change that can be reliably discriminated from random long-term variations in patients on stable therapy, was determined by evaluating intra-individual variation in patient scores. Other outcomes of interest included Disease Activity Score-28 joints and patient-reported pain and fatigue. Results The HAQ-DI-dcrit was calculated as an improvement (decrease) from baseline of 0.68 in a discovery cohort (N = 1645) of RA patients on stable therapy and with moderate disease activity (mean DAS28 [standard deviation] of 4.4 [1.6]). In the full patient cohort (N = 2740), 22.1% of patients achieved a HAQ-DI-dcrit improvement at month 6. Compared with patients with a small improvement in HAQ-DI (decrease of ≥0.22 to < 0.68) or no improvement (< 0.22), patients achieving a HAQ-DI-dcrit at month 6 had better therapeutic outcomes at months 12 and 24, including stable functional improvements. Change in pain was the most important predictor of HAQ-DI improvement during the first 6 months of therapy. Conclusions A HAQ-DI-dcrit of 0.68 is a reliable measure of functional improvement. This measure may be useful in routine clinical care and clinical trials. Trial registration ClinicalTrials.gov NCT01076205. Registered on February 26, 2010 (retrospectively registered).

scholarly journals Reliability, Feasibility, and Patient Acceptance of an Electronic Version of a Multidimensional Health Assessment Questionnaire for Routine Rheumatology Care: Validation and Patient Preference Study (Preprint)

2019 ◽  
Author(s):  
Theodore Pincus ◽  
Isabel Castrejon ◽  
Mariam Riad ◽  
Elena Obreja ◽  
Candice Lewis ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Patient Preference ◽  
Health Assessment Questionnaire ◽  
Clinical Care ◽  
Intraclass Correlation ◽  
Health Assessment ◽  
The United States ◽  
Patient Acceptance ◽  
Multidimensional Health ◽  
Assessment Questionnaire

BACKGROUND A multidimensional health assessment questionnaire (MDHAQ) that was developed primarily for routine rheumatology care has advanced clinical research concerning disease burden, disability, and mortality in rheumatic diseases. Routine Assessment of Patient Index Data 3 (RAPID3), an index within the MDHAQ, is the most widely used index to assess rheumatoid arthritis (RA) in clinical care in the United States, and it recognizes clinical status changes in all studied rheumatic diseases. MDHAQ physical function scores are far more significant in the prognosis of premature RA mortality than laboratory or imaging data. However, electronic medical records (EMRs) generally do not include patient questionnaires. An electronic MDHAQ (eMDHAQ), linked by fast healthcare interoperability resources (FIHR) to an EMR, can facilitate clinical and research advances. OBJECTIVE This study analyzed the reliability, feasibility, and patient acceptance of an eMDHAQ. METHODS Since 2006, all Rush University Medical Center rheumatology patients with all diagnoses have been asked to complete a paper MDHAQ at each routine care encounter. In April 2019, patients were invited to complete an eMDHAQ at the conclusion of the encounter. Analyses were conducted to determine the reliability of eMDHAQ versus paper MDHAQ scores, arithmetically and by intraclass correlation coefficient (ICC). The feasibility of the eMDHAQ was analyzed based on the time for patient completion. The patient preference for the electronic or paper version was analyzed through a patient paper questionnaire. RESULTS The 98 study patients were a typical routine rheumatology patient group. Seven paper versus eMDHAQ scores were within 2%, differences neither clinically nor statistically significant. ICCs of 0.86-0.98 also indicated good to excellent reliability. Mean eMDHAQ completion time was a feasible 8.2 minutes. The eMDHAQ was preferred by 72% of patients; preferences were similar according to age and educational level. CONCLUSIONS The results on a paper MDHAQ versus eMDHAQ were similar. Most patients preferred an eMDHAQ.

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