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Normative Values for the Health Assessment Questionnaire Disability Index
... The HAQ-DI score is the mean of the eight domains. In line with the literature [31], disability was defined as HAQ-DI .0. The HAQ had shown high validity, a good test-retest reliability, and internal consistency, and can be applied very well to elderly people [31]. ...
... In line with the literature [31], disability was defined as HAQ-DI .0. The HAQ had shown high validity, a good test-retest reliability, and internal consistency, and can be applied very well to elderly people [31]. For more detailed information regarding disability within the KORA-Age framework see Strobl et al. [32]. ...
Introduction
Accelerometry is an important method for extending our knowledge about intensity, duration, frequency and patterns of physical activity needed to promote health. This study has used accelerometry to detect associations between intensity levels and related activity patterns with multimorbidity and disability. Moreover, the proportion of people meeting the physical activity recommendations for older people was assessed.
Methods
Physical activity was measured in 168 subjects (78 males; 65–89 years of age), using triaxial GT3X accelerometers for ten consecutive days. The associations between physical activity parameters and multimorbidity or disability was examined using multiple logistic regression models, which were adjusted for gender, age, education, smoking, alcohol consumption, lung function, nutrition and multimorbidity or disability.
Results
35.7% of the participants met the physical activity recommendations of at least 150 minutes of moderate to vigorous activity per week. Only 11.9% reached these 150 minutes, when only bouts of at least 10 minutes were counted. Differences in moderate to vigorous activity between people with and without multimorbidity or disability were more obvious when shorter bouts instead of only longer bouts were included. Univariate analyses showed an inverse relationship between physical activity and multimorbidity or disability for light and moderate to vigorous physical activity. A higher proportion of long activity bouts spent sedentarily was associated with higher risk for multimorbidity, whereas a high proportion of long bouts in light activity seemed to prevent disability. After adjustment for covariates, there were no significant associations, anymore.
Conclusions
The accumulated time in moderate to vigorous physical activity seems to have a stronger relationship with health and functioning when shorter activity bouts and not only longer bouts were counted. We could not detect an association of the intensity levels or activity patterns with multimorbidity or disability in elderly people after adjustment for covariates.
... One could also potentially calculate and compare the costs and could cost utility measures such as disability-adjusted life years (DALYs) across populations. Benchmarks for the HAQ-DI in a general population are also available for such computations [19]. ...
... Furthermore, none of our patients had been exposed to biologics, a class of medications whose effect on long-term functional disability can be expected to be substantial. In the future our benchmark curves may be replaced by population benchmarks of functional disability [19]; until such a time, our benchmarks will prove useful. ...
Physicians are in need of a simple objective, standardized tool to compare their patients with rheumatoid arthritis, as a group and individually, with national standards. The Disability Index of the Health Assessment Questionnaire (HAQ-DI) is a simple, robust tool that can fulfill these needs. However, use of this tool as a quality indicator (QI) is hampered by the unavailability of national reference values or benchmarks based on large, multicentric, heterogenous longitudinal patient cohorts. We utilized the 20-year longitudinal prospective data from 11 data banks of Arthritis Rheumatism and Aging Medical Information to calculate reference values for HAQ-DI. Overall, 6436 patients with rheumatoid arthritis were longitudinally followed for 32,324 person-years over the 20 years from 1981 to 2000. There were 64,647 HAQ-DI measurements, with an average of 19 measurements per person. Overall, 75% of patients were women and 89% were Caucasian; the median baseline age was 58.4 years and the median baseline HAQ-DI was 1.13. Few patients were treated with biologics. The HAQ-DI values had a Gaussian distribution except for the approximately 10% of observations showing no disability. Percentile benchmarks allow disability outcomes to be compared and contrasted between different patient populations. Reference values for the HAQ-DI, presented here numerically and graphically, can be used in clinical practice as a QI measure to track functional disability outcomes and to measure response to therapy, and by arthritis patients in self-management programs.
... Second, our results suggest that patients with both spinal and joint pain had a more important impairment on HAQ scale. Their functional disability is probably more important to those of the young general population (38). Some investigators have suggested that the Minimal Clinical Important Difference is 0.1 (39). ...
Background
With the improvement of cystic fibrosis (CF) patient survival, the prevalence of long-term complications increased, among them rheumatologic disorders.
Methods
The aim of this prospective study was to evaluate the prevalence of spinal and joint pain, and their impact on disability, anxiety, depression, and quality of life in CF adult patients.
Results
Forty-seven patients were analyzed, 72% of men, mean aged 28 years, with a mean body mass index of 22 kg/m ² and a mean FEV 1 % of 63%. Twenty-two patients (47%) described rheumatologic pain either spinal ( n = 15, 32%) and/or joint pain ( n = 14, 30%). Patients with spinal and/or joint pain were shorter ( p = 0.023), more frequently colonized with Staphylococcus aureus ( p < 0.008), had more frequent ΔF508 homozygous mutations ( p = 0.014), and a trend for more impairment of the 6-min walking distance ( p = 0.050). The presence of rheumatologic pain tended to be associated with disability according to the Health Assessment Questionnaire (HAQ) and anxiety. Compared with patients with no pain patients with both spinal and joint pain exhibited a more pronounced impact on the St George's Respiratory Questionnaire (SGRQ).
Conclusion
Rheumatologic pain is frequent in CF adult patients, and may affect daily living, anxiety and quality of life. Systematic assessment of rheumatologic pain should be included in the management of CF patients.
... A previous report 8 suggested that the majority of individuals above 50 years of age did not meet the previous version of ACR remission criteria 9 . The patients' age was shown to be an important factor affecting the health assessment questionnaire-disability index (HAQ-DI) and patient VAS scores 10,11 . Therefore, we conducted a cross-sectional study comparing 301 patients without defined rheumatic disease with RA patients with negative joint counts and normal serum CRP levels experiencing "objective" clinical remission to further delineate the relevance of age on PRO measures such as patient VAS and HAQ-DI scores. ...
Patient-reported outcome (PRO) is included in the remission criteria of rheumatoid arthritis (RA). We aimed to determine the effect of age on PRO and the subsequent achievement of clinical and functional RA remission criteria. Three hundred and one patients with non-rheumatic diseases were evaluated using the 0-10 cm visual analog scale (VAS) assessment for musculoskeletal symptoms and a functional health assessment questionnaire-disability index (HAQ-DI). These assessments were compared with those obtained from 149 patients with RA with negative tender/swollen joint counts and normal serum C-reactive levels (objective clinical remission). Of the 301 patients, 32.2%, 26.6%, and 41.2% were classified as non-elderly (< 65 years), early elderly (65-74 years), and late-elderly (≥ 75 years) patients, respectively. VAS > 1 cm and HAQ-DI ≥ 0.5 were observed in 7.3% and 14.5%, respectively, in late-elderly patients, whereas ≤ 1.0% of non-elderly and early elderly patients for the both. Among 149 RA patients in objective remission, however, > 20% and > 10% of early elderly patients (and even non-elderly patients) had VAS > 1 cm and HAQ-DI ≥ 0.5, respectively, and 34.0% and 35.8% of late-elderly patients with RA had VAS > 1 cm and HAQ-DI ≥ 0.5, respectively. Multivariate logistic analysis revealed that age and RA were associated with the non-achievement of VAS ≤ 1 cm and HAQ-DI < 0.5. Therefore, the effect of age, which was independent of the presence of RA even without any objective disease activity, on PRO and the non-achievement of clinical and functional remission criteria was demonstrated.
... Er wurde ursprünglich bei Patienten mit rheumatoider Arthritis eingesetzt, ist aber eher ein generischer als krankheitsspezifischer, vom Patienten auszufüllender Fragebogen, der ausschließ-lich Aktivitäten -das ist die neue Kategorienbezeichnung in der ICF (International Classification of Functioning, Disability and Health), die der Kategorie Behinderung (Disability) in der ICIDH entspricht -erfasst. Normwerte für die finnische Bevölkerung [12] und für Patienten mit rheumatischen Erkrankungen (rheumatoider Arthrits, Gonarthrose, Fingerpolyarthrose, chronische Kreuz-und Nackenschmerzen, Fibromyalgie) [13] wurden publiziert. In der letztgenannten Arbeit wird auch darauf hingewiesen, dass das Ausmaß der Einschränkung der Aktivität keine Folge einer spezifischen Erkrankung darstellt; Patienten mir rheumatoider Arthritis und Patienten mit Fibromyalgie boten beide einen gleich hohen Grad von Behinderung. ...
... 12 PROs were assessed at OLE baseline and OLE week 24; PtGA and pain VAS were also assessed at week 48. Patients reporting scores ≥normative values for the US general population in HAQ-DI (≤0.25), 15 FACIT-F (≥40.1), 16 SF-36 PCS and MCS (≥50) and for each of the SF-36 domains were also assessed. ...
Objective
Evaluate open-label sarilumab monotherapy in patients with rheumatoid arthritis switching from adalimumab monotherapy in MONARCH ( NCT02332590 ); assess long-term safety and efficacy in patients continuing sarilumab during open-label extension (OLE).
Methods
During the 48-week OLE, patients received sarilumab 200 mg subcutaneously once every 2 weeks. Safety (March 2017 cut-off) and efficacy, including patient-reported outcomes, were evaluated.
Results
In the double-blind phase, patients receiving sarilumab or adalimumab monotherapy showed meaningful improvements in disease activity; sarilumab was superior to adalimumab for improving signs, symptoms and physical function. Overall, 320/369 patients completing the 24-week double-blind phase entered OLE (155 switched from adalimumab; 165 continued sarilumab). Sarilumab safety profile was consistent with previous reports. Treatment-emergent adverse events were similar between groups; no unexpected safety signals emerged in the first 10 weeks postswitch. Among switch patients, improvement in disease activity was evident at OLE week 12: 47.1%/34.8% had changes ≥1.2 in Disease Activity Score (28 joints) (DAS28)-erythrocyte sedimentation rate/DAS28-C-reactive protein. In switch patients achieving low disease activity (LDA: Clinical Disease Activity Index (CDAI) ≤10; Simplified Disease Activity Index (SDAI) ≤11) by OLE week 24, 70.7%/69.5% sustained CDAI/SDAI LDA at both OLE weeks 36 and 48. Proportions of switch patients achieving CDAI ≤2.8 and SDAI ≤3.3 by OLE week 24 increased through OLE week 48. Improvements postswitch approached continuation-group values, including scores ≥normative values.
Conclusions
During this OLE, there were no unexpected safety issues in patients switching from adalimumab to sarilumab monotherapy, and disease activity improved in many patients. Patients continuing sarilumab reported safety consistent with prolonged use and had sustained benefit.
... El cuestionario constaba de 6 segmentos: 1) datos generales; 2) antecedentes personales y familiares de enfermedades reumáticas; 3) dolor en los últimos 7 días, tipo de dolor (traumático y ME), escala visual análoga del dolor (EVA-dolor), ubicación de dolor; 4) dolor anterior a los 7 días; 5) comportamiento en búsqueda de atención médica; 6) cuestionario HAQ-DI, validado previamente 7 , de acuerdo a las recomendaciones para adaptarla en estudios epidemiológicos 8 . Se definió como respondedor positivo a una persona que reporte dolor ME no provocado por traumatismo, en los últimos 7 días o anterior a los 7 días; dos reumatólogos aplicaban las siguientes fases el mismo día. ...
Objective
Estimate the prevalence of musculoskeletal manifestations and related disabilities of an urban population living at high altitude in Juliaca, Puno, Peru, using the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) questionnaire and Health Assessment Questionnaire (HAQ) Disability Index.
Methods
A cross-sectional study was performed in a sample of 1095 people. In each interview, the COPCORD methodology and the HAQ were applied. The city was divided into 8 sectors.
Results
In all, 614 (56.1%) women were evaluated; 44% were from the Quechua community and 5.1% were Aymara. Before the final 7 days of the study, 132 people (12.05%; 95% CI 9.99–14.11) reported musculoskeletal pain. During the final 7 days of the study, 347 people (31.69%; 95% CI 28.36–35.02) who were predominately women (218; 35.5%; 95% CI 30.8–40.2) reported musculoskeletal pain. The most frequent rheumatic diseases were rheumatoid arthritis (1.27%), gout (0.64%), hand osteoarthritis (OA) (2.83%), knee OA (1.55%), hip OA (0.37%), fibromyalgia (1.09%), and soft tissue rheumatism (8.86%). The HAQ showed an incremental increase proportional to age. The HAQ average for the population was 0.18 (±0.36). Ten people (5.71%) of 175 with rheumatic disease received the services of a shaman.
Conclusion
It is the first COPCORD study in an urban native population living at high altitude in Peru. The population affected by chronic rheumatic disease preferred professional rather than traditional care; this population had access to limited medical services. Impaired functional capacity measured by HAQ was associated with advanced age.
... El cuestionario constaba de 6 segmentos: 1) datos generales; 2) antecedentes personales y familiares de enfermedades reumáti- cas; 3) dolor en los últimos 7 días, tipo de dolor (traumático y ME), escala visual análoga del dolor (EVA-dolor), ubicación de dolor; 4) dolor anterior a los 7 días; 5) comportamiento en búsqueda de atención médica; 6) cuestionario HAQ-DI, validado previamente 7 , de acuerdo a las recomendaciones para adaptarla en estudios epidemiológicos 8 . Se definió como respondedor positivo a una per- sona que reporte dolor ME no provocado por traumatismo, en los últimos 7 días o anterior a los 7 días; dos reumatólogos aplicaban las siguientes fases el mismo día. ...
Objectives
To determine the impact of individual and regional variables on the geographic distribution of RD across six Latin-American countries
Methods
This is a secondary multilevel analysis of cross-sectional data of COPCORD studies that investigated the prevalence of RD in Argentina, Colombia, Ecuador, México, Peru, and Venezuela. Individual factors were sex, age, comorbidities, job status, and Health Assessment Questionnaire (HAQ) score. Contextual level variables were country and subject's identification as indigenous. RD predictors, including individual and regional variables, particularly indigenous status were identified with logistic regression models. The effect of contextual variables was estimated with median odds ratio's (OR) estimation.
Results
Most individuals included in this analysis came from urban areas (82.40%); their mean age was 43.12 years (95% CI 43.01–43.35); and 56.0% were women. Nearly all of them reported >1 comorbidity (94.70%) and 72.19% were economically active. The prevalence of any RD varied from 1.55% in Peru to 26.09% in Argentina. The mean prevalence of Rheumatoid Arthritis (RA) was 1.58 (range 0.64 to 2.47) (table 1). Aside comorbidities, individual level variables associated to any RD were sex (OR: 1.35; 95% CI 1.28–1.43), age (OR: 1.02; 95% CI 1.01 -1.03), and HAQ score (OR: 3.71; 95% CI 3.22–4.28). Crude comparisons showed significant variations among countries (p<0.01) and indigenous groups (OR: 1.69; 95% CI 1.58–1.81). These findings were confirmed by adjusted analysis (Median OR 1.26; 95% CI 1.14–1.38) (table 2). View this table:
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Table 1. General prevalences and sample sizes across countries
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Table 2. Individual and contextual factors associated to any RD
Conclusions
There common factors associated to the prevalence of RD in the region, however, the estimation of its impact varies in significant way across countries and related to the fact of belong to an indigenous group indicating an increase in the estimated ORs.
Acknowledgements
National Council for Science and Technology (CONACYT);Colegio Mexicano de Reumatologia (Mexico). EsSalud (Perú). Universidad de Cuenca (Ecuador).ASOREUMA (Colombia). Federico Wilhelm Agricola Foundation (Argentina). PDVSA East, SUELOPETROL and Bristol-Myers Laboratory (Venezuela)
Disclosure of Interest
None declared
... El cuestionario constaba de 6 segmentos: 1) datos generales; 2) antecedentes personales y familiares de enfermedades reumáticas; 3) dolor en los últimos 7 días, tipo de dolor (traumático y ME), escala visual análoga del dolor (EVA-dolor), ubicación de dolor; 4) dolor anterior a los 7 días; 5) comportamiento en búsqueda de atención médica; 6) cuestionario HAQ-DI, validado previamente 7 , de acuerdo a las recomendaciones para adaptarla en estudios epidemiológicos 8 . Se definió como respondedor positivo a una persona que reporte dolor ME no provocado por traumatismo, en los últimos 7 días o anterior a los 7 días; dos reumatólogos aplicaban las siguientes fases el mismo día. ...
Objective:
Estimate the prevalence of musculoskeletal manifestations and related disabilities of an urban population living at high altitude in Juliaca, Puno, Peru, using the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) questionnaire and Health Assessment Questionnaire (HAQ) disability index.
Methods:
A cross-sectional study was performed in a sample of 1095 people. In each interview, the COPCORD methodology and the HAQ were applied. The city was divided into 8 sectors.
Results:
In all, 614 (56.1%) women were evaluated; 44% were from the Quechua community and 5.1% were Aymara. Before the final 7 days of the study, 132 people (12.05%; 95% CI 9.99-14.11) reported musculoskeletal pain. During the final 7 days of the study, 347 people (31.69%; 95% CI 28.36-35.02) who were predominately women (218; 35.5%; 95% CI 30.8-40.2) reported musculoskeletal pain. The most frequent rheumatic diseases were rheumatoid arthritis (1.27%), gout (0.64%), hand osteoarthritis (OA) (2.83%), knee OA (1.55%), hip OA (0.37%), fibromyalgia (1.09%), and soft tissue rheumatism (8.86%). The HAQ showed an incremental increase proportional to age. The HAQ average for the population was 0.18 (±0.36). Ten people (5.71%) of 175 with rheumatic disease received the services of a shaman.
Conclusion:
It is the first COPCORD study in an urban native population living at high altitude in Peru. The population affected by chronic rheumatic disease preferred professional rather than traditional care; this population had access to limited medical services. Impaired functional capacity measured by HAQ was associated with advanced age.
... Kuiper and co-workers have argued that the postmenopausal state may be responsible for the major part of the outcome difference between women and men with RA (Kuiper et al, 2001). In contrast, it was recently reported that there were no signifi-38 cant differences in HAQ scores between women and men in a general Finnish population with a mean age of 55 years (Krishnan et al, 2004). ...
... The dependent variable was the precision of the estimates of the 50th, 75th, 90th, 95th, and 99th percentiles. Percentile values of 50, 75, 90, 95, and 99 are commonly presented as norms (Bride, 2007; Glaesmer et al., 2012; Krishnan et al., 2004; and Wizniter et al., 1992) or cutoff scores in testing practice (Crawford & Henry, 2003; Crawford et al., 2001; Lee, Loring, & Martin, 1992; Mond et al., 2006; Murphy & Barkley, 1996; Posserud, Lundervold, & Gillberg, 2006; Van den Berg et al., 2009; Van Roy, Grøholt, Heyerdahl, & Clench-Aas, 2006; Wozencraft & Wagner, 1991). Based on the assumption that the sampling variance of the 1st, 5th, 10th, and 25th percentile is the same as that of the 99th, 95th, 90th, and 75th percentiles, respectively, we did not include the low percentiles in the study. ...
Test norms enable determining the position of an individual test taker in the group. The most frequently used approach to obtain test norms is traditional norming. Regression-based norming may be more efficient than traditional norming and is rapidly growing in popularity, but little is known about its technical properties. A simulation study was conducted to compare the sample size requirements for traditional and regression-based norming by examining the 95% interpercentile ranges for percentile estimates as a function of sample size, norming method, size of covariate effects on the test score, test length, and number of answer categories in an item. Provided the assumptions of the linear regression model hold in the data, for a subdivision of the total group into eight equal-size subgroups, we found that regression-based norming requires samples 2.5 to 5.5 times smaller than traditional norming. Sample size requirements are presented for each norming method, test length, and number of answer categories. We emphasize that additional research is needed to establish sample size requirements when the assumptions of the linear regression model are violated.
© The Author(s) 2015.
... A HAQ score of 0.025 indicates little to no disability and a high functional ability. Disability scores of 0.75 to 1.0 indicate moderate disability and are commonly reported among subjects with rheumatoid arthritis or osteoarthritis [1,13]. The newly recruited ultra-marathoners and nursing home participants had no prior HAQ scores but were selected because of the high likelihood that most ultramarathoners would be at or near the ceiling and nursing home residents would be at or near the floor. ...
Disability and Physical Function (PF) outcome assessment has had limited ability to measure functional status at the floor (very poor functional abilities) or the ceiling (very high functional abilities). We sought to identify, develop and evaluate new floor and ceiling items to enable broader and more precise assessment of PF outcomes for the NIH Patient-Reported-Outcomes Measurement Information System (PROMIS).
We conducted two cross-sectional studies using NIH PROMIS item improvement protocols with expert review, participant survey and focus group methods. In Study 1, respondents with low PF abilities evaluated new floor items, and those with high PF abilities evaluated new ceiling items for clarity, importance and relevance. In Study 2, we compared difficulty ratings of new floor items by low functioning respondents and ceiling items by high functioning respondents to reference PROMIS PF-10 items. We used frequencies, percentages, means and standard deviations to analyze the data.
In Study 1, low (n = 84) and high (n = 90) functioning respondents were mostly White, women, 70 years old, with some college, and disability scores of 0.62 and 0.30. More than 90% of the 31 new floor and 31 new ceiling items were rated as clear, important and relevant, leaving 26 ceiling and 30 floor items for Study 2. Low (n = 246) and high (n = 637) functioning Study 2 respondents were mostly White, women, 70 years old, with some college, and Health Assessment Questionnaire (HAQ) scores of 1.62 and 0.003. Compared to difficulty ratings of reference items, ceiling items were rated to be 10% more to greater than 40% more difficult to do, and floor items were rated to be about 12% to nearly 90% less difficult to do.
These new floor and ceiling items considerably extend the measurable range of physical function at either extreme. They will help improve instrument performance in populations with broad functional ranges and those concentrated at one or the other extreme ends of functioning. Optimal use of these new items will be assisted by computerized adaptive testing (CAT), reducing questionnaire burden and insuring item administration to appropriate individuals.
... Indeed, an assumption of no disability progression while on biologic therapy was the basis of the reference case in the most recent version of BRAMpersonally, a most discomfiting stance. The effect of ageing on functional decline has been quantified in RA and non-RA populations [13,14]. This decline, in individuals, is likely to occur stepwise, dependent on particular www.rheumatology.oxfordjournals.org ...
Modelling cost-effectiveness of new drugs for RA has become increasingly prevalent and sophisticated. This situation has arisen
largely because regulatory agencies, such as the National Institute for Health and Clinical Excellence, have demanded models
from industry and have commissioned independent models. Many technical aspects of health economic models have converged—yet
the results of models differ greatly. These differences can be accounted for in large part by differences in assumptions about
the nature of patients likely to be treated; likely treatment sequences; likely responses to treatment; likely continuation
on drug and likely disease progression, in particular. Such parameters cannot be fixed and evolve with changing practice and
are ideally captured by contemporary data. Importantly, data from the local setting to which a health economic problem is
applied are necessary, but in the absence of ideal sources, for the many contributions needed, considerable differences in
opinion and biases are commonplace. In the final analysis, all models are just that, models, and as such an approximation
of real life. Thus, although considerable heat is generated during debates about model parameters, model outputs may just
yield sufficient light for regulatory agencies allocating resources.
... Therefore, the reference values of BASFI in the general population presented in this study may contribute to better understanding of BASFI scores in patients with AS. At present, the capacity to benchmark a patient's health status against that of age-and gender matched peers in the general population exists AUC: area under the curve ROC, BASFI: Bath Ankylosing Spondylitis Functional Index; CI: confidence interval, ROC: Receiver Operating Characteristic only for the SF-36 [15], HAQ [16,17], WOMAC, and AUSCAN indices [18]. Thus, our report is among the few in the English medical literature that identifies the discriminating power of BASFI after stratification by age and determines the best cutoff of this index in the general population compared with AS patients. ...
The Bath Ankylosing Spondylitis Functional Index (BASFI) has been commonly used in rheumatology to quantify functional disability in patients with ankylosing spondylitis (AS). Our aim was to evaluate the discriminating power of BASFI and determine the best cutoff score of this index in the general population compared with AS patients.
A cross-sectional study that included 200 patients suffering from AS and 223 subjects from the general population matched for age and sex was carried-out. The discriminating power of the BASFI by strata of age was evaluated by the area under the Receiver Operating Characteristic curve and the best cutoff was determined by the Youden index.
The mean age of the general population was 39 ± 12 years. 76.7% of them were male. The median BASFI of the healthy subjects and patients was 0.2 and 4.5 (P < 0.001) respectively. The best cutoff of BASFI was 1.5 with a sensitivity of 86% and a specificity of 90%. In the age group of 18-29 years, the best cutoff of the BASFI was 0.9 with a sensitivity of 93% and a specificity of 94%. In the age group of 30-50 years, the best cutoff of the BASFI was 1.5 with a sensitivity of 84% and a specificity of 88%. For those over 50 years of age, the best cutoff of the BASFI was 2.5 with a sensitivity of 84% and a specificity of 97%.
This study suggests that the discriminating power of BASFI is considered good at any age. The best cutoff of this index increased as age increases as functional disability is associated in part with lifestyle choices and increases with age. The cutoff values of the BASFI that we have presented could be used as a reference benchmark for both clinical practice and research.
... Reliability and validity have been repeatedly documented for all HAQ variables (4,(8)(9)(10), and it is among the outcome measures required by the FDAfor new drug approval. It has been used in thousands of clinical trials and other research studies, has frequently been used in the clinic, and its normative values are well established (11). In addition, other validated self-assessment instruments have periodically been included in ARAMIS assessments. ...
Chronic diseases such as atherosclerosis, arthritis, diabetes, and cancer are among major public health concerns. To understand their cumulative risk factors and antecedents, a chronic disease databank consisting of time-oriented, multidisciplinary longitudinal data, prospectively collected on consecutive patients and describing their clinical courses, provides a systematic anthology of patient reported outcome (PRO) data. ARAMIS, which began in the mid-1970s, was the first large-scale chronic disease data bank system. Outcomes data are collected using the Health Assessment Questionnaire (HAQ), a well established PRO instrument that collects patient-centered data in the areas of disability, pain and other symptoms, adverse effects of treatment, economic impact, and mortality. More than 900 peer-reviewed studies have emanated from ARAMIS since its inception. In the earlier days, and even today, ARAMIS had to invent its own tools for the study of these new sciences. ARAMIS has made dominant contributions to the understanding of PROs and to helping improve treatment and health outcomes in rheumatoid arthritis (RA), osteoarthritis (OA), scleroderma, lupus, aging, and drug side effects. It continues to traverse terrain with participation in the NIH "Roadmap" project, the Patient Reported Outcome Measurement Information System (PROMIS). PROMIS is designed to provide improved assessment of health status across all chronic illnesses as part of an improved infrastructure for clinical research. As initiator of the rich history of chronic disease data banks with "rolling" consecutive open patient cohorts, ARAMIS has enabled the study of real-world PROs in rheumatology, with a wealth of resultant improved approaches to treatment, outcome, cost effectiveness, and quality of life.
Obesity is associated with chronic musculoskeletal pain and is a risk factor for disability and osteoarthritis.
To describe the prevalence, sites, and intensity of musculoskeletal pain in adolescents with severe obesity; to evaluate associations between musculoskeletal pain and self-reported physical function as well as weight-related quality of life; and to evaluate the association between musculoskeletal pain and high-sensitivity C-reactive protein level.
Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) is a prospective, observational study that collects standardized data on adolescents undergoing weight loss surgery at 5 US centers. We examined baseline data from this cohort between February 28, 2007, and December 30, 2011. We excluded adolescents with Blount disease and slipped capital femoral epiphyses. A total of 233 participants were included in these analyses.
We assessed musculoskeletal pain and pain intensity of the lower back, hips, knees, and ankles/feet using the visual analog scale, categorizing musculoskeletal pain into lower back pain, lower extremity (hips, knees, and feet/ankles combined) pain, and no pain. We assessed self-reported physical function status with the Health Assessment Questionnaire Disability Index and assessed weight-related quality of life with the Impact of Weight on Quality of Life-Kids measure. We adjusted for sex, race, age at surgery, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and clinical depressive symptoms in regression analyses.
Among the 233 participants, the mean (SD) age at surgery was 17.1 (1.56) years and the median BMI was 50.4. Participants were predominantly female (77%), white (73%), and non-Hispanic (93%). Among the participants, 49% had poor functional status and 76% had musculoskeletal pain. Lower back pain was prevalent (63%), followed by ankle/foot (53%), knee (49%), and hip (31%) pain; 26% had pain at all 4 sites. In adjusted analyses, compared with pain-free participants, those reporting lower extremity pain had greater odds of having poor physical function according to scores on the Health Assessment Questionnaire Disability Index (odds ratio = 2.82; 95% CI, 1.35 to 5.88; P < .01). Compared with pain-free participants, those reporting lower extremity pain had significantly lower Impact of Weight on Quality of Life-Kids total scores (β = -9.42; 95% CI, -14.15 to -4.69; P < .01) and physical comfort scores (β = -17.29; 95% CI, -23.32 to -11.25; P < .01). After adjustment, no significant relationship was observed between musculoskeletal pain and high-sensitivity C-reactive protein level.
Adolescents with severe obesity have musculoskeletal pain that limits their physical function and quality of life. Longitudinal follow-up will reveal whether weight loss surgery reverses pain and physical functional limitations and improves quality of life.
Nach einem kurzem geschichtlichen Überblick über die Geschichte der ICF und der Darstellung der wesentlichen Begriffsdefinitionen, werden gegenseitigen Abhängigkeiten der einzelnen ICF-Kategorien
bei rheumatischen Erkrankungen an Hand der Literatur dargestellt. Der Zusammenhang zwischen
Körperfunktion, speziell Schmerz, aber auch eingeschränkte Beweglichkeit, und Aktivität bei
Patienten mit Arthrosen bzw. Schulterschmerzen wird diskutiert. Bei der rheumatoiden Arthritis werden
die Abhängigkeiten zwischen Körper, Aktivität und Kontextfaktoren besprochen, wobei die persönlichen
und die Umfeldbedingungen sowohl die Folgen der Krankheit mildern (Faziltatoren) aber auch
verstärken können (Barrieren). Auf häufig eingesetzte Messinstrumente zur Dokumentation des Zustandes
einer Person in der jeweiligen ICF ´-Kategorie wird hingewiesen.
SUMMARY
After a short overview on the history of the ICF and the description of the definition basic terms, the dependency
of ICF-categories from each other will be shown based on the current literature. The relationship between body function, especially pain or restricted range of motion, and activity in patients suffering from osteoarthritis or shoulder pain is discussed. In patients suffering from rheumatoid arthritis, interaction of between body, activity and contextual factors is shown focusing the fact, that both the personal condition and the environment
may reduce (facilitator)or aggravate (barrier) the consequences of the disease. Commonly used outcome
measures appropriate to describe the condition of a subject in each ICF-category are named.
Comment on the paper by Krishnan E et al. Normative Values for the Health Assessment Questionnaire Disability Index; published in Arthritis & Rheumatism 2004, 50, 953-960
A CAT tailors assessment to each individual by selecting and administering subsequent questions based on the individual's response to the previous question. The program begins by selecting a question from the middle of the continuum of the calibrated item bank. Based on how the respondent answers the question, the computer calculates an initial score and level of precision. The CAT will conclude the test based on predetermined stop rules based on level of precision and/or a maximum number of items that are to be used to estimate the score. After the first question is answered, the program decides if the stop rule has been met. If not, another question is selected from the item bank based on the answer given for the previous question. This process is repeated until the stop rule has been satisfied, and a final score is calculated. This approach allows for the selection of items that provide the most relevant information at the level of the individual's current score estimate, therefore eliminating irrelevant questions from being asked (102–104).
To determine the prevalence of chronic back pain and its changes over 5 years in patients with RA compared with community controls and to evaluate the influence of chronic back pain in functional capacity, general pain and global health.
The prevalence of chronic back pain in 1076 patients with RA and in 1491 community controls was evaluated using a mailed questionnaire, which also queried the functional capacity on the HAQ, and general pain and global health on visual analogue scales.
Chronic back pain was more frequent in the general population than in patients with RA: 19% of patients with RA and 25% of controls reported chronic back pain (P < 0.001). After 5 years, 57% of these patients initally reporting pain and 58% of controls still reported chronic back pain. In community controls with and without chronic back pain, the median HAQ, general pain and global health were 0.13 vs 0.00, 28 vs 6 and 28 vs 11, respectively (P < 0.001). The figures were 0.88 vs 0.63 (P = 0.05), 42 vs 26 and 42 vs 30 (P < 0.001), respectively, in patients with RA. All analyses were adjusted for age and sex.
Chronic back pain does not occur more frequently in patients with RA than in the general population. Almost 60% of patients and controls who reported chronic back pain still reported it 5 years later. In patients with RA and in the control population, subjects with chronic back pain had worse functional capacity, general pain and global health.
To develop population-based age- and gender-specific normative values for the pain, stiffness, and physical function subscales of the WOMAC Index for benchmarking applications.
A scannable survey questionnaire capable of capturing WOMAC Index data and demographic information was developed, pretested, and distributed to a stratified random sample of 36,000 members of the Australian general public generated by the Australian Electoral Commission.
Age- and gender-specific WOMAC normative values were estimated based on approximately 7300 subjects. Age-related differences were noted in all 3 WOMAC subscales. In general, pain, stiffness, and difficulty with physical function percentiles increased with age.
WOMAC normative values provide opportunity for benchmarking the health status of individuals with hip and knee osteoarthritis against their age- and gender-matched peers in the general population. These normative values provide unique opportunities for using the WOMAC Index in benchmarking applications in both clinical practice and research.
To develop population-based age- and gender-specific normative values for the pain, stiffness, and physical function subscales of the AUSCAN Index for benchmarking applications.
A scannable survey questionnaire capable of capturing AUSCAN Index data and demographic information was developed, pretested, and distributed to a stratified random sample of 36,000 members of the Australian general public generated by the Australian Electoral Commission.
Age- and gender-specific AUSCAN normative values were estimated based on approximately 7300 subjects. Age-related differences were noted in all 3 AUSCAN subscales. In general, pain, stiffness, and difficulty with physical function percentiles increased with age.
AUSCAN normative values provide opportunity for benchmarking the health status of individuals with hand osteoarthritis against their age- and gender-matched peers in the general population. These normative values provide unique opportunities for using the AUSCAN Index in benchmarking applications, in both clinical practice and research.
To develop age- and gender-specific normative values for the physical function subscales of the WOMAC and AUSCAN Indices.
A scannable survey questionnaire capable of capturing WOMAC and AUSCAN Index and demographic information was developed, pre-tested, and distributed to a stratified random sample of 24,000 members of the Australian general public generated by the Australian Electoral Commission (AEC).
Age- and gender-specific WOMAC and AUSCAN normative values were estimated based on approximately 5,500 subjects. Age-related differences were noted at the subscale level. In general, disability increased with age for all items and both Indices.
Normative values provide opportunity for benchmarking the health status of individuals against their age- and gender-matched peers in the general population. These normative values provide unique opportunities, for using the WOMAC and AUSCAN Indices in benchmarking applications, in both clinical practice and research.
Quantitative measurement has led to major advances in the diagnosis, prognosis and management of chronic diseases. Quantitative measures in rheumatic diseases differ from measures in many chronic diseases in several respects. There is no single "gold standard," such as blood pressure or cholesterol, in the diagnosis, management, and prognosis of any rheumatic disease. Laboratory tests are limited; for example, in rheumatoid arthritis > 40% of patients or more have a normal erythrocyte sedimentation rate (ESR). Formal joint counts have poor reliability and are not performed at most visits of most patients. Radiographs are rarely read quantitatively, except in formal clinical trials. The optimal quantitative measures to monitor status and assess long-term prognosis are often derived from patient self-report questionnaires. Quantitative measures may reflect disease activity, e.g., swollen joint counts or C-reactive protein (CRP), long-term damage, e.g., radiographic damage, or poor outcomes, e.g., work disability and premature death. Disease activity measures used in clinical trials are primarily surrogates for long-term outcomes. As there is no single "gold standard" measure, indices of multiple measures are used in patient assessment. Indices used in rheumatoid arthritis assess primarily disease activity, but separate indices have been developed to assess disease activity versus damage in patients with ankylosing spondylitis, systemic lupus erythematosus, and vasculitis.
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