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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1995 Jun;54(6):461–465. doi: 10.1136/ard.54.6.461

Ceiling effects of the Health Assessment Questionnaire and its modified version in some ambulatory rheumatoid arthritis patients.

G Stucki 1, S Stucki 1, P Brühlmann 1, B A Michel 1
PMCID: PMC1009903  PMID: 7632087

Abstract

OBJECTIVE--To examine if the reduced number of items in the modified version of the Health Assessment Questionnaire (MHAQ) concerning difficulty of performing activities of daily living may lead to a reduced ability to detect clinical changes compared with the original HAQ. METHODS--In 56 consecutive ambulatory patients with rheumatoid arthritis, we examined the mean change in clinical and laboratory parameters for those who recorded improved, unchanged, or worse MHAQ scores one year after a baseline assessment. RESULTS--At baseline, about 50% of the patients had an MHAQ score < 0.3 and clustered at the normal end of the scale. Because of a ceiling effect, the MHAQ failed to detect clinical improvement in 18% of the patients. Changes in clinical and laboratory parameters were associated with improved, unchanged, or worse scores with the HAQ but not the MHAQ. CONCLUSION--Although the format of the MHAQ has the advantage of eliciting a 'satisfaction' score, limitations in its sensitivity to detect clinical improvement in patients with relatively little difficulty in activities of daily living may not justify the use of this particular version of shorter questionnaire in certain clinical settings.

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Selected References

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  1. Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
  2. Bergner M., Bobbitt R. A., Pollard W. E., Martin D. P., Gilson B. S. The sickness impact profile: validation of a health status measure. Med Care. 1976 Jan;14(1):57–67. doi: 10.1097/00005650-197601000-00006. [DOI] [PubMed] [Google Scholar]
  3. Brühlmann P., Stucki G., Michel B. A. Evaluation of a German version of the physical dimensions of the Health Assessment Questionnaire in patients with rheumatoid arthritis. J Rheumatol. 1994 Jul;21(7):1245–1249. [PubMed] [Google Scholar]
  4. Fries J. F., Spitz P., Kraines R. G., Holman H. R. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 Feb;23(2):137–145. doi: 10.1002/art.1780230202. [DOI] [PubMed] [Google Scholar]
  5. Hochberg M. C., Chang R. W., Dwosh I., Lindsey S., Pincus T., Wolfe F. The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis. Arthritis Rheum. 1992 May;35(5):498–502. doi: 10.1002/art.1780350502. [DOI] [PubMed] [Google Scholar]
  6. Hurst N. P. An evaluation of the Health Assessment Questionnaire (HAQ) in a long-term longitudinal follow-up of disability in rheumatoid arthritis. Br J Rheumatol. 1994 Feb;33(2):195–197. doi: 10.1093/rheumatology/33.2.195-a. [DOI] [PubMed] [Google Scholar]
  7. Jette A. M., Davies A. R., Cleary P. D., Calkins D. R., Rubenstein L. V., Fink A., Kosecoff J., Young R. T., Brook R. H., Delbanco T. L. The Functional Status Questionnaire: reliability and validity when used in primary care. J Gen Intern Med. 1986 May-Jun;1(3):143–149. doi: 10.1007/BF02602324. [DOI] [PubMed] [Google Scholar]
  8. Katz J. N., Larson M. G., Phillips C. B., Fossel A. H., Liang M. H. Comparative measurement sensitivity of short and longer health status instruments. Med Care. 1992 Oct;30(10):917–925. doi: 10.1097/00005650-199210000-00004. [DOI] [PubMed] [Google Scholar]
  9. Liang M. H., Fossel A. H., Larson M. G. Comparisons of five health status instruments for orthopedic evaluation. Med Care. 1990 Jul;28(7):632–642. doi: 10.1097/00005650-199007000-00008. [DOI] [PubMed] [Google Scholar]
  10. Liang M. H., Larson M. G., Cullen K. E., Schwartz J. A. Comparative measurement efficiency and sensitivity of five health status instruments for arthritis research. Arthritis Rheum. 1985 May;28(5):542–547. doi: 10.1002/art.1780280513. [DOI] [PubMed] [Google Scholar]
  11. Mallya R. K., Mace B. E. The assessment of disease activity in rheumatoid arthritis using a multivariate analysis. Rheumatol Rehabil. 1981 Feb 1;20(1):14–17. doi: 10.1093/rheumatology/20.1.14. [DOI] [PubMed] [Google Scholar]
  12. Merbitz C., Morris J., Grip J. C. Ordinal scales and foundations of misinference. Arch Phys Med Rehabil. 1989 Apr;70(4):308–312. [PubMed] [Google Scholar]
  13. Pincus T., Summey J. A., Soraci S. A., Jr, Wallston K. A., Hummon N. P. Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. Arthritis Rheum. 1983 Nov;26(11):1346–1353. doi: 10.1002/art.1780261107. [DOI] [PubMed] [Google Scholar]
  14. Ramey D. R., Raynauld J. P., Fries J. F. The health assessment questionnaire 1992: status and review. Arthritis Care Res. 1992 Sep;5(3):119–129. doi: 10.1002/art.1790050303. [DOI] [PubMed] [Google Scholar]
  15. Stucki G., Schönbächler J., Brühlmann P., Mariacher S., Stoll T., Michel B. A. Does a muscle strength index provide complementary information to traditional disease activity variables in patients with rheumatoid arthritis? J Rheumatol. 1994 Dec;21(12):2200–2205. [PubMed] [Google Scholar]
  16. Wallston K. A., Brown G. K., Stein M. J., Dobbins C. J. Comparing the short and long versions of the Arthritis Impact Measurement Scales. J Rheumatol. 1989 Aug;16(8):1105–1109. [PubMed] [Google Scholar]
  17. Ware J. E., Jr, Sherbourne C. D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed] [Google Scholar]
  18. Wolfe F., Pincus T. Standard self-report questionnaires in routine clinical and research practice--an opportunity for patients and rheumatologists. J Rheumatol. 1991 May;18(5):643–646. [PubMed] [Google Scholar]
  19. Ziebland S., Fitzpatrick R., Jenkinson C., Mowat A., Mowat A. Comparison of two approaches to measuring change in health status in rheumatoid arthritis: the Health Assessment Questionnaire (HAQ) and modified HAQ. Ann Rheum Dis. 1992 Nov;51(11):1202–1205. doi: 10.1136/ard.51.11.1202. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. van der Heijde D. M., van't Hof M. A., van Riel P. L., van Leeuwen M. A., van Rijswijk M. H., van de Putte L. B. Validity of single variables and composite indices for measuring disease activity in rheumatoid arthritis. Ann Rheum Dis. 1992 Feb;51(2):177–181. doi: 10.1136/ard.51.2.177. [DOI] [PMC free article] [PubMed] [Google Scholar]

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