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Toward a multidimensional Health Assessment Questionnaire (MDHAQ):assessment of advanced activities of daily living & psychological status in the patient-friendly health assessment questionnaire format - fibromyalgia related research

  [ 46 votes ]   [ Discuss This Article ] • October 8, 1999

OBJECTIVE: To develop components of a multidimensional Health
Assessment Questionnaire (MDHAQ) through the addition of new
items in the "patient-friendly" HAQ format, including advanced
activities of daily living (ADL), designed to overcome "floor
effects" of the HAQ and modified HAQ (MHAQ) in which patients
may report normal scores although they experience meaningful
functional limitations, and psychological items, designed to
screen efficiently for psychological distress in routine care.

METHODS: The new MDHAQ items, as well as scales for pain,
fatigue, helplessness, and global health status on a 2-page
questionnaire, were completed by 688 consecutive patients with
various rheumatic diseases, including 162 with rheumatoid
arthritis (RA), 114 with fibromyalgia, 63 with osteoarthritis,
34 with systemic lupus erythematosus, 20 with vasculitis, 18
with psoriatic arthritis, 16 with scleroderma, and 261 with
various other rheumatic diseases, over 2 years at a weekly
academic rheumatology clinic.

RESULTS: The new MDHAQ items
have good test-retest reliability and face validity. MHAQ
scores were highest in patients with RA, and scores for other
scales were highest in patients with fibromyalgia. On the
advanced ADL, 58% of patients reported difficulty with
errands, 68% with climbing stairs, 79% with walking two miles,
87% with participating in sports and games, and 94% with
running or jogging two miles. On the psychological items, 75%
of patients reported difficulty with sleep, 63% with stress,
61% with anxiety, and 57% with depression. Normal MHAQ scores
were reported by 23% of patients and normal HAQ scores by 16%
of patients who completed these questionnaires, while fewer
than 5% had normal scores on the MDHAQ.

items overcome in large part the "floor effects" seen on the
HAQ and MHAQ, and are useful to screen for problems with
sleep, stress, anxiety, and depression in the
"patient-friendly" HAQ format. These data support the value of
completion of a simple 2-page patient questionnaire by each
patient at each visit to a rheumatologist.

Pincus T, Swearingen C, Wolfe F

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