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

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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