Background/Purpose: Patients with rheumatoid arthritis (RA) have significantly better clinical status in recent years compared with previous decades.¹ Health assessment questionnaire (HAQ) scores were almost always elevated in 1980 when the HAQ was reported.² In a 1999 report, 16% of patients had HAQ scores of zero, suggesting “no difficulty” in function, but most nonetheless reported problems with function as well as psychosocial issues, reflecting “floor effects”.³ Therefore, a multidimensional HAQ (MDHAQ) was developed to include 13 queries in the user-friendly HAQ format, 8 simple activities of daily living (ADL) from the HAQ, and 2 unique complex activities: “walk 2 miles or 3 kilometers” and “participate in recreation and sports as you would like,” and 2 psychological items. We analyzed mean scores and percent of patients with scores of “0”, suggesting normal function, for each of the 10 MDHAQ activities in patients with RA in 3 rheumatology settings, 2 in the USA and one in Australia.

Methods: All patients at 3 settings in Ridley Park, PA, USA, Baltimore, MD, USA, and Liverpool, NSW, Australia, complete an MDHAQ at each visit in the reception area before seeing the physician. The MDHAQ queries 10 activities, 8 simple activities on the HAQ and 2 unique complex activities only on the MDHAQ (Table), all scored 0-3, with 4 response options: without any difficulty=0, with some difficulty=1, with much difficulty=2 and unable to do=3. Mean scores were analyzed in RA patients. Statistical significance was evaluated using Wilcoxon signed rank tests.

Results: A total of 314 patients were analyzed. A similar pattern was observed at each of the three sites.  Mean scores were less than 0.92 (0-3 scale) for all 8 HAQ items in all patient groups; 33%-83% scored “0” on these items.  Mean scores were greater than 1.27 on the 2 complex activities, “walk 2 miles/3 kilometers” and “participate in recreation/sports as you would like.” Fewer than 32% of patients scored “0” on these items.

Questionnaire items		USA, PA: RA (n=224 pts)	USA, MD: RA (n=27 pts)	Australia: RA (n=63 pts)
		Mean  (% 0)	Mean  (% 0)	Mean  (% 0)
Traditional HAQ items	a. Dress yourself	0.49    64%	0.65    46%	0.62    55%
	b. Get in and out of bed	0.43    64%	0.52    54%	0.53    67%
	c. Lift a cup to your mouth	0.18    83%	0.27    71%	0.33    75%
	d. Walk outdoors on flat ground	0.58    58%	0.81    37%	0.39    67%
	e. Wash/dry one’s body	0.39    70%	0.73    42%	0.52    64%
	f. Bend down to pick up clothing	0.57    57%	0.61    46%	0.60    54%
	g. Turn on taps/faucets	0.29    77%	0.50    54%	0.64    54%
	h. Get in and out of car/bus	0.57    55%	0.92    33%	0.54    59%
Unique MDHAQ items	i. Walk 2 miles/3 kilometers	1.48   30%	1.85     8%	1.27    32%
	j. Participate in recreation/sports	1.48   24%	1.77     4%	1.64    20%

Conclusion: The 2 unique MDHAQ complex activities identify patient problems which are not captured by the 8 items from the HAQ, similarly in USA and Australia. This information may be valuable in clinical management and documentation of improvement over time, which is not possible when baseline scores are zero. The MDHAQ might be considered for usual clinical care as well as in clinical trials.

References: 1) Arthritis Rheum 2005;52:1009-19. 2) Arthritis Rheum 1980;23:137-45. 3) Arthritis Rheum 1999;42:2220-30.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/normal-scores-of-0-floor-effects-are-seen-in-33-83-of-patients-with-rheumatoid-arthritis-ra-on-8-haq-activities-which-also-are-found-on-the-mdhaq-but-in-fewer-than-32-of-patient/