Background/Purpose: Functional status assessment measures (FSAMs) are important outcomes in rheumatology and used to monitor response to treatment and aid in prediction of rheumatic disease outcomes. We conducted a systematic review of FSAMs used in the evaluation of patients with rheumatoid arthritis (RA). In this first phase of the study, we report on the identification and characteristics of the FSAMS. The ultimate objective is to develop American College of Rheumatology (ACR) recommendations for the use of FSAMs in clinical practice and quality measurement.

Methods: A search strategy was developed in consultation with a medical librarian and based on a published strategy for finding studies that evaluate the measurement properties of clinical instruments from the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) group. This strategy involves the use of MeSH terms/keywords in three themes: #1 construct search (functional status), #2 population search (rheumatoid arthritis), #3 instrument search (including terms for instruments of interest). MEDLINE, EMBASE, Cochrane Library and CINHAL were searched from inception until March 16^th 2017. Two reviewers independently considered papers for inclusion with disagreements resolved by consensus. FSAMs were included if the primary objective of the study was to develop, validate or establish the psychometric properties of a patient-reported FSAMs. Performance-based measures (e.g., grip strength, walk tests) and FSAMs addressing function of a single body part/region were excluded. Health related quality of life or health status measures that only in part addressed function were also excluded as they captured different constructs.

Results: 11,835 unique citations were found and 649 were selected for full-text review. Twenty-three FSAMs met inclusion criteria including 7 published variations of the Health Assessment Questionnaire (HAQ). Eleven measures were developed in the USA (48%), while the remainder were developed in Europe or with international participation. All of the FSAMs were questionnaires varying in length from 2 to 47 items with the exception of a single visual analogue scale. Eight (35%) FSAMs included questions about the use of assistive devices and one FSAM was specific to valued life activities. Range of scores was also often based on the original HAQ range of 0-3 (52% of measures). Where reported, time to administer scores was universally <10 minutes. Preliminary results indicate that the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function questionnaires were highly robust and were correlated with the HAQ but had fewer ceiling effects, were sensitive to change and had high convergent validity.

Conclusion: There are 23 FSAMs for RA in the published literature of varying complexity. Further evaluation of the FSAMs along the 9 domains of COSMIN rating (internal consistency, reliability, measurement error, hypothesis testing, responsiveness and validity (content, structural, criterion and cross-cultural) is presently ongoing and will help determine final ACR recommendations for FSAM use in clinical practice.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/towards-recommendations-on-functional-assessment-status-measures-for-rheumatoid-arthritis-preliminary-results-from-a-systematic-review/