Rheumatoid Arthritis

Measuring Functional Status in RA

Introduction

Why it matters1

  • Poor functional status correlates with work disability, poor QoL, and mortality in RA
  • Functional status assessment measures provide information that can help make prognoses and treatment decisions for patients with RA

The ACR recommends the following 3 functional status assessment measures based on their feasibility for regular use in clinical practice and psychometric properties.1

Measures

RA functional status assessment measures

Measure

PROMIS PF10a1,2

Information

Developed by the NIH to standardise physical health measurement in chronic conditions


Length

10 questions

Topics

  • Vigorous activities
  • Walking >1 mile (1.6 km)
  • Stairs
  • Carrying groceries
  • Bending/kneeling/stooping
  • Vacuuming/yard work
  • Dressing
  • Shampoo hair
  • Wash and dry body
  • On/off toilet

Link

Score

0 (low disability) – 100 (high disability)

Attributes

  • Good hypothesis testing, responsiveness, and interpretability
  • Can be reliably followed over time
  • Superior development methodology, resulting in improved floor/ceiling effects
  • Most feasible PROMIS measure due to fewer number of questions and no need for computer or proprietary software
  • Rigorously developed and extensively tested in general population and chronic conditions but not yet used widely in RA studies

Measure

HAQ-II1,3,4

Information

Developed to assess functional status in rheumatic disease and designed to be short with reduced floor effects


Length

10 questions

Topics

  • Toileting
  • Opening doors
  • Standing from a chair
  • Walking on flat ground
  • Waiting in line
  • Reaching for an object
  • Ambulating up steps
  • Performing outdoor work
  • Lifting heavy objects
  • Moving heavy objects

Link

Score

0 (normal physical functioning) – 3 (high disability)

Attributes

  • Good internal consistency and interpretability
  • Can be reliably followed over time
  • Superior development methodology, resulting in the smallest floor effect among the HAQ measures
  • Easier to administer and score than the HAQ
  • Captures disability spectrum better than M-HAQ, MDHAQ, and HAQ-DI

Measure

MDHAQ1,3,4

Information

Derived from the HAQ to measure functional status with a shorter time commitment and designed to be sensitive to changes at the low end of the scale


Length

10 questions

Topics

  • Dressing and grooming
  • Arising
  • Eating
  • Walking
  • Hygiene
  • Reaching
  • Gripping
  • Errands and chores
  • 'Walk 2 miles' (3.2 km)
  • 'Participate in recreational activities and sports as you would like'

Link

Score

0 (normal physical functioning) – 3 (high disability)

Attributes

  • Good internal consistency and interpretability
  • Can be reliably followed over time
  • Greater feasibility than HAQ
  • More favourable psychometric properties relative to M-HAQ
  • Inferior performance to HAQ-II and PROMIS

Related

Disease Activity Measures

Learn more about disease activity measures

Unmet Needs

Take a closer look at the unmet needs of patients with RA

Discover our product information for rheumatoid arthritis

ACR, American College of Rheumatologists; HAQ, Health Assessment Questionnaire; HAQ-II, Health Assessment Questionnaire II; MDHAQ, Multidimensional Health Assessment Questionnaire; M-HAQ, Modified Health Assessment Questionnaire; NIH, National Institutes of Health; PROMIS, Patient-Reported Outcomes Measurement Information System; PROMIS PF10a, Patient-Reported Outcomes Measurement Information System Physical Function 10-Item Short Form; QoL, quality of life; RA, rheumatoid arthritis.


REFERENCES

1. Barber CEH, Zell J, Yazdany J, et al. Arthritis Care Res (Hoboken). 2019;71(12):1531-1539. 2. Bartlett SJ, Orbai AM, Duncan T, et al. PLoS One. 2015;10(9):e0138543. 3. Maska L, Anderson J, Michaud K. Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S4-S13. 4. Health Assessment Questionnaires (HAQ, HAQ-II, MDHAQ). RheumInfo. Accessed March 3, 2021. https://rheuminfo.com/physician-tools/health-assessment-questionnaires-haq-haq-ii-mdhaq/