2019 American College of Rheumatology Recommended Patient‐Reported Functional Status Assessment Measures in Rheumatoid Arthritis

Abstract

Objective. To develop American College of Rheumatology (ACR) recommendations for patient-reported Functional Status Assessment Measures (FSAMs) for use in routine clinical practice in patients with rheumatoid arthritis (RA).Methods. We convened a workgroup to conduct a systematic review of published literature through March 16, 2017 and abstract FSAM properties. Based upon initial search results and clinical input, we focused on the following FSAMs appropriate for routine clinical use: the Health Assessment Questionnaire (HAQ) and derived measures and the Patient-Reported Outcomes Measurement Information System (PROMIS) tool. We used the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 4-point scoring method to evaluate each FSAM, allowing for overall level of evidence assessment. We identified FSAMs fulfilling a predefined minimum standard and, through a modified Delphi process, selected preferred FSAMs for regular use in most clinic settings.Results. The search identified 11,835 articles, of which 56 were included in the review. Descriptions of the measures, properties, study quality, level of evidence, and feasibility were abstracted and scored. Following a modified Delphi process, 7 measures fulfilled the minimum standard for regular use in most clinic settings, and 3 measures were recommended: the PROMIS physical function 10-item short form (PROMIS PF10a), the HAQ-II, and the Multidimensional HAQ.Conclusion. This work establishes ACR recommendations for preferred RA FSAMs for regular use in most clinic settings. These results will inform clinical practice and can support future ACR quality measure development as well as highlight ongoing research needs.

General Functional Status: Common Outcome Measures for Adults With Rheumatic Disease

“…The M‐HAQ has only eight items, which represent each of the eight functional categories , and may be considered a fully separate measure from the HAQ DI because their scores cannot be easily compared . Although it is shorter than the HAQ DI, the M‐HAQ has been shown to have weaker psychometric values than the HAQ DI, and it demonstrates limited clinical and research usability . The multidimensional HAQ (MDHAQ) adds two questions to the M‐HAQ regarding walking and participation in sports and recreational activity for a total of 10 items in 10 domains, which improves the psychometric properties of the MDHAQ over the M‐HAQ .…”

“…The multidimensional HAQ (MDHAQ) adds two questions to the M‐HAQ regarding walking and participation in sports and recreational activity for a total of 10 items in 10 domains, which improves the psychometric properties of the MDHAQ over the M‐HAQ . The MDHAQ is also a component of the Routine Assessment of Patient Index Data 3 (RAPID3), a commonly used measure of disease activity . The HAQ‐II is 10 items, retaining five items from the original HAQ DI and adding five new items.…”

“…The HAQ‐II is 10 items, retaining five items from the original HAQ DI and adding five new items. The HAQ‐II was designed using Rasch analysis to overcome several limitations of the original HAQ DI, including length, burden, and gaps in the continuum of functional status . A detailed comparison of the original HAQ DI, M‐HAQ, MDHAQ, and HAQ‐II was recently published by Barber et al and can be accessed at https://www.rheumatology.org/Portals/0/Files/2019-ACR-Recommended-Patient-Reported-Functional-Status-Assessment-Measures-in-Rheumatoid-Arthritis.pdf.…”

Reply

“…There was debate as to whether the first FSAMs to be ACR recommended should be limited to patients with RA. None of the 3 FSAMs recommended are RA specific, yet all have been validated thoroughly in RA cohorts (5). Because physical function ability or disability is an important aspect of most patients with RMDs, these FSAMs were developed to be used in the rheumatology clinic by all patients.…”

“…Yet we all know there is not yet one set of measures that is best for understanding the health and current status of our rheumatology patients. This caveat is highlighted in both our recent recommendations for regular clinical measurement of patients with RA (5,6). The ACR has been attempting to maintain some control and partitioning of these quality measures by systematically collecting data (via the Rheumatology Informatics System for Effectiveness registry [8] and systematic reviews) and reaching consensus from the rheumatology community on what measures can be reasonably used and acted upon.…”