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Values for function in rheumatoid arthritis: patients, professionals, and public
S Hewlett1, A P Smith, J R Kirwan
1University of Bristol Rheumatology Academic, Division of Medicine, Bristol Royal Infirmary, UK. Sarah.Hewlett@bristol.ac.uk
Annals of the Rheumatic Diseases
|September 15, 2001
Summary
Patients, health professionals, and controls disagree on disability importance. Current questionnaires like the Health Assessment Questionnaire (HAQ) capture disability but not personal relevance, highlighting the need for patient-centered assessments.
Area of Science:
- Rheumatology
- Patient-Reported Outcomes
- Health Services Research
Background:
- Existing disability questionnaires efficiently measure limitations but neglect individual relevance.
- Professional interpretation of disability relevance may impact treatment outcomes.
- Patient-centered care necessitates understanding the personal impact of disability.
Purpose of the Study:
- To assess agreement on the importance of disability items within the Health Assessment Questionnaire (HAQ) and Modified HAQ (MHAQ) across patient, professional, and control groups.
- To determine if patient-prioritized functional items are included in the HAQ and if HAQ items hold importance for patients.
Main Methods:
- 25 rheumatoid arthritis patients, 25 rheumatology health professionals, and 25 healthy controls rated the importance of HAQ and MHAQ items.
- Patients generated a list of personally important functional items before reviewing the HAQ.
Main Results:
- Slight to fair agreement (kappa <0.38) was observed within and between groups regarding the importance of HAQ and MHAQ items.
- The HAQ incorporated 70% of the functional items patients deemed important.
- No HAQ items were consistently considered unimportant by any group.
Conclusions:
- Significant disagreement exists among patients, professionals, and controls regarding the importance of specific disabilities.
- The findings underscore the necessity of assessing both disability levels and their personal impact.
- A novel model weighting disability importance by level is proposed for calculating personal impact, with a new assessment tool under development.