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Comparing Novel and Legacy Health Assessment Questionnaire Scoring Methods: A Scleroderma Patient-centered

Yining Lu1, Daphna Harel2, Klint Kanopka1

  • 1Y. Lu, MSc, D. Harel, PhD, K. Kanopka, PhD, Department of Applied Statistics, Social Science, and Humanities, New York University, New York, USA.

The Journal of Rheumatology
|February 1, 2026
PubMed
Summary

Comparing Health Assessment Questionnaire (HAQ) scoring methods for systemic sclerosis (SSc) found the HAQ Disability Index (HAQ-DI) to be the most practical and preferred method due to its ease of use and available data.

Keywords:
Health Assessment Questionnairedisabilityitem response treessclerodermasystemic sclerosis

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Area of Science:

  • Rheumatology
  • Medical Assessment
  • Patient-Reported Outcomes

Background:

  • Systemic sclerosis (SSc), or scleroderma, is a chronic autoimmune disease characterized by fibrosis and vascular abnormalities.
  • Accurate measurement of functional disability is crucial for assessing disease impact and treatment efficacy in SSc patients.
  • The Health Assessment Questionnaire (HAQ) is a widely used tool, but various scoring methods exist, necessitating comparison.

Purpose of the Study:

  • To compare five different scoring methods for the Health Assessment Questionnaire (HAQ) in individuals with systemic sclerosis (SSc).
  • To evaluate the convergent validity of these HAQ scoring methods against external measures of physical function, pain interference, and hand function.

Main Methods:

  • Participants from the Scleroderma Patient-centered Intervention Network Cohort completed the 20-item HAQ.
  • Scores were calculated using five methods: HAQ Disability Index (HAQ-DI), Alternative Disability Index (HAQ-ADI), Modified HAQ (MHAQ), a simple summed score, and an Item Response Tree (IRTree) model.
  • Convergent validity was assessed using Pearson's correlations with physical function, pain interference, and hand function measures.

Main Results:

  • IRTree-based scores demonstrated high correlations with other HAQ scoring methods (r=0.90-0.95) and moderate-to-strong correlations with external measures (r=0.68-0.80).
  • No significant difference was found between IRTree-based and HAQ-DI correlations with external measures.
  • IRTree-based scores outperformed HAQ-ADI, MHAQ, and summed scores for physical function and pain interference, but performed worse for hand function.

Conclusions:

  • The Item Response Tree (IRTree) approach offers a novel way to score HAQ data, incorporating item information and aid usage.
  • Despite its novel approach, IRTree-based scoring did not show superior association with external measures compared to the standard HAQ-DI.
  • The HAQ Disability Index (HAQ-DI) remains the preferred scoring method due to its simplicity, ease of implementation, and extensive supporting comparative data.