Values for function in rheumatoid arthritis: patients, professionals, and public

Background-Although many disability questionnaires measure fact very effici ently, they do not allow for consideration of the relevance of that disabil ity to the patient. Data suggest that professionals misinterpret the releva nce of disability for the patient and thus, also, the outcome of treatment. Objectives-Firstly, to examine agreement on levels of importance for the it ems on a validated disability scale (Health Assessment Questionnaire (HAQ) and Modified HAQ (MHAQ)), within groups of patients with rheumatoid arthrit is, health professionals, and controls. Secondly, to see if functional item s important to patients are included in the HAQ, and whether the HAQ items are important to patients. Methods-25 patients with RA, 25 rheumatology health professionals, and 25 h ealthy controls were asked to rate the importance of the HAQ (20 items) and MHAQ (eight domains). Before seeing the HAQ, patients were asked to genera te items of function important to them. Results-Only a slight-fair agreement within each group was found for the le vel of importance of the HAQ and MHAQ, and also within any combination of t he groups (kappa values <0.38). Most of the functional items valued by pati ents were contained on the HAQ (70%), and no HAQ items were consistently ra ted as unimportant. Conclusion-Patients, professionals, and healthy controls do not agree on th e importance of disabilities. These data support the need to assess the per sonal impact of disability, as well as disability itself. Individual import ance of disability weighted by level of disability is proposed as a model f or calculating the personal impact of disability. A new tool to assess the personal impact of disability is being developed.