293Scleroderma Health Assessment Questionnaire (SHAQ)
The HAQ is not disease specifi c. Although it was designed for RA, it is used in
several types of infl ammatory arthritis and some connective tissue diseases (CTDs),
but it focuses mostly on upper extremity function. Steen and Medsger developed the
Scleroderma HAQ (SHAQ), an adapted version of the HAQ to address concerns
specifi c to SSc, with added visual analog scales (VAS) for gastrointestinal symp-
toms, lung symptoms, vascular problems, digital ulcers, pain, and overall disease
severity [ 32 ]. These added scales assess common symptoms of SSc beyond func-
tional impairment and pain. Patients mark on a 15 cm line how much they feel their
symptoms or disease interfere with their activities, and a score is generated accord-
ing to a translation of 1 cm to 0.2 points (or measuring the total in cm and dividing
by 5 to convert the scale into 0–3). Like the HAQ, it is an inexpensive, fast, and
easy-to-use tool. With the SHAQ, an aggregate score is generated, as in the HAQ-DI,
but each VAS score is reported individually.
The SHAQ has demonstrated concurrent, convergent and predictive validity, reli-
ability, and responsiveness to change [ 6 , 28 , 30 , 32 ]. Comparing the two tools, the
SHAQ has incremental content and face validity over the HAQ-DI; this is because
the SHAQ assesses manifestations specifi c to SSc [ 29 ].
EuroQol-5D
Many general measures for health-related quality of life (HRQoL) beyond the HAQ
have been used in SSc. Developed in 1987, the EuroQol-5D (EQ- 5D ) is a general
measure of HRQoL, assessing health states related to the domains of self-care, pain/
discomfort, mobility, anxiety/depression, and usual activities, based on the severity
of problems [ 35 , 36 ], for a total of 245 states. The EQ-5D also includes a VAS scale
from 0 (worst imaginable health state) to 100 (best imaginable health state) for
overall self-reported health [ 36 ]. The EQ-5D correlates well with the HAQ-DI,
SHAQ, and SF-6D, as well as assessments of pain, dyspnea, weakness, fatigue, and
other disease factors for SSc [ 37 – 40 ]. The EQ-5D has been found to have accept-
able validity for patients with SSc [ 37 , 40 ].
Global Assessments
Global assessments are helpful and important tools for examining many aspects of
disease. They can be completed by the patient and/or physician and may be in the
form of a VAS from 0 to 100 or a Likert scale ranging between a negative and posi-
tive value, with a lower number usually representing less disease activity, severity,
or damage. The assessment can be just a single global assessment or may also con-
tain several subscales for different manifestations. Scoring is easy and fast, and the
result is helpful because it quantifi es what the patient is experiencing and how they
perceive the impact of their disease activity. The patient and physician may weigh
the importance of certain aspects differently, and therefore there may be signifi cant
11 PROMs for Systemic Sclerosis (Scleroderma)