Patient_Reported_Outcome_Measures_in_Rheumatic_Diseases

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The MDHAQ Compared to the HAQ

Both the HAQ (see Appendix Chapter) and MDHAQ (see Appendix A) for “return”
patients (Table 3.3 ) are 2-page questionnaires (both sides of a single sheet of paper)
completed by a patient in 5–10 min, and both have templates for a composite quan-
titative score. Both include a score for physical function by patient self-report on a
0–3 scale (0 = without any diffi culty, 1 = with some diffi culty, 2 = with much diffi -
culty, 3 = unable to do). Both include scores for pain and patient global estimate on a
0–10 visual analog scale (VAS). Quantitative scores for physical function, pain, and
patient global estimate are the three self-report measures in an RA core data set of
seven measures [ 68 ].
Primary differences between the HAQ and MDHAQ, developed to enhance fea-
sibility, provide clinical information in a busy setting, save time for the physician
and patient, and improve documentation, include (Table 3.3 ):

1. Activities : The HAQ includes 20 activities grouped into 8 categories of 2 or 3
   activities each, while the MDHAQ includes 10 activities, 8 verbatim from the
   HAQ (1 from each of the 8 HAQ categories), and 2 additional complex activi-
   ties, added in the 1990s, when patient status was much improved from 2 decades
   earlier [ 39 ]. By the 1980’s, many patients had scores of “zero” on the simple
   HAQ activities, suggesting “normal” physical function, despite experiencing
   ongoing limitations to perform more diffi cult physical activities [ 51 ]. A scoring
   template is available to convert the sum of ten 0–3 scores (range 0–30) to a
   0–10 physical function score through division by 3.

Table 3.3 Comparison of health assessment questionnaire (HAQ) and multidimensional health
assessment questionnaire (MDHAQ)

HAQ MDHAQ

First report 1980 1999

Patient completion 5–10 min 5–10 min

# Activities of daily living 20 10

Pain VAS 10 cm line 21 circles

Patient global VAS 10 cm line 21 circles

Fatigue No 21 circles

Psychological variables: sleep, anxiety, depression No 3-HAQ format

Review of systems No 60 symptoms

Medical history No Yes

Demographic data No Yes

Social history No Yes

Scoring templates No Yes

MD scan (“eyeball”) 30 s 5 s

Time to score 41.8 s 4.5 s

Time to score index of 3 measures Not available 9.5 s

3 PROMs (MDHAQ/RAPID3) and Physician RheuMetric Measures

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