Patient_Reported_Outcome_Measures_in_Rheumatic_Diseases

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  1. Psychological queries in HAQ format : Many patients also reported problems
    with sleep, anxiety, and depression, which appeared relevant to document.
    Therefore, three new queries were introduced in the patient-friendly HAQ
    format concerning sleep quality and capacity to deal with anxiety and
    depression.




  2. Visual analog scales (VAS) for pain and patient global estimate on the MDHAQ
    are in a 21-circle format, rather than a 10-cm line as on the HAQ [ 69 ], which
    facilitates scoring for patients, doctors, and staff. A ruler is not needed, and
    boxes are available to enter scores for these individual measures, to calculate
    RAPID3 (routine assessment of patient index data).




  3. RAPID3 (routine assessment of patient index data) —a 0–30 composite index
    of 3 0–10 scales for physical function, pain, and patient global estimate [ 70 ,
    71 ].




  4. Self-report joint count , as a rheumatoid arthritis disease activity index (RADAI)
    [ 52 ], is positioned on the MDHAQ between two 0–10 VAS for pain and global
    status in order to reduce the likelihood of patients giving the same answer on
    both VAS (although scores are similar in most patients, as level of pain is related
    to global well-being). RADAI scores are correlated signifi cantly with tender
    joint count ( r = 0.55) and swollen joint count ( r = 0.42), in the same range as
    ESR with CRP ( r = 0.50) in the same database [ 71 ].




  5. Symptom checklist: The MDHAQ includes a symptom checklist not found on
    the HAQ, introduced initially to serve as a review of systems. Over the years, it
    has been found that patients who check more than 20 of 60 symptoms generally
    have non-infl ammatory problems of distress, such as fi bromyalgia or depres-
    sion, although they may also meet formal criteria for RA, systemic lupus ery-
    thematosus (SLE), or other rheumatic disease [ 61 , 63 ]. Fibromyalgia is seen in
    15–30 % of patients with RA [ 72 ] or SLE [ 73 ], and a clue from a symptom
    checklist can be quite helpful clinically in these patients.




  6. Fatigue VAS : The MDHAQ also includes a 0–10 VAS for fatigue, not found on
    the HAQ. Fatigue is an important problem for many patients with rheumatic
    diseases [ 74 ].




  7. Exercise status : The MDHAQ includes queries about exercise status. Lack of
    exercise is an important prognostic indicator for mortality in the general elderly
    population, as signifi cant as smoking in the prognosis of 5-year survival [ 18 ].




  8. Medical history information : The MDHAQ includes 12 queries concerning
    recent medical history: surgeries, illnesses, hospitalization, etc. A series of “no”
    responses saves a physician at least 2 min, whereas a “yes” response indicates
    a matter that should be characterized at the visit.




  9. Demographic data : Date of birth, gender, ethnic group, marital status, occupa-
    tion, and formal education level are queried, so a database can be developed
    directly from the questionnaire.
    As noted, the most effective strategy for collection of an MDHAQ in standard
    clinical care is to distribute the questionnaire to each patient with any diagnosis
    upon registration at the reception desk in any clinical setting [ 75 ]. Completion in the




T. Pincus et al.
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