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Evaluation of Functional Disability Using the Health Assessment Questionnaire in Japanese Patients with Systemic Sclerosis
MASATAKA KUWANA, SHINICHI SATO, KANAKO KIKUCHI, YASUSHI KAWAGUCHI, ATSUSHI FUJISAKU, YOSHIKATA MISAKI, ATSUSHI HATAMOCHI, HIROBUMI KONDO, and KAZUHIKO TAKEHARA
ABSTRACT. Objective. To assess whether the functional disability in Japanese patients with systemic sclerosis (SSc) can be adequately evaluated by the Health Assessment Questionnaire (HAQ) developed in the United States. Methods. The HAQ was completed by 121 Japanese patients with SSc, in whom SSc-specific physical examinations and laboratory tests were performed at the same time. Clinical findings associated with the disability index (DI) and individual components of the HAQ were examined using Student's t tests and Pearson's correlation tests. Logistic regression analysis was used to identify clinical findings that independently contributed to the increase in the HAQ-DI score. Results. Japanese patients with SSc had significant functional disability, especially in the categories of eating and gripping, but the degree of disability was much less than was reported in previous studies carried out in the US. The increase in the HAQ-DI score was strongly correlated with increased total skin score, reduced oral aperture, reduced hand extension, increased finger flexion, subcutaneous calcinosis, flexion contractures, increased erythrocyte sedimentation rates, decreased percent vital capacity, and vascular involvement (p < 0.001 for all correlations). Multivariate logistic regression analysis showed that hand extension was the most important and an independent correlate of the HAQ-DI. Conclusion. Our multicenter, cross-sectional study has demonstrated that the self-administered HAQ is a valuable assessment tool of functional disability in Japanese SSc patients, who have social customs different from Americans, but functional disability measured by the HAQ is potentially influenced by ethnic variability. (J Rheumatol 2003;30:1253-8) Key Indexing Terms:
FUNCTIONAL DISABILITY
From the Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo; the Department of Dermatology, Kanazawa University Graduate School of Medical Science, Kanazawa; the Department of Dermatology and Department of Allergy and Rheumatology, University of Tokyo School of Medicine and the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; the Department of Internal Medicine, Tomakomai Municipal Hospital, Tomakomai; the Department of Dermatology, Chiba University School of Medicine, Chiba; and the Department of Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan. Supported in part by grants from the Keio University Medical Science Fund and the Japanese Ministry of Education, Science, Sports, and Culture. M. Kuwana, MD, Keio University School of Medicine; S. Sato, MD; K. Takehara, MD, Kanazawa University Graduate School of Medical Science; K. Kikuchi, MD; Y. Misaki, MD, University of Tokyo School of Medicine; Y. Kawaguchi, MD, Tokyo Women's Medical University; A. Fujisaku, MD, Tomakomai Municipal Hospital; A. Hatamochi, MD, Chiba University School of Medicine; H. Kondo, MD, Kitasato University School of Medicine. Address reprint requests to Dr. M. Kuwana, Institute for Advanced Medical Research, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. E-mail: kuwanam@sc.itc.keio.ac.jp Submitted September 6, 2002; revision accepted November 26, 2002. |