Determining Rheumatologists' Accuracy at Assessing Functional Disability in Rheumatoid Arthritis Patients Using the Health Assessment Questionnaire–Disability Index
JOHN D. CARTER, ABDUL B. LODHI, SONIA R. NAGDA, LOUIS RICCA, COLLEEN WARD, ERICA TRAINA, ZACHARY J. THOMPSON, YANGXIN HUANG, JOANNE VALERIANO, and FRANK B. VASEY
Objective. To test rheumatologists' accuracy in determining functional disability of their patients with rheumatoid arthritis (RA).
Methods. We used the Health Assessment Questionnaire–Disability Index (HAQ-DI) as our guide at assessing functional disability in patients with RA. Included were male and female patients, 18 to 65 years of age, diagnosed with RA. Demographic data collected included the patients' age, disease duration, rheumatoid factor (RF) status, presence of rheumatoid nodules, absence or presence of erosive disease, and class and stage of their disease. The primary endpoint was the mean difference in the patients' HAQ-DI scores versus that of the physicians' (mHAQ-Diff). Secondary endpoints were the mean difference in pain assessment scale (mPAS-Diff) score; and assessing to see if the physicians' HAQ-DI was altered by the patients' age, disease duration, RF status, rheumatoid nodules, absence or presence of erosive disease, and class or stage of the patient's RA.
Results. A total of 223 patients (139 female, 84 male) were evaluated. The mHAQ-Diff score was statistically significant at –0.3 (p = 0.03) with the rheumatologists more often overestimating the degree of functional disability in their RA patients. The mPAS-Diff score was 0.16, but this was not significant (p = 0.53). There was no significant difference between the scores based on sex, presence or absence of RF, erosions, or rheumatoid nodules. However, the rheumatologists' estimated HAQ and PAS did seem to be more accurate in patients with lower class and stage of their RA.
Conclusion. Our results indicate that there is a clear difference between patients' and rheumatologists' assessment of patients' functional disability in RA, with the rheumatologists significantly overestimating the degree of this disability. Although the rheumatologists' accuracy at determining the amount of their patients' functional disability was poor overall, they were somewhat more accurate in patients with RA having less severe disease. (First Release April 1 2007; J Rheumatol 2007;34:958–63)
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From the Department of Internal Medicine, Division of Rheumatology, and Department of Biostatistics, University of South Florida; and James A. Haley Veterans' Hospital, Tampa, Florida, USA.
Dr. Carter and Dr. Lodhi contributed equally to this work.
J.D. Carter, MD, Assistant Professor of Medicine; E. Traina, Medical Student; J. Valeriano, MD, Associate Professor of Medicine; F.B. Vasey, MD, Professor of Medicine, Division of Rheumatology; Z.J. Thompson, PhD Student; Y. Huang, PhD, Department of Biostatistics, University of South Florida; L. Ricca, MD, Rheumatologist; C. Ward, DO, Rheumatologist, James A. Haley Veterans' Hospital, Tampa; S. Nagda, Medical Student, University of Florida, Gainesville, Florida; A. Lodhi, MD, Rheumatologist, Mississippi, USA.
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Accepted for publication January 12, 2007.