The health assessment questionnaire disability index and scleroderma health assessment questionnaire in scleroderma trials: An evaluation of their measurement properties

Abstract

Objective. To evaluate the measurement properties of the Health Assessment Questionnaire (HAQ) disability index (DI) for group comparisons in scleroderma trials, and to determine if the Scleroderma Health Assessment Questionnaire (SHAQ) visual analog scales confer any measurement advantage over the HAQ DI. Methods. A computer search for articles describing the use of the HAQ DI and SHAQ in scleroderma was performed. Evidence supporting the sensibility, reliability, validity, and responsiveness of these measures was evaluated. Results. The SHAQ has incremental face and content validity over the HAQ DI because it addresses scleroderma-specific manifestations that also contribute to disability. The HAQ DI has good concurrent validity, construct validity, and predictive validity. Whether SHAQ confers incremental construct, concurrent, or predictive validity over the HAQ DI is uncertain. The HAQ DI appears more reliable than the SHAQ; however, reliability studies provide insufficient data to ascertain if minimum standards have been achieved. Responsiveness of the HAQ DI subscales has been demonstrated. INTRODUCTIONThe Health Assessment Questionnaire (HAQ) disability index (DI) and the Scleroderma Health Assessment Questionnaire (SHAQ) are instruments increasingly utilized to assess scleroderma patients in randomized trials (1-4). The HAQ DI is a measure of disability developed for rheumatoid arthritis patients. It is valid, reliable, and responsive to change in this population (5,6). The HAQ DI contains 8 domains of activity (dressing, arising, eating, walking, hygiene, reach, grip, and common daily activities) each of which has at least 2 questions, for a total of 20 items. For each item, patients report the amount of difficulty experienced performing the activity. There are 4 possible responses for each item ranging from 0 (without any difficulty) to 3 (unable to do). A mean score is calculated for each domain ranging from 0 to 3. A composite HAQ DI score is calculated by dividing the summed domain scores by the number of domains answered. The composite score is reported, falling between 0 and 3 on an ordinal scale. The scores are interpreted as 0 (no impairment in function) to 3 (maximal impairment of function) (7).The HAQ-DI also contains a visual analog scale (VAS) that patients use to report the amount of pain experienced in the past week. The VAS is a 15-cm line that is converted to a continuous scale from 0 to 3 where 1 cm is equivalent ). To obtain the patient score, a metric ruler is used to measure the distance in centimeters from the left anchor to the patient's mark, and then multiplied by 0.2 (8). The VAS pain score is not incorporated into the HAQ DI composite score.Steen and Medsger extrapolated use of the HAQ DI to scleroderma patients. Believing the HAQ DI was inadequate to evaluate the multisystem effects of scleroderma, they added 5 scleroderma-specific VASs, thereby creating the SHAQ (8) (See Appendix A available at the Arthritis Care & Research Web site at http://www.interscience. wiley.com/jp...

A valid and reliable belief elicitation method for Bayesian priors

“…They also reported excellent face validity and acceptable time to completion. These findings are comparable to other commonly used questionnaires, such as the Health Assessment Questionnaire [36]. The recommended standard of feasibility suggests that self-reported instruments should be completed in less than 15 minutes [37].…”

Development and validation of a patient-reported outcome instrument for skin involvement in patients with systemic sclerosis

“…However, there are several instruments that address similar conceptual constructs to the SSPRO (other than the PE construct) and have also been validated in SSc: CHFS,30 HAQ-DI,31 SF-3632 and PROMIS-29 33. To compare, the SSPRO PL subscale had moderate-to-strong correlations with the CHFS (0.73) and HAQ-DI (0.60).…”

Translation and cross-cultural adaptation of the Scleroderma Health Assessment Questionnaire to Brazilian Portuguese

“…7,14,15 In the study by Steen et al, 9 who created SHAQ, and 10 The addition of these five VASs addressing the symptoms of systemic scleroderma makes SHAQ a specific questionnaire that assesses function in patients with this disease. 18 The VAS relating to Raynaud's phenomenon was not validated in the original questionnaire, but was administered in the study by Georges et al 10 in order to validate the French version of SHAQ.…”

“…18 This author reported that both questionnaires were sensitive for assessing difficulties in performing activities of daily living, among patients with systemic scleroderma, and that SHAQ enhances HAQ, since it assesses the impact of the symptoms of the disease on daily activities.…”