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Correlates of the disability index of the health assessment questionnaire: A measure of functional impairment in systemic sclerosis
- Source :
- Arthritis & Rheumatism. 42:2372-2380
- Publication Year :
- 1999
- Publisher :
- Wiley, 1999.
-
Abstract
- To evaluate functional impairment in systemic sclerosis (SSc) patients with diffuse cutaneous scleroderma at the time of entry into a trial of a therapeutic intervention (D-penicillamine).The 20-item Disability Index of the Health Assessment Questionnaire (HAQ-DI) was administered to 134 patients as they entered a multicenter trial of high-dose versus low-dose D-penicillamine. All patients had diffuse SSc of18 months' duration. SSc patients who had severe organ system involvement and recent renal crisis and who were receiving prednisone10 mg/day were excluded from entry. Logistic regression modeling was used to examine the relationship of HAQ-DI scores to SSc skin and organ system involvement. Odds ratios (OR) and 95% confidence intervals (95% CI) were used to estimate effects.The mean (+/-SD) HAQ-DI score at entry was 1.04 +/- 0.67. Fifty-three percent of patients had HAQ-DI scoresor = 1.0 (signifying moderate-to-severe functional impairment). Multivariate logistic regression demonstrated that impaired fist closureor = 23 mm (OR 4.24, 95% CI 1.68-10.70), reduced handspreador = 175 mm (OR 4.5, 95% CI 1.80-11.24), joint tenderness countor = 1.0 (OR 2.93, 95% CI 1.16-7.40), ageor = 43 years (OR 2.44, 95% CI 1.01-5.95), platelet countor = 330,000/mm3 (OR 2.30, 95% CI 0.96-5.57), and female sex (OR 2.43, 95% CI 0.77-7.73) were the most important correlates of HAQ-DI scoresor = 1.0.Increased HAQ-DI scores at baseline were correlated with reduced fist closure, reduced hand-spread, elevated platelet count, presence of tender joints, older age, and female sex. The most important contributor to functional impairment was hand dysfunction. Even within the first 18 months after SSc onset, moderate-severe functional impairment (HAQ-DI scoresor = 1.0) was frequent (53%) in this group of diffuse SSc patients. In early diffuse SSc, the self-administered HAQ-DI is therefore a valuable assessment of function that correlates with objective physical and laboratory measures of SSc disease involvement. Abnormal HAQ-DI scores may support patient claims of functional impairment, help to focus physician attention on implementing measures to reduce functional impairment, and be useful in reflecting the disease course over time.
- Subjects :
- Adult
Male
medicine.medical_specialty
Systemic disease
Adolescent
Immunology
Disease
Logistic regression
Disability Evaluation
Rheumatology
Surveys and Questionnaires
Internal medicine
Multicenter trial
Immunopathology
Odds Ratio
medicine
Humans
Immunology and Allergy
Pharmacology (medical)
skin and connective tissue diseases
Aged
Models, Statistical
Scleroderma, Systemic
business.industry
Penicillamine
Odds ratio
Middle Aged
medicine.disease
Health Surveys
Connective tissue disease
Confidence interval
Logistic Models
Physical therapy
Female
business
Subjects
Details
- ISSN :
- 15290131 and 00043591
- Volume :
- 42
- Database :
- OpenAIRE
- Journal :
- Arthritis & Rheumatism
- Accession number :
- edsair.doi.dedup.....4828a445a6bbb6fa70d5845d65ea4572