A systematic review of the effectiveness of adalimumab

The Health Assessment
Questionnaire (HAQ)
The HAQ now comprises a family of
questionnaires designed to assess the functional
capacity of patients with musculoskeletal
complaints and specifically RA. The most widely
used HAQ is derived from the Stanford Health
Assessment Questionnaire 204 and consists of two or
three questions in eight categories:
● Dressing and grooming: dress yourself, including
doing shoelaces, and shampoo your hair
● Rising: from an armless chair and in and out of
bed
● Eating: being able to cut meat, lift a full cup or
glass to the mouth, and open a new carton of
milk
● Walking: outdoors on flat ground and climb five
steps
● Hygiene: wash and dry entire body, take a bath,
get on and off the toilet
● Reaching: reach and get down a 5-lb object,
bend down and pick up clothing
● Grip: open car doors, open previously
unopened jars, turn taps on and off
● Activities: run errands and shop, get in and out
of car, do chores.
The score from the most limited activity in each
category is obtained. Each category is scored 0
(without any difficulty), 1 (with some difficulty),
2 (with much difficulty) or 3 (unable to do). Use of
aids or devices to help with function is taken into
account, so that the need for such assistance
automatically scores 2 (unless 3 has been ticked).
The maximum score in each of the eight
categories is added to give a maximum possible
score of 24. This total score may be divided by 8
to give an average value in the range 0–3.
HAQ has several modifications: 205
● Modified HAQ (MHAQ): a shortened version
of HAQ which uses only one question in each
of the eight categories and does not consider
the use of aids and devices to assist function.
It is simpler to score and has the same range as
HAQ (0–3).
Appendix 1
Health Technology Assessment 2006; Vol. 10: No. 42
Details of key outcomes used in RA trials
© Queen’s Printer and Controller of HMSO 2006. All rights reserved.
● RA-HAQ: another shortened version of HAQ
designed to overcome some of the metric
limitations of MHAQ. .
● DHAQ: uses the original eight categories of
HAQ, but is based on the most difficult items in
each of the categories. Neither the RA-HAQ
nor DHAQ has been widely used, unlike
MHAQ.
American College for
Rheumatology response criteria 206
To achieve an ACR20 response a 20%
improvement in the score for tender joints and a
20% improvement in swollen joints is necessary,
and 20% improvement in at least three of the
following:
● global disease activity assessed by observer
● global disease activity assessed by patient
● patient assessment of pain
● physical disability score (e.g. HAQ)
● acute-phase response (e.g. ESR or CRP).
Responses may also be defined as ACR50 (50%)
or ACR70 (70%) depending on the degree of
benefit.
ACR-N is an extension of the ACR response
criteria, and is defined as the lowest of the
following three values:
● percentage change in the number of swollen
joints
● percentage change in the number of tender
joints
● the median of the percentage change in the
other five measures listed above.
It is thus a continuous variable. For example, an
ACR-N of 38 means an improvement of at least
38% in tender and swollen joint counts and an
improvement of at least 38% in three of the five
other parameters. 207 The ACR-N has been
adopted in some clinical trials, such as the ERA
study 123 without prior validation; its advantages
and disadvantages have recently been
debated. 207,208
139