ARTHRITIS & RHEUMATISM Vol. 42, No. 10, October 1999, pp 2220–2230 © 1999, American College of Rheumatology TOWARD A MULTIDIMENSIONAL HEALTH ASSESSMENT QUESTIONNAIRE (MDHAQ) Assessment of Advanced Activities of Daily Living and Psychological Status in the Patient-Friendly Health Assessment Questionnaire Format THEODORE PINCUS, CHRISTOPHER SWEARINGEN, and FREDERICK WOLFE Objective. To develop components of a multidimen- sional Health Assessment Questionnaire (MDHAQ) through the addition of new items in the “patient-friendly” HAQ format, including advanced activities of daily living (ADL), designed to overcome “floor effects” of the HAQ and modified HAQ (MHAQ) in which patients may report normal scores although they experience meaningful func- tional limitations, and psychological items, designed to screen efficiently for psychological distress in routine care. Methods. The new MDHAQ items, as well as scales for pain, fatigue, helplessness, and global health status on a 2-page questionnaire, were completed by 688 consecutive patients with various rheumatic diseases, including 162 with rheumatoid arthritis (RA), 114 with fibromyalgia, 63 with osteoarthritis, 34 with systemic lupus erythematosus, 20 with vasculitis, 18 with psori- atic arthritis, 16 with scleroderma, and 261 with various other rheumatic diseases, over 2 years at a weekly academic rheumatology clinic. Results. The new MDHAQ items have good test– retest reliability and face validity. MHAQ scores were highest in patients with RA, and scores for other scales were highest in patients with fibromyalgia. On the advanced ADL, 58% of patients reported difficulty with errands, 68% with climbing stairs, 79% with walking two miles, 87% with participating in sports and games, and 94% with running or jogging two miles. On the psycho- logical items, 75% of patients reported difficulty with sleep, 63% with stress, 61% with anxiety, and 57% with depression. Normal MHAQ scores were reported by 23% of patients and normal HAQ scores by 16% of patients who completed these questionnaires, while fewer than 5% had normal scores on the MDHAQ. Conclusion. The MDHAQ items overcome in large part the “floor effects” seen on the HAQ and MHAQ, and are useful to screen for problems with sleep, stress, anxiety, and depression in the “patient- friendly” HAQ format. These data support the value of completion of a simple 2-page patient questionnaire by each patient at each visit to a rheumatologist. The Health Assessment Questionnaire (HAQ) (1) and its derivatives, the modified HAQ (MHAQ) (2,3) and clinical HAQ (CLINHAQ) (4–6), are widely used to assess and monitor patients with rheumatic diseases (7). In patients with rheumatoid arthritis (RA), questionnaire data are as effective as any available clinical measure, including laboratory tests and radio- graphs, to predict functional disability (8–10), work disability (11), costs (12), joint replacement surgery (13), and premature mortality (14–16), as well as to detect changes in status in clinical trials (17). Data from the MHAQ are correlated significantly with data from tra- ditional physical, radiographic, and laboratory measures (3). The HAQ, MHAQ, and CLINHAQ have also been found to be clinically informative in all rheumatic dis- eases (in addition to RA) in which they have been used, Supported in part by the Jack C. Massey Foundation, Maury County Lupus Fund, the Arthritis Foundation, Boehringer-Ingelheim Pharmaceuticals, and Novartis Pharmaceuticals. Theodore Pincus, MD, Christopher Swearingen, BA: Vander- bilt University School of Medicine, Nashville, Tennessee; Frederick Wolfe, MD: University of Kansas School of Medicine, Wichita. Dr. Pincus has received consulting fees concerning use of questionnaires from various organizations. He is president of Health Report Services, which receives royalty fees from profit-making orga- nizations for use of questionnaires protected by copyright. No royalty fees are collected for use of questionnaires by physicians in usual clinical care. Address reprint requests to Theodore Pincus, MD, Vander- bilt University School of Medicine, Division of Rheumatology and Immunology, 203 Oxford House, Nashville, TN 37232. Submitted for publication November 28, 1998; accepted in revised form April 15, 1999. 2220