Does removal of aids/devices and help make a difference in the Childhood Health Assessment Questionnaire disability index?
OBJECTIVE
To assess whether the removal of aids/devices and/or help from another person in the Childhood Health Assessment Questionnaire (C-HAQ) leads to a significant change in the disability index (DI) score and responsiveness in juvenile idiopathic arthritis (JIA).


METHODS
Changes in the C-HAQ DI score in a cross-sectional sample of 2663 children with JIA and in 530 active patients with JIA in a trial of methotrexate (MTX) were compared.


RESULTS
Patients in the MTX trial had higher disease activity and disability than the cross-sectional sample. The frequency of aids/devices (range 1.2-10.2%) was similar between the two samples, while help (range 5.3-38.1%) was more frequently used in the MTX group. Correlation between disease severity variables and the two different C-HAQ DI scoring methods did not change substantially. There was a decrease in the C-HAQ DI score for both the cross-sectional (mean score from 0.64 with the original method to 0.54 without aids/devices and help, p<0.0001) and the MTX sample (mean score from 1.23 to 1.07, p<0.0001). A linear regression analysis of the original C-HAQ DI score versus the score without aids/devices and help demonstrated the substantial overlap of the different scoring methods. Responsiveness in the responders to MTX treatment did not change with the different C-HAQ DI scoring methods (range 0.86-0.82).


CONCLUSIONS
The removal of aids/devices and help from the C-HAQ does not alter the interpretation of disability at a group level. The simplified C-HAQ is a more feasible and valid alternative for the evaluation of disability in patients with JIA.
Saad-Magalhães
C
C
IRCCS G Gaslini, Pediatria II, Reumatologia, PRINTO, Genova 16147, Italy.
Pistorio
A
A
Ravelli
A
A
Filocamo
G
G
Viola
S
S
Brik
R
R
Mihaylova
D
D
Cate
R Ten
RT
Andersson-Gare
B
B
Ferriani
V
V
Minden
K
K
Hashkes
P
P
Rygg
M
M
Sauvain
M-J
MJ
Venning
H
H
Martini
A
A
Ruperto
N
N
D000203:Activities of Daily Living; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000188:drug therapy / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D015203:Reproducibility of Results; D012656:Self-Help Devices; D012720:Severity of Illness Index; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D008727:Methotrexate