title: Does removal of aids/devices and help make a difference in the Childhood Health Assessment Questionnaire disability index?
abstract: 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.
authors.affiliation: IRCCS G Gaslini, Pediatria II, Reumatologia, PRINTO, Genova 16147, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Saad-Magalhães
authors.forename: A
authors.initials: A
authors.lastname: Pistorio
authors.forename: A
authors.initials: A
authors.lastname: Ravelli
authors.forename: G
authors.initials: G
authors.lastname: Filocamo
authors.forename: S
authors.initials: S
authors.lastname: Viola
authors.forename: R
authors.initials: R
authors.lastname: Brik
authors.forename: D
authors.initials: D
authors.lastname: Mihaylova
authors.forename: R Ten
authors.initials: RT
authors.lastname: Cate
authors.forename: B
authors.initials: B
authors.lastname: Andersson-Gare
authors.forename: V
authors.initials: V
authors.lastname: Ferriani
authors.forename: K
authors.initials: K
authors.lastname: Minden
authors.forename: P
authors.initials: P
authors.lastname: Hashkes
authors.forename: M
authors.initials: M
authors.lastname: Rygg
authors.forename: M-J
authors.initials: MJ
authors.lastname: Sauvain
authors.forename: H
authors.initials: H
authors.lastname: Venning
authors.forename: A
authors.initials: A
authors.lastname: Martini
authors.forename: N
authors.initials: N
authors.lastname: Ruperto
mesh_terms: 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
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate