A practical guide to scoring a Multi-Dimensional Health Assessment Questionnaire (MDHAQ) and Routine Assessment of Patient Index Data (RAPID) scores in 10–20 seconds for use in standard clinical care, without rulers, calculators, websites or computers

The American College of Rheumatology Core Data Set for rheumatoid arthritis (RA) includes 3 measures which are found on a patient self-report questionnaire, physical function, pain, and patient estimate of global status. These measures are included in all clinical trials, but not assessed at most encounters in standard rheumatology care. Rheumatologists may have experience with lengthy research questionnaires in clinical trials and other clinical research, which (appropriately) are regarded as relatively cumbersome research tools and do not contribute to clinical care. A format of a questionnaire known as the multidimensional health assessment questionnaire (MDHAQ) has been developed for standard rheumatology care to contribute to rheumatology clinical care in daily practice. The 3 scores for physical function, pain, and global status can be “eyeballed” in a second or two and formally scored into a composite index known as rheumatology assessment patient index data (RAPID) in about 10 seconds. This chapter provides a brief tutorial designed to instruct rheumatologists and their staffs regarding how to use and score the MDHAQ and RAPID in standard clinical care.

Introduction

Patient questionnaires concerning functional status provide the most significant prognostic clinical measure for all important long-term outcomes of rheumatoid arthritis (RA), including functional status1, 2, work disability*3, *4, *5, costs⁶, joint replacement surgery⁷, and premature death.1, 8, 9, *10, 11, *12, *13, *14 The levels at which these are prognostic are comparable to systolic or diastolic blood pressure, cholesterol, and smoking as risk factors for premature cardiovascular death.¹⁰ Nonetheless, patient questionnaires have not been incorporated into standard rheumatology care, which continues to emphasize laboratory tests, radiographs, and physical joint-count findings as the primary quantitative measures.

One reason that questionnaires have not been incorporated into standard care might be that relatively little attention has been devoted to practical use of patient questionnaires in a busy clinical setting. Most of the literature concerning questionnaires addresses validity and reliability. Although this literature has greatly advanced clinical science of measurement, it would also appear desirable for clinicians and their staffs to have available practical information concerning scoring of a patient questionnaire in standard clinical care.

The multi-dimensional Health Assessment Questionnaire (MDHAQ) (Figure 1a, Figure 1b) is easily completed by patients and scored by health professionals in standard clinical care. The MDHAQ offers several advantages over the standard Health Assessment Questionnaire (HAQ) when quantitating functional status, pain, and global status: all the activities appear on one side of one page, the pain and patient global visual analog scales (VAS) are in 21 circles rather than a 10-cm line, and there are scoring templates for individual scores, as well as indices termed ‘routine assessment of patient index data’ (RAPID) scores, which can be charted on a flow sheet for comparison with scores from previous visits.