A reappraisal of HAQ disability in rheumatoid arthritis
A reappraisal of HAQ disability in rheumatoid arthritis
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DOI：
10.1002/1529-0131(200012)43:12
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发表时间：
2000-12-01
影响因子：
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通讯作者：
Wolfe, F
中科院分区：
文献类型：
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作者：
Wolfe, F
客观的。使用功能障碍的主要自我报告测量指标——健康评估问卷（HAQ）来调查类风湿性关节炎（RA）的自我报告残疾病程。方法。在进行 HAQ 的 32,525 名观察对象（1,843 名患者）中评估了 HAQ 残疾的过程。此外，还对来自 50 名患者的 2,189 次就诊进行了研究，平均随访时间为 17 年，以模拟疾病持续时间对个体患者 HAQ 残疾过程的影响。将线性和分数多项式回归以及平滑算法应用于 RA 患者组，然后应用于患者的个体病程。结果。研究发现，病程对HAQ残疾影响的群体线性和非线性模型具有3个特点：1）HAQ残疾评分在发病时较高，而不是逐渐增加； 2) HAQ 残疾随着时间的推移增长非常缓慢（每年 0.03 单位）； 3) 所有这些模型的拟合效果都很差，只能解释 HAQ 残疾评分中 5% 的方差。然而，将非线性模型应用于个体患者病程（而不是患者群体）可以解释 37% 的 HAQ 残疾评分变化。在一些患者中，HAQ 残疾的过程要么是 1) 混乱（分数变化没有任何模式），要么是 2) 可确定，但与时间无关。然而，当将协变量添加到组模型中时，HAQ 残疾的病程变得更加清晰，并且残疾评分中 51% 的方差可以通过疼痛、抑郁、红细胞沉降率和疾病持续时间进行统计解释。结论。各个 RA 患者有不同的、可表征的病程：1) 非线性，2) 混乱，或 3) 非时间决定的。根据 HAQ 的测量，自我报告的身体残疾是疾病随时间作用的函数而发生的模型与数据不太吻合，是一个不充分的模型。这种差异也可能是患者随着时间的推移而向上重新评估功能能力的结果。 RA 中 HAQ 残疾的主要决定因素是疾病活动性、疼痛和社会心理因素，而不是结构异常。尽管 HAQ 是一种有用的临床工具和疾病结果的核心衡量标准，但它既衡量过程又衡量结果，而且通常更多的是过程而不是结果。与传统的基于群体的模型相比，包含有关患者的所有已知信息的个体患者模型（临床护理范例）可能是检查 RA 病程的更有效方法。
Objective. To investigate the course of self-reported disability in rheumatoid arthritis (RA) using the major self-report measure of functional impairment, the Health Assessment Questionnaire (HAQ).Methods. The course of HAQ disability was assessed in 32,525 observations (1,843 patients) in which the HAQ was administered. In addition, a subset of 2,189 visits from 50 patients, followed on average for 17 years, was studied to model the effect of disease duration on the course of HAQ disability in individual patients. Linear and fractional polynomial regression as well as smoothing algorithms were applied to the group of RA patients and then to the individual course of patients.Results. Group linear and nonlinear models of the effect of disease duration on HAQ disability were found to have 3 characteristics: 1) HAQ disability scores are high at disease onset rather than gradually increasing; 2) HAQ disability increases very slowly over time (0.03 units per year); and 3) all such models fit very poorly, explaining only 5% of the variance in HAQ disability scores. However, application of nonlinear models to individual patient courses (as opposed to groups of patients) explains 37% of the HAQ disability score variation. In some patients, the course of HAQ disability was either 1) chaotic (scores change without any pattern) or 2) determinable, but unrelated to time. When covariates were added to the group model, however, the course of HAQ disability became clearer, and 51% of the variance in the disability score could be explained, statistically, by pain, depression, erythrocyte sedimentation rate, and disease duration.Conclusion. Individual RA patients have differing, characterizable courses: 1) nonlinear, 2) chaotic, or 3) non-time determined. The model that self-reported physical disability, as measured by the HAQ, occurs as a function of disease acting over time does not fit the data well and is an inadequate model. This discrepancy may also be the result of the patient's upward reappraisal of functional ability with increasing time. The predominant determinants of HAQ disability in RA are disease activity, pain, and psychosocial factors rather than structural abnormality. Although the HAQ is a useful clinical tool and a central measure of disease outcome, it measures both process and outcome, and usually more process than outcome. Individual patient models that include all that is known about the patient-the paradigm of clinical care-may be a more effective way to examine the course of RA than are conventional group-based models.