The Stanford Health Assessment Questionnaire: a review of its history, issues, progress, and documentation.

Over the last 2 decades, assessment of patient health status has undergone a dramatic paradigm shift, evolving from a predominant reliance on biochemical and physical measurements to an emphasis upon health outcomes based on the patient's personal appreciation of their illness. The Health Assessment Questionnaire (HAQ), published in 1980, was among the first instruments based on patient centered dimensions. The HAQ was designed to represent a model of patient oriented outcome assessment and has played a major role in diverse areas such as prediction of successful aging, inversion of the therapeutic pyramid in rheumatoid arthritis (RA), quantification of nonsteroidal antiinflammatory drug gastropathy, development of risk factor models for osteoarthrosis, and examination of mortality risks in RA. The HAQ has established itself as a valuable, effective, and sensitive tool for measurement of health status. It has increased the credibility and use of validated self-report measurement techniques as a quantifiable set of hard data endpoints and has contributed to a new appreciation of outcome assessment. We review the development, content, and dissemination of the HAQ and provide reference sources for its uses, translations, and validations. We discuss contemporary issues regarding outcome assessment instruments relative to the HAQ's identity and utility. These include: (1) the issue of labeling instruments as generic versus disease-specific; (2) floor and ceiling effects in scales such as "disability"; (3) distances between values on scales; and (4) the continuing introduction of new measurement instruments and their potential effects.

[1]  F. Wolfe,et al.  Determinants of WOMAC function, pain and stiffness scores: evidence for the role of low back pain, symptom counts, fatigue and depression in osteoarthritis, rheumatoid arthritis and fibromyalgia. , 1999, Rheumatology.

[2]  T. Kohlmann,et al.  [Comparative evaluation of a German version of the Health Assessment Questionnaire and the Hannover Functional Capacity Questionnaire]. , 1997, Zeitschrift fur Rheumatologie.

[3]  Reduced joint counts in rheumatoid arthritis clinical trials. American College of Rheumatology Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. , 1994, Arthritis and rheumatism.

[4]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[5]  U. Brodin,et al.  Auranofin improves outcome in early rheumatoid arthritis. Results from a 2-year, double blind placebo controlled study. , 1988, The Journal of rheumatology.

[6]  L. D. de Witte,et al.  Continuation of group physical therapy is necessary in ankylosing spondylitis: results of a randomized controlled trial. , 1994, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[7]  M. Ward Rheumatology visit frequency and changes in functional disability and pain in patients with rheumatoid arthritis. , 1997, The Journal of rheumatology.

[8]  P. Helders,et al.  Correlates of disablement in polyarticular juvenile chronic arthritis--a cross-sectional study. , 1996, British journal of rheumatology.

[9]  T. Arasıl,et al.  The development and psychometric assessment of the Turkish version of the Nottingham Health Profile , 2000, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[10]  Richard W. Martin,et al.  Skin thickness score as a predictor and correlate of outcome in systemic sclerosis: high-dose versus low-dose penicillamine trial. , 2000, Arthritis and rheumatism.

[11]  F. Salaffi,et al.  [Disability in rheumatoid arthritis: the predictive value of age and depression]. , 1992, Recenti progressi in medicina.

[12]  S. Cavuto,et al.  The Italian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[13]  M. Mayes,et al.  Correlates of the disability index of the health assessment questionnaire: a measure of functional impairment in systemic sclerosis. , 1999, Arthritis and rheumatism.

[14]  P. Bendtsen,et al.  Severity of rheumatoid arthritis, function and quality of life: sub-group comparisons. , 1993, Clinical and experimental rheumatology.

[15]  K. Eberhardt,et al.  HLA-DR antigens, Gm allotypes and antiallotypes in early rheumatoid arthritis--their relation to disease progression. , 1993, The Journal of rheumatology.

[16]  Z. Balogh,et al.  The Hungarian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and Experimental Rheumatology.

[17]  O. Steinbrocker,et al.  Therapeutic criteria in rheumatoid arthritis. , 1949, Journal of the American Medical Association.

[18]  J. Melo-Gomes,et al.  The Brazilian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[19]  B. Dijkmans,et al.  The limited value of the Health Assessment Questionnaire as an outcome measure in short term exercise trials. , 1997, The Journal of rheumatology.

[20]  N. Kuzmina,et al.  The Russian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[21]  J. Fries,et al.  Platonic outcomes. , 1993, Journal of Rheumatology.

[22]  A. Donabedian,et al.  Promoting Quality through Evaluating the Process of Patient Care , 1968 .

[23]  S. Katz,et al.  STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. , 1963, JAMA.

[24]  P. Doležalová,et al.  The Czech version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[25]  T. Medsger,et al.  The value of the Health Assessment Questionnaire and special patient-generated scales to demonstrate change in systemic sclerosis patients over time. , 1997, Arthritis and rheumatism.

[26]  R. Burgos-Vargas,et al.  Validation of a Spanish version of the Childhood Health Assessment Questionnaire. , 1997, The Journal of rheumatology.

[27]  A. Martini,et al.  Responsiveness of clinical measures in children with oligoarticular juvenile chronic arthritis. , 1999, The Journal of rheumatology.

[28]  A. Silman,et al.  Associations between demographic and disease-related variables and disability over the first five years of inflammatory polyarthritis: a longitudinal analysis using generalized estimating equations. , 2000, Journal of clinical epidemiology.

[29]  A. Young,et al.  Use of the short form 36 (SF36) for health status measurement in rheumatoid arthritis. , 1997, British journal of rheumatology.

[30]  F. Wolfe,et al.  Which HAQ is best? A comparison of the HAQ, MHAQ and RA-HAQ, a difficult 8 item HAQ (DHAQ), and a rescored 20 item HAQ (HAQ20): analyses in 2,491 rheumatoid arthritis patients following leflunomide initiation. , 2001, The Journal of rheumatology.

[31]  J. Ostojić,et al.  The Croatian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[32]  J. Hunter,et al.  Combination therapy in rheumatoid arthritis--no benefit of addition of hydroxychloroquine to patients with a suboptimal response to intramuscular gold therapy. , 1993, The Journal of rheumatology.

[33]  B. Flatø,et al.  The Norwegian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[34]  R. Chang,et al.  The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis. , 1992, Arthritis and rheumatism.

[35]  E. Batlle-Gualda,et al.  Spanish version of the Health Assessment Questionnaire: reliability, validity and transcultural equivalency. Grupo para la Adaptación del HAQ a la Población Española. , 1993, The Journal of rheumatology.

[36]  D. Symmons,et al.  The impact of rheumatoid arthritis on employment status in the early years of disease: a UK community-based study. , 2000, Rheumatology.

[37]  H. Holman,et al.  Measurement of patient outcome in arthritis. , 1980, Arthritis and rheumatism.

[38]  D. Ruzicki Measurement and evaluation in health education and health promotion , 1986 .

[39]  B. Flatø,et al.  Outcome and predictive factors in juvenile rheumatoid arthritis and juvenile spondyloarthropathy. , 1998, The Journal of rheumatology.

[40]  P. Tugwell,et al.  Patient based method of assessing adverse events in clinical trials in rheumatology: the revised Stanford Toxicity Index. , 2001, The Journal of rheumatology.

[41]  D L Gill,et al.  The relationship of self-efficacy and perceived well-being to physical activity and stair climbing in older adults. , 1994, Research quarterly for exercise and sport.

[42]  P. Bendtsen,et al.  Perceived needs and patient satisfaction in relation to care provided in individuals with rheumatoid arthritis. , 1993, Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care.

[43]  S. Adami,et al.  A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. Italian Study Group on Bone Mass in Rheumatoid Arthritis. , 2000, The Journal of rheumatology.

[44]  M. Inanç,et al.  The Use of Two Different Health Assessment Questionnaires in Turkish Rheumatoid Arthritis Population and Assessment of the Associations with Disability , 1999, Clinical Rheumatology.

[45]  H. Kautiainen,et al.  Work disability in an inception cohort of patients with seropositive rheumatoid arthritis: a 20 year study. , 1999, Rheumatology.

[46]  D. Schwartz,et al.  Rheumatoid arthritis lung disease. Determinants of radiographic and physiologic abnormalities. , 1996, Arthritis and rheumatism.

[47]  A. Martini,et al.  The Slovak version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[48]  I. Wiklund,et al.  Measurement of functional status in juvenile chronic arthritis: evaluation of a Swedish version of the Childhood Health Assessment Questionnaire. , 1993, Clinical and experimental rheumatology.

[49]  K. Harms-Ringdahl,et al.  Clinical reliability of shoulder function assessment in patients with rheumatoid arthritis. , 1991, Scandinavian journal of rheumatology.

[50]  B. Dijkmans,et al.  Predictors of functional status in patients with early rheumatoid arthritis , 2000, Annals of the rheumatic diseases.

[51]  E. Koh,et al.  Cross cultural adaptation and validation of the Chinese Health Assessment Questionnaire for use in rheumatoid arthritis. , 1998, The Journal of rheumatology.

[52]  P. Tugwell,et al.  World Health Organization and International League of Associations for Rheumatology core endpoints for symptom modifying antirheumatic drugs in rheumatoid arthritis clinical trials. , 1994, The Journal of rheumatology. Supplement.

[53]  A. Martini,et al.  The Serbian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[54]  D. Glass,et al.  Long-term health outcomes and quality of life in American and Italian inception cohorts of patients with juvenile rheumatoid arthritis. II. Early predictors of outcome. , 1997, The Journal of rheumatology.

[55]  M. Moussa,et al.  Validation of the Arabic version of the Health Assessment Questionnaire (HAQ) in patients with rheumatoid arthritis. , 1998, Revue du rhumatisme.

[56]  F. Guillemin,et al.  [Measurement of the functional capacity in rheumatoid polyarthritis: a French adaptation of the Health Assessment Questionnaire (HAQ)]. , 1991, Revue du rhumatisme et des maladies osteo-articulaires.

[57]  J. Wong,et al.  Long-term morbidity, mortality, and economics of rheumatoid arthritis. , 2001, Arthritis and rheumatism.

[58]  D. Scott,et al.  The Nottingham Health Profile as a measure of disease activity and outcome in rheumatoid arthritis. , 1997, British journal of rheumatology.

[59]  C. Ekdahl,et al.  Assessing disability in patients with rheumatoid arthritis. Use of a Swedish version of the Stanford Health Assessment Questionnaire. , 1988, Scandinavian journal of rheumatology.

[60]  H. Paulus,et al.  Relative contributions of the components of the American College of Rheumatology 20% criteria for improvement to responder status in patients with early seropositive rheumatoid arthritis. , 2000, Arthritis and rheumatism.

[61]  F. Keefe,et al.  The assessment of pain in rheumatoid arthritis: disease differentiation and temporal stability of a behavioral observation method. , 1987, The Journal of rheumatology.

[62]  J. Fries,et al.  The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. , 1982, The Journal of rheumatology.

[63]  K. Eberhardt,et al.  Early rheumatoid arthritis--some social, economical, and psychological aspects. , 1993, Scandinavian journal of rheumatology.

[64]  K. Eberhardt,et al.  Functional assessment of early rheumatoid arthritis. , 1988, British journal of rheumatology.

[65]  A. Kankainen,et al.  Scores for functional disability in patients with rheumatoid arthritis are correlated at higher levels with pain scores than with radiographic scores. , 2000, Arthritis and rheumatism.

[66]  R. Madhok,et al.  Effect of social deprivation on disease severity and outcome in patients with rheumatoid arthritis , 1997, Annals of the rheumatic diseases.

[67]  G. Grimby,et al.  Assessments of disability in women with rheumatoid arthritis in relation to grip force and pain. , 1997, Disability and rehabilitation.

[68]  S. Sawhney,et al.  The British version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[69]  J. Sibley,et al.  Predicting the short term direct medical costs incurred by patients with rheumatoid arthritis. , 1999, The Journal of rheumatology.

[70]  R. E. Lambert,et al.  Socioeconomic status and health in women with systemic lupus erythematosus. , 1998, The Journal of rheumatology.

[71]  Ware J.E.Jr.,et al.  THE MOS 36- ITEM SHORT FORM HEALTH SURVEY (SF- 36) CONCEPTUAL FRAMEWORK AND ITEM SELECTION , 1992 .

[72]  P. Gertman,et al.  The arthritis impact measurement scales. Further investigations of a health status measure. , 1982, Arthritis & Rheumatism.

[73]  A. Glennås,et al.  Social network size of female patients with rheumatoid arthritis compared to healthy controls. , 2000, Scandinavian journal of rheumatology.

[74]  R. Harwood,et al.  Handicap in inflammatory arthritis. , 1996, British journal of rheumatology.

[75]  S. Bae,et al.  The Korean version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[76]  S. Nielsen,et al.  The Danish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[77]  F. Guillemin,et al.  The French version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and Experimental Rheumatology.

[78]  I. Rumba,et al.  The Latvian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[79]  A. Stewart,et al.  Translation and validation of arthritis outcome measures into Spanish. , 1995, Arthritis and rheumatism.

[80]  E. Libman,et al.  The Hebrew version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[81]  A. Martini,et al.  Long-term health outcomes and quality of life in American and Italian inception cohorts of patients with juvenile rheumatoid arthritis. I. Outcome status. , 1997, The Journal of rheumatology.

[82]  N. Hurst,et al.  A pilot study of the economic cost and clinical outcome of day patient vs inpatient management of active rheumatoid arthritis. , 1994, British journal of rheumatology.

[83]  J. Bonica,et al.  THE MANAGEMENT OF PAIN , 1954 .

[84]  M. Ferraz,et al.  EPM-ROM Scale: an evaluative instrument to be used in rheumatoid arthritis trials. , 1990, Clinical and experimental rheumatology.

[85]  D. Lubeck,et al.  Longterm health outcomes of patients with rheumatoid arthritis treated in managed care and fee-for-service practice settings. , 1998, The Journal of rheumatology.

[86]  F. Baldi,et al.  Bone mineral density in patients with psoriatic arthritis. , 2001, The Journal of rheumatology.

[87]  J. Fries,et al.  Comparative toxicity of non-steroidal anti-inflammatory agents. , 1994, Pharmacology & therapeutics.

[88]  K. Eberhardt,et al.  Early rheumatoid arthritis —onset, course, and outcome over 2 years , 2005, Rheumatology International.

[89]  A. Bakkaloğlu,et al.  The Turkish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[90]  P. Tugwell,et al.  Crosscultural reliability of the physical ability dimension of the health assessment questionnaire. , 1990, The Journal of rheumatology.

[91]  M. Huemer,et al.  The Austrian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[92]  B. Radanov,et al.  Relationship between self-rated functional status and psychosocial stress in patients suffering from rheumatoid arthritis. , 1997, Psychotherapy and psychosomatics.

[93]  G. Kolarz,et al.  The use of questionnaires in the evaluation of the functional capacity in rheumatoid arthritis , 1982, Clinical Rheumatology.

[94]  D. Lubeck,et al.  Direct and indirect medical costs incurred by Canadian patients with rheumatoid arthritis: a 12 year study. , 1997, The Journal of rheumatology.

[95]  M. Ahern,et al.  The longterm effect of pulsed corticosteroids on the efficacy and toxicity of chrysotherapy in rheumatoid arthritis. , 1994, The Journal of rheumatology.

[96]  M. V. van Leeuwen,et al.  Interrelationship of outcome measures and process variables in early rheumatoid arthritis. A comparison of radiologic damage, physical disability, joint counts, and acute phase reactants. , 1994, The Journal of rheumatology.

[97]  D. Alarcón-Segovia,et al.  How to measure health status in rheumatoid arthritis in non-English speaking patients: validation of a Spanish version of the Health Assessment Questionnaire Disability Index (Spanish HAQ-DI). , 1993, Clinical and experimental rheumatology.

[98]  A. Zwinderman,et al.  Radiographic damage of large joints in long-term rheumatoid arthritis and its relation to function. , 2000, Rheumatology.

[99]  F. Guillemin,et al.  Life events and disability in rheumatoid arthritis: a European cohort. , 1997, British journal of rheumatology.

[100]  P. Tugwell,et al.  Evaluation of functional ability of Thai patients with rheumatoid arthritis by the use of a Thai version of the Health Assessment Questionnaire. , 2001, Rheumatology.

[101]  J. Fries,et al.  Relationship of running to musculoskeletal pain with age. A six-year longitudinal study. , 1996, Arthritis and rheumatism.

[102]  F. Wolfe The C-reactive protein but not erythrocyte sedimentation rate is associated with clinical severity in patients with osteoarthritis of the knee or hip. , 1997, The Journal of rheumatology.

[103]  P. Pelkonen,et al.  The Finnish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[104]  M. Bojidarova,et al.  The Bulgarian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[105]  R. Gelber,et al.  Quality-of-life assessment in clinical trials. , 1995, Cancer treatment and research.

[106]  E. Seifried,et al.  Association of (Q)R/KRAA positive HLA-DRB1 alleles with disease progression in early active and severe rheumatoid arthritis. , 1999, The Journal of rheumatology.

[107]  B. Alman,et al.  Function of dislocated hips in children with lower level spina bifida. , 1996, The Journal of bone and joint surgery. British volume.

[108]  P. Nieminen,et al.  Joint impairment is strongly correlated with disability measured by self-report questionnaires. Functional status assessment of individuals with rheumatoid arthritis in a population based series. , 1994, The Journal of rheumatology.

[109]  J. Fries,et al.  The relative toxicity of disease-modifying antirheumatic drugs. , 1993, Arthritis and rheumatism.

[110]  Stenström Ch Home exercise in rheumatoid arthritis functional class II: goal setting versus pain attention. , 1994 .

[111]  J. Fries,et al.  Measurement of health status in children with juvenile rheumatoid arthritis. , 1994, Arthritis and rheumatism.

[112]  M. Trachana,et al.  The Greek version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[113]  Gurkirpal Singh,et al.  Running and the Development of Disability with Age , 1994, Annals of Internal Medicine.

[114]  B. Spilker,et al.  Quality of life and pharmacoeconomics in clinical trials , 1996 .

[115]  A. Kress,et al.  Decreased physical function in juvenile rheumatoid arthritis. , 1999, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[116]  L. D. de Witte,et al.  Determinants of self-reported health status in ankylosing spondylitis. , 1994, Journal of Rheumatology.

[117]  J. Wessel,et al.  The relationship between strength and function in females with juvenile rheumatoid arthritis. , 1998, The Journal of rheumatology.

[118]  R. Meenan The AIMS approach to health status measurement: conceptual background and measurement properties. , 1982, The Journal of rheumatology.

[119]  E. Cook,et al.  Psychometric evaluation of a Korean Health Assessment Questionnaire for clinical research. , 1998, The Journal of rheumatology.

[120]  B. Feldman,et al.  Medium- and long-term functional outcomes in a multicenter cohort of children with juvenile dermatomyositis. , 2000, Arthritis and rheumatism.

[121]  O. Førre,et al.  Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis , 1991, The Lancet.

[122]  D A Bloch,et al.  Risk factors for physical disability in an aging cohort: the NHANES I Epidemiologic Followup Study. , 1993, The Journal of rheumatology.

[123]  M. Ahern,et al.  Shared rheumatoid epitope as a risk factor in determining outcome in rheumatoid arthritis. , 1999, Australian and New Zealand journal of medicine.

[124]  D. Gladman,et al.  Responsiveness of health status instruments to changes in articular status and perceived health in patients with psoriatic arthritis. , 1998, The Journal of rheumatology.

[125]  M. Ferraz,et al.  Crosscultural reliability of the Childhood Health Assessment Questionnaire. , 1994, The Journal of rheumatology.

[126]  J J Anderson,et al.  The American college of rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials , 1993 .

[127]  A. Fasth,et al.  Development of a Costa Rican version of the Childhood Health Assessment Questionnaire. , 1997, The Journal of rheumatology.

[128]  J. J. García,et al.  The European Spanish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[129]  G. Stucki,et al.  A patient-derived disease activity score can substitute for a physician-derived disease activity score in clinical research. , 1999, Rheumatology.

[130]  K. Eberhardt,et al.  Effect of rheumatoid arthritis on work status and social and leisure time activities in patients followed 8 years from onset. , 1998, The Journal of rheumatology.

[131]  B. Andersson Gäre,et al.  The Swedish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[132]  C. Stenström Home exercise in rheumatoid arthritis functional class II: goal setting versus pain attention. , 1994, The Journal of rheumatology.

[133]  J. Fries,et al.  The relative toxicity of nonsteroidal antiinflammatory drugs. , 2010, Arthritis and rheumatism.

[134]  E. Yelin,et al.  An assessment of the annual and long-term direct costs of rheumatoid arthritis: the impact of poor function and functional decline. , 1999, Arthritis and rheumatism.

[135]  F. Wolfe,et al.  The longterm outcomes of rheumatoid arthritis: Work disability: a prospective 18 year study of 823 patients. , 1998, The Journal of rheumatology.

[136]  B. Archenholtz,et al.  Reliability, validity, and sensitivity of a Swedish version of the revised and expanded Arthritis Impact Measurement Scales (AIMS2). , 1997, The Journal of rheumatology.

[137]  G. Calori,et al.  The Italian version of the Functional Disability Index of the Health Assessment Questionnaire. A reliable instrument for multicenter studies on rheumatoid arthritis. , 1993, Clinical and experimental rheumatology.

[138]  P. Brooks,et al.  The psychosocial and clinical status of younger women with early rheumatoid arthritis: a longitudinal study with frequent measures. , 1994, British journal of rheumatology.

[139]  M Gillen,et al.  Injuries from Construction Falls: Functional Limitations and Return to Work , 1999, AAOHN journal : official journal of the American Association of Occupational Health Nurses.

[140]  T. Mittlmeier,et al.  Stage-related surgery for cervical spine instability in rheumatoid arthritis , 1999, European Spine Journal.

[141]  Meenan Rf The AIMS approach to health status measurement: conceptual background and measurement properties. , 1982 .

[142]  G. Singh,et al.  NSAID induced gastrointestinal complications: the ARAMIS perspective--1997. Arthritis, Rheumatism, and Aging Medical Information System. , 1998, The Journal of rheumatology. Supplement.

[143]  W. Kuis,et al.  The Dutch version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and Experimental Rheumatology.

[144]  K. Minden,et al.  The German version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[145]  M. Snaith,et al.  Generic and condition-specific outcome measures for people with osteoarthritis of the knee. , 1999, Rheumatology.

[146]  T. Moum,et al.  Measuring disability in early juvenile rheumatoid arthritis: evaluation of a Norwegian version of the childhood Health Assessment Questionnaire. , 1998, The Journal of rheumatology.

[147]  M. Hochberg,et al.  Self-reported functional status in osteoarthritis of the knee in a rural southern community: the role of sociodemographic factors, obesity, and knee pain. , 1996, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[148]  K. Eberhardt,et al.  Psychological reactions in patients with early rheumatoid arthritis. , 1993, Patient education and counseling.

[149]  C. Bombardier,et al.  Consequences of delayed therapy with second-line agents in rheumatoid arthritis: a 3 year followup on the hydroxychloroquine in early rheumatoid arthritis (HERA) study. , 2000, The Journal of rheumatology.

[150]  J. Wessel,et al.  Isometric strength measurements in children with arthritis: reliability and relation to function. , 1999, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[151]  A. Carr,et al.  Questionnaire on the perceptions of patients about total knee replacement. , 1998, The Journal of bone and joint surgery. British volume.

[152]  R. Burgos-Vargas,et al.  The Mexican version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[153]  M. Hochberg,et al.  Ethnic differences in self-reported functional status in the rural south: the Johnston County Osteoarthritis Project. , 1996, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[154]  H. Capell,et al.  Prevalence of low body mass in rheumatoid arthritis: association with the acute phase response , 1997, Annals of the rheumatic diseases.

[155]  V. Riccieri,et al.  Comparison of the Health Assessment Questionnaire and Arthritis Impact Measurement Scale in patients with psoriatic arthritis. , 1998, Revue du rhumatisme.

[156]  J. Fries,et al.  "Arthritis specific" global health analog scales assess "generic" health related quality-of-life in patients with rheumatoid arthritis. , 1997, The Journal of rheumatology.

[157]  K. Lorig,et al.  Converging and diverging beliefs about arthritis: Caucasian patients, Spanish speaking patients, and physicians. , 1984, The Journal of rheumatology.

[158]  D. Lubeck,et al.  Assessment of quality of life in early stage HIV-infected persons: data from the AIDS Time- Oriented Health Outcome Study (ATHOS) , 1997, Quality of Life Research.

[159]  E. Silverman,et al.  Measuring disability in juvenile dermatomyositis: validity of the childhood health assessment questionnaire. , 1995, The Journal of rheumatology.

[160]  S P McKenna,et al.  Adaptation into Danish of the Stanford Health Assessment Questionnaire (HAQ) and the Rheumatoid Arthritis Quality of Life Scale (RAQoL). , 2001, Scandinavian journal of rheumatology.

[161]  N. Ruperto,et al.  The Georgian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[162]  J. García-García,et al.  Development of a Spanish (Castillian) version of the Childhood Health Assessment Questionnaire. Measurement of health status in children with juvenile chronic arthritis. , 2000, Clinical and experimental rheumatology.

[163]  H. Canhão,et al.  The Portuguese version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[164]  R. Saurenmann,et al.  The Swiss German and Swiss French versions of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[165]  D. Amiel,et al.  Polyarticular disability: a functional assessment. , 1977, Archives of physical medicine and rehabilitation.

[166]  J. Fries,et al.  Why health care costs more in the US: comparing health care expenditures between systemic lupus erythematosus patients in Stanford and Montreal. , 1996, Arthritis and rheumatism.

[167]  J F Fries,et al.  The health assessment questionnaire 1992: status and review. , 1992, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[168]  K. Brandt,et al.  Views of patients and physicians regarding the importance of various aspects of arthritis treatment. Correlations with health status and patient satisfaction , 1986 .

[169]  R. Russo,et al.  Cross-cultural adaptation and validation of an Argentine Spanish Version of the Stanford Childhood Health Assessment Questionnaire. , 1998, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[170]  M. Gattinara,et al.  Validation of the Italian version of the Stanford Childhood Health Assessment Questionnaire for measuring functional status in children with chronic arthritis. , 1995, Clinical and experimental rheumatology.

[171]  J. Listing,et al.  Loss of physical independence in rheumatoid arthritis: interview data from a representative sample of patients in rheumatologic care. , 2000, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[172]  J. Ware,et al.  Determining minimally important changes in generic and disease-specific health-related quality of life questionnaires in clinical trials of rheumatoid arthritis. , 2000, Arthritis and rheumatism.

[173]  H. Paulus,et al.  The relationship between socioeconomic status and recently diagnosed rheumatoid arthritis. , 1996, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[174]  C. Ekdahl Muscle function in rheumatoid arthritis. Assessment and training. , 1990, Scandinavian journal of rheumatology. Supplement.

[175]  R. Holder,et al.  The acute phase and function in early rheumatoid arthritis. C-reactive protein levels correlate with functional outcome. , 1997, The Journal of rheumatology.

[176]  E. Wyszyńska,et al.  The Polish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[177]  G. Stucki,et al.  Isometric muscle strength is an indicator of self-reported physical functional disability in patients with rheumatoid arthritis. , 1998, British journal of rheumatology.

[178]  C. Wouters,et al.  The Belgian-Flemish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[179]  C. Méndez,et al.  The Chilean version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.