Disabilities of importance for patients to improve – using a patient preference tool in rheumatoid arthritis

Abstract

Purpose: To investigate, using the McMaster Toronto Arthritis patient preference disability questionnaire (MACTAR), disabilities most important to improve in Swedish patients with rheumatoid arthritis (RA) and to compare these with the pre-defined activities in the International Classification of Functioning (ICF) comprehensive core set for RA and the Stanford Health Assessment Questionnaire (HAQ). Also to categorize patient preference selected disabilities using the ICF, to correlate the MACTAR score to RA core set measures and to evaluate the MACTAR’s test–retest reliability. Methods: 45 patients with RA (median (md) age 59 years, diagnosis duration md 10 years) were included. Assessments included disease activity score (DAS28), timed-stands test (TST), shoulder function assessment (SFA), visual analogue scale for pain (VAS), HAQ, patients’ global assessment of well-being (PGA) and the MACTAR. Results: 58 disabilities were identified of which 17 were identified by at least 5 patients. 47% of them were represented in the Comprehensive ICF RA core set and 53% in the HAQ. 16/17 were categorized in the ICF activities and participation component. Correlations between the MACTAR and other measures were: DAS28 (r_s −0.65), TST (r_s −0.19), SFA (r_s 0.38), VAS (r_s −0.61), HAQ (r_s −0.51) and PGA (r_s −0.61). Weighted κ was 0.59. Conclusions: Half of the disabilities patients with RA identified by use of the MACTAR are not evaluated in the Comprehensive ICF core set for RA or the HAQ. MACTAR has moderate test–retest reliability. MACTAR can be considered to be used in addition to traditional RA outcomes and may potentially improve clinical assessment of patients with RA.

Implications for Rehabilitation

• RA has an impact on personal life areas.

• The MACTAR helps identify individual disease-related disabilities of importance to improve.

• The MACTAR provides an opportunity for individualized goal-setting in rehabilitation and can thus promote adherence in rehabilitation.

• MACTAR may potentially improve clinical assessment for patients with RA.

• Activities of daily living
• ICF
• individual preferences
• rheumatoid arthritis