Pragmatic Assessment of Exercise in Routine Care Using an MDHAQ: Associations with Changes in RAPID3 and Other Clinical Variables

Overview

Journal Arthritis Res Ther

Publisher Biomed Central

Specialty Rheumatology

Date 2016 Sep 8

PMID 27600736

Citations 1

Authors

Isabel Castrejon

Yusuf Yazici

Selda Celik

Theodore Pincus

Affiliations

Soon will be listed here.

Abstract

Background: Exercise is associated with major benefits in patients with rheumatic diseases for both cardiovascular and rheumatic status. However, information about exercise generally is not collected systematically in routine rheumatology care. A multidimensional health assessment questionnaire (MDHAQ), which was designed for busy clinical settings, includes a query about exercise status. We analyzed possible associations between change in MDHAQ exercise scores and other MDHAQ measures in patients with various rheumatic diseases over one year.

Methods: In one rheumatology clinical setting, all patients, regardless of diagnosis, complete an MDHAQ before seeing a rheumatologist. The MDHAQ includes scores for physical function, pain, and patient global estimate, compiled into an index, routine assessment of patient index data (RAPID3), as well as a self-report joint count and a query about exercise. Patients were classified into four groups according to their exercise status at baseline and one year later as: EXER-Yes (regular exercise), EXER-Yes; EXER-No (no regular exercise), EXER-Yes; EXER-Yes, EXER-No; and EXER-No, EXER-No. These groups were compared using the chi square and Kruskal-Wallis tests and analysis of variance (ANOVA).

Results: Patients who reported regular exercise at baseline were younger, had higher formal education, and better clinical status than other patients. The EXER-No, EXER-Yes group had greater improvement in other MDHAQ variables than patients in the other three groups. By contrast, the EXER-Yes, EXER-No group was the only group with poorer status one year later.

Conclusions: The MDHAQ exercise query indicates that regular exercise is associated with better clinical status. Patients in the EXER-No, EXER-Yes group reported the best clinical improvement, although it is not known whether exercise preceded or followed the improved clinical status.

Citing Articles

Reliability, Feasibility, and Patient Acceptance of an Electronic Version of a Multidimensional Health Assessment Questionnaire for Routine Rheumatology Care: Validation and Patient Preference Study.

Pincus T, Castrejon I, Riad M, Obreja E, Lewis C, Krogh N JMIR Form Res. 2020; 4(5):e15815.

PMID: 32459182 PMC: 7287716. DOI: 10.2196/15815.

References

de Jong Z, Munneke M, Zwinderman A, Kroon H, Jansen A, Ronday K . Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial. Arthritis Rheum. 2003; 48(9):2415-24. DOI: 10.1002/art.11216. View

Pincus T, Castrejon I . MDHAQ/RAPID3 scores: quantitative patient history data in a standardized "scientific" format for optimal assessment of patient status and quality of care in rheumatic diseases. Bull NYU Hosp Jt Dis. 2011; 69(3):201-14. View

Pincus T, Yazici Y, Bergman M . Development of a multi-dimensional health assessment questionnaire (MDHAQ) for the infrastructure of standard clinical care. Clin Exp Rheumatol. 2005; 23(5 Suppl 39):S19-28. View

Pincus T, Sokka T, Kautiainen H . Further development of a physical function scale on a MDHAQ [corrected] for standard care of patients with rheumatic diseases. J Rheumatol. 2005; 32(8):1432-9. View

Smith R, POLLEY H . Rest therapy for rheumatoid arthritis. Mayo Clin Proc. 1978; 53(3):141-5. View

Sokka T, Pincus T . Poor physical function, pain and limited exercise: risk factors for premature mortality in the range of smoking or hypertension, identified on a simple patient self-report questionnaire for usual care. BMJ Open. 2011; 1(1):e000070. PMC: 3191419. DOI: 10.1136/bmjopen-2011-000070. View

Pincus T, Marcum S, Callahan L, Adams R, Barber J, Barth W . Longterm drug therapy for rheumatoid arthritis in seven rheumatology private practices: I. Nonsteroidal antiinflammatory drugs. J Rheumatol. 1992; 19(12):1874-84. View

Sokka T, Kautiainen H, Toloza S, Makinen H, Verstappen S, Hetland M . QUEST-RA: quantitative clinical assessment of patients with rheumatoid arthritis seen in standard rheumatology care in 15 countries. Ann Rheum Dis. 2007; 66(11):1491-6. PMC: 2111618. DOI: 10.1136/ard.2006.069252. View

Pincus T, Swearingen C, Wolfe F . Toward a multidimensional Health Assessment Questionnaire (MDHAQ): assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. Arthritis Rheum. 1999; 42(10):2220-30. DOI: 10.1002/1529-0131(199910)42:10<2220::AID-ANR26>3.0.CO;2-5. View

10.

Perandini L, de Sa-Pinto A, Roschel H, Braga Benatti F, Rodrigues Lima F, Bonfa E . Exercise as a therapeutic tool to counteract inflammation and clinical symptoms in autoimmune rheumatic diseases. Autoimmun Rev. 2012; 12(2):218-24. DOI: 10.1016/j.autrev.2012.06.007. View

11.

Castrejon I, Yazici Y, Samuels J, Luta G, Pincus T . Discordance of global estimates by patients and their physicians in usual care of many rheumatic diseases: association with 5 scores on a Multidimensional Health Assessment Questionnaire (MDHAQ) that are not found on the Health Assessment.... Arthritis Care Res (Hoboken). 2013; 66(6):934-42. DOI: 10.1002/acr.22237. View

12.

Pincus T, Askanase A, Swearingen C . A multi-dimensional health assessment questionnaire (MDHAQ) and routine assessment of patient index data (RAPID3) scores are informative in patients with all rheumatic diseases. Rheum Dis Clin North Am. 2009; 35(4):819-27, x. DOI: 10.1016/j.rdc.2009.10.017. View

13.

de Jong Z, Munneke M, Zwinderman A, Kroon H, Ronday K, Lems W . Long term high intensity exercise and damage of small joints in rheumatoid arthritis. Ann Rheum Dis. 2004; 63(11):1399-405. PMC: 1754798. DOI: 10.1136/ard.2003.015826. View

14.

Sokka T, Hakkinen A, Kautiainen H, Maillefert J, Toloza S, Mork Hansen T . Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis Rheum. 2008; 59(1):42-50. DOI: 10.1002/art.23255. View

15.

Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood J . Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002; 346(11):793-801. DOI: 10.1056/NEJMoa011858. View

16.

van den Ende C, Hazes J, le Cessie S, Mulder W, Belfor D, Breedveld F . Comparison of high and low intensity training in well controlled rheumatoid arthritis. Results of a randomised clinical trial. Ann Rheum Dis. 1996; 55(11):798-805. PMC: 1010314. DOI: 10.1136/ard.55.11.798. View

17.

Pincus T, Maclean R, Yazici Y, Harrington J . Quantitative measurement of patient status in the regular care of patients with rheumatic diseases over 25 years as a continuous quality improvement activity, rather than traditional research. Clin Exp Rheumatol. 2007; 25(6 Suppl 47):69-81. View

18.

Munneke M, de Jong Z, Zwinderman A, Jansen A, Ronday H, Peter W . Adherence and satisfaction of rheumatoid arthritis patients with a long-term intensive dynamic exercise program (RAPIT program). Arthritis Rheum. 2003; 49(5):665-72. DOI: 10.1002/art.11382. View

19.

Stucki G, Liang M, Stucki S, Bruhlmann P, Michel B . A self-administered rheumatoid arthritis disease activity index (RADAI) for epidemiologic research. Psychometric properties and correlation with parameters of disease activity. Arthritis Rheum. 1995; 38(6):795-8. DOI: 10.1002/art.1780380612. View

20.

SHORT C, BAUER W . The course of rheumatoid arthritis in patients receiving simple medical and orthopedic measures. N Engl J Med. 1948; 238(5):142-8. DOI: 10.1056/NEJM194801292380502. View