Assessments of disability in women with rheumatoid arthritis in relation to grip force and pain

The aim of this study was to assess disability with the Health Assessment Questionnaire (HAQ) and to evaluate the relationships between grip force, pain and difficulty in daily activities. Twenty women with rheumatoid arthritis were assessed with measurements of grip force and pain before and after grip test. Both the original HAQ version and an alternative rating model, not taking the use of assistive devices into account, were used. All patients reported pain which significantly increased after grip test and with a significant inverse correlation to grip force. All patients had assistive devices, on average 15 devices (range 1-27). Ninety-one per cent of the patient's devices were in continued use, most frequently in the categories; Eating, Grip and Hygiene. Disability was significantly correlated to pain, grip force and use of assistive devices. When using the alternative ratings of 20 questions in HAQ, 8 of the 20 questions showed significantly (p = 0.0003-0.0339) lower scoring, and the number of questions with significant correlations between grip force and disability increasing from 9 (r = 0.48-0.74, p = 0.039-0.001) to 14 questions (r = 0.47-0.74, p = 0.047-0.001). Difference between intrinsic disability (without assistive devices) and actual disability (with such assistance) is not reflected in original HAQ. The present study indicates that assessment of actual disability by the alternative rating model is more often correlated to impairment (grip force) than disability assessed by original HAQ and can be considered to give a better assessment of actual disability than the original HAQ model.