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Rheumatologists Overestimate Physical Disability
Of Rheumatoid Arthritis Patients Study Finds
July 3, 2007
University of South Florida Health
Science Daily — Rheumatologists substantially overestimate the physical
disability of patients with rheumatoid arthritis – which may lead to
inaccurate evaluations of the patient’s ability to work and need for
lifestyle modifications, a new study found.
Researchers at the University of South Florida College of
Medicine and James A. Haley Veterans’ Hospital found a clear
physician-patient difference in assessment of the patients’ functional
disability. The rheumatologists consistently rated their rheumatoid
arthritis patients’ degree of difficulty in performing activities of
daily living, such as walking, dressing and eating, higher than the
patients themselves. This was particularly true for patients in
advanced stages of the disease. The findings appear in the May 2007
issue of the Journal of Rheumatology.
“We flunked,” said co-first author John D. Carter, MD, assistant
professor of medicine in the USF Division of Rheumatology. “The very
physicians deemed to be experts in rheumatoid arthritis failed to make
the grade when it came to determining their patients’ functional
status.
“This discrepancy is important to correct because patients can rely on
these assessments for their livelihood or other necessities to perform
activities of daily living.”
Rheumatologists are frequently asked to complete functional disability
reports by employers, disability attorneys, insurance companies and
government agencies weighing a person’s eligibility for disability
payments, employment, or assistive devices such as wheelchairs,
walkers, braces and splints.
Using the Stanford Health Assessment Questionnaire-Disability Index
(HAQ-DI), rheumatologists evaluated 223 patients during their regularly
scheduled visits to the USF Rheumatology Clinics and James A. Haley
Veterans’ Hospital. The effectiveness of the HAQ-DI, based on patient
self-reporting of their disability status, has been validated in
clinical studies. The questionnaire covers eight activities of daily
living: dressing, arising, eating, hygiene, walking, reach, grip and
outside activity.
Both physician and patient completed the HAQ-DI independently
immediately following the visit and their respective scores were not
shared.
The rheumatologists overestimated the degree of functional disability
in 154, or 69 percent, of the 223 the patients. However, they were
significantly more accurate at determining the degree of physical
limitations in patients with less severe disease.
The reasons for the
overestimation are
unclear, but may include empathy and suggest that even patients with
advanced rheumatoid arthritis adapt their activities to the progression
of the chronic disease, Dr. Carter said. “We tend to associate visible
joint deformities with incapacitated function, but patients may
actually be more capable than we think.”
Rheumatologists typically determine
functional disability based on the patient’s examination and medical
history, but these impressions during routine care are inadequate, Dr.
Carter said. The study points to the need for a formal, standardized
evaluation, such as the HAQ-DI. “It needs to be reimbursable and
include input from physical and occupational therapists who could add
valuable insight to the process of evaluating disability,” he added.
Rheumatoid
arthritis affects about 2.1 million Americans, or 1 percent of the
population. Over the last decade new drugs have revolutionized the
treatment of this debilitating inflammatory disease, but nearly all
patients with rheumatoid arthritis eventually develop some degree of
work or daily lifestyle disability, often severe.
Other authors of the study were Abdul B.
Lohdi, MD (co-first author); Sonia R. Nagda; Louis Ricca, MD; Colleen
Ward, DO; Erica Traina; Zachary J. Thompson; Yangxin Huang, PhD; Joanne
Valeriano, MD; and Frank B. Vasey, MD.
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