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Qual Life Res. 2010 Nov;19(9):1255-63. doi: 10.1007/s11136-010-9690-9. Epub 2010 Jun 18.

Application of the health assessment questionnaire disability index to various rheumatic diseases.

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  • 1Institute for Behavioral Research, Faculty of Behavioral Sciences, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.



To investigate whether the Stanford Health Assessment Questionnaire Disability Index (HAQ-DI) can serve as a generic instrument for measuring disability across different rheumatic diseases and to propose a scoring method based on item response theory (IRT) modeling to support this goal.


The HAQ-DI was administered to a cross-sectional sample of patients with confirmed rheumatoid arthritis (n = 619), osteoarthritis (n = 125), or gout (n = 102). The results were analyzed using the generalized partial credit model as an IRT model.


It was found that 4 out of 8 item categories of the HAQ-DI displayed substantial differential item functioning (DIF) over the three diseases. Further, it was shown that this DIF could be modeled using an IRT model with disease-specific item parameters, which produces measures that are comparable for the three diseases.


Although the HAQ-DI partially functioned differently in the three disease groups, the measurement regarding the disability level of the patients can be made comparable using IRT methods.

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