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Measurement Characteristics and Clinical Utility of the ABILHAND Among People With Rheumatoid Arthritis

      Evaluating functional disability in people with rheumatoid arthritis is important in evaluating disease progression and therapy effectiveness.1 The ABILHAND questionnaire measures the patient’s perceived difficulty in performing everyday unimanual and bimanual activities. Durez et al1 used ABILHAND to examine self-perceived functional limitation in 112 people with rheumatoid arthritis; the study evaluated content validity with Rasch Measurement Theory. The statistical analysis with the Rasch Measurement Theory led to a selection of 27 items rated on a 3-point scale (0=impossible; 1=any difficulty; 2=easy), that fitted the Rasch measurement model. The items ranged from -2.18 to 2.65 “logits,” with higher logits indicating more difficult activities. The item-difficulty hierarchy was stable across demographic and clinical subgroups and over time. Only items about tasks that might require moderate physical strength (eg, screwing on a nut, hammering a nail, and handling a stapler) were more difficult for women than for men.1 ABILHAND has excellent internal consistency (person item separation=0.96)2 and adequate to excellent test-retest reliability (ICC 0.74-0.86).1. 3. The minimal clinically important difference was 0.47 logits for a small change, 1.18 logits for moderate change, and 1.89 logits for large change.3 Questionnaire completion takes 5-10 minutes. The website at http://www.rehab-scales.org/abilhand-rasch-analysis-rheumatoid-arthritis.html provides a free online scoring sheet, a conversion of the total score into a logit score, and a Rasch-converted percentage for each patient. ABILHAND has fair to moderate correlations with grip strength, pinch strength, and digital dexterity, ranging from r=0.42-0.56; and excellent convergent validity with the health assessment portion of the ABILHAND questionnaire (P=0.78).1
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