A simple extension to the Rheumatoid Arthritis Quality of Life Questionnaire (RAQol) to explore individual patient concerns and monitor group outcome in clinical practice

Objectives. To find out if the RAQol, if extended by a qualifying question on the level of concern associated with each item, can function both as a group outcome measure and as a useful tool to identify the concerns of individual patients. Methods. Thirty-seven rheumatoid arthritis (RA) patients completed the questionnaire before and after starting a biological therapy. One hundred and forty-five others receiving routine care completed it at baseline, weeks 12 and 13 with EuroQol VAS and questions on global arthritis impact and any other concerns. Reproducibility was assessed in all 59 participants whose condition remained stable between weeks 12 and 13. Results. The RAQol score was highly reproducible (intraclass correlation coefficient 0.986, n^59), reflected global RA impact (P^ 0.000, n^140), negatively correlated with EuroQol VAS (Spearman coefficient^20.639, two-tailed significance^0.000, n^142), responsive to biological therapy (two-tailed P^ 0.000) and to increased global RA impact over 12 weeks (two-tailed P^0.012, n^37), and had high internal consistency (Cronbach’s alpha^0.94, n^143). The number of issues of great concern and their percentage contribution to the RAQol score were related to global arthritis impact (P^0.000 for both) and reduced by a biological therapy (two-tailed P^0.000 and 0.001 respectively). The mean kappa for consistency in identifying each item as a concern was 0.801 (range 0.633–0.921). Conclusions. Use of the ‘extended’ RAQol in clinical practice could provide a valid and sensitive score for monitoring group outcome and a comprehensive and consistent list of an individual’s main issues of concern to assist assessment of needs in routine clinical practice. This study concerns the use of the Rheumatoid Arthritis Quality of Life Questionnaire (RAQol) in routine clinical practice to assess the specific quality-of-life needs of individual patients and to monitor the outcome of care for patient groups. The case for assessing quality of life (QoL) in the rheumatology clinic has been concisely put by Guillemin [1] who stated that ‘quality of life assessment of RA should be encouraged in clinical practice because it fosters better patient-physician relations and provides much needed long-term outcome information on drug therapy beyond clinical trials’. While the RAQol is established as a disease-specific QoL instrument potentially useful for monitoring group outcomes [2–4], the score alone is of limited utility in individual patient care. The overall objective of this study was to test whether the addition of a qualifying question regarding the level of concern associated with each item would enhance its value to the individual patient and clinician in routine clinical practice through highlighting the QoL issues currently of most concern to the patient. These key areas of concern could then be used as a focus for the consultation between patient and professional. The study therefore tested whether, with the additional questions, the RAQol would identify a comprehensive and consistent list of the specific issues relevant to the individual without compromising the validity of the RAQol score. Methods