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2019 American College of Rheumatology Recommended Patient-Reported Functional Status Assessment Measures in Rheumatoid Arthritis


Barber CEH1, Zell J2, Yazdany J3, Davis AM4, Cappelli L5, Ehrlich-Jones L6, Everix D7, Thorne JC8, Bohm V1, Suter L9, Limanni A10, Michaud K11. Arthritis Care Res (Hoboken). 2019 Dec;71(12):1531-1539. doi: 10.1002/acr.24040. Epub 2019 Nov 11.

Author Information

1 University of Calgary, Calgary, Alberta, Canada.

2 Denver Health, Denver, Colorado.

3 University of California, San Francisco.

4 Krembil Research Institute, University Health Network, and University of Toronto, Toronto, Ontario, Canada.

5 Johns Hopkins University, Baltimore, Maryland.

6 Shirley Ryan AbilityLab, Chicago, Illinois.

7 Mills Peninsula Health Services, Burlingame, California, and OnMyCare Home Health, Fremont, California.

8 University of Toronto, Toronto, Ontario, Canada.

9 Yale University, New Haven, Connecticut, and Veterans Affairs Medical Center, West Haven, Connecticut.

10 Arthritis Centers of Texas, Dallas.

11 University of Nebraska Medical Center, Omaha, and FORWARD, the National Databank for Rheumatic Diseases, Wichita, Kansas.



To develop American College of Rheumatology (ACR) recommendations for patient-reported Functional Status Assessment Measures (FSAMs) for use in routine clinical practice in patients with rheumatoid arthritis (RA).


We convened a workgroup to conduct a systematic review of published literature through March 16, 2017 and abstract FSAM properties. Based upon initial search results and clinical input, we focused on the following FSAMs appropriate for routine clinical use: the Health Assessment Questionnaire (HAQ) and derived measures and the Patient-Reported Outcomes Measurement Information System (PROMIS) tool. We used the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 4-point scoring method to evaluate each FSAM, allowing for overall level of evidence assessment. We identified FSAMs fulfilling a predefined minimum standard and, through a modified Delphi process, selected preferred FSAMs for regular use in most clinic settings.


The search identified 11,835 articles, of which 56 were included in the review. Descriptions of the measures, properties, study quality, level of evidence, and feasibility were abstracted and scored. Following a modified Delphi process, 7 measures fulfilled the minimum standard for regular use in most clinic settings, and 3 measures were recommended: the PROMIS physical function 10-item short form (PROMIS PF10a), the HAQ-II, and the Multidimensional HAQ.


This work establishes ACR recommendations for preferred RA FSAMs for regular use in most clinic settings. These results will inform clinical practice and can support future ACR quality measure development as well as highlight ongoing research needs.