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Brief Report: Adaptation of American College of Rheumatology Rheumatoid Arthritis Disease Activity and Functional Status Measures for Telehealth Visits


Arthritis Care Res (Hoboken). 2020 Aug 19. doi: 10.1002/acr.24429. Online ahead of print.

Bryant R England 1, Claire E H Barber 2 3, Martin Bergman 4, Veena K Ranganath 5, Lisa G Suter 6, Kaleb Michaud 1 7

Author Information

1 Division of Rheumatology & Immunology, University of Nebraska Medical Center & VA Nebraska-Western Iowa Heath Care System, Omaha, NE, United States.

2 Department of Medicine & Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

3 Arthritis Research Canada, Canada.

4 Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, United States.

5 University of California, David Geffen School of Medicine, Los Angeles, California, USA.

6 Yale University School of Medicine, Department of Medicine, Section of Rheumatology, Yale-New Haven Health System, Center for Outcome Research and Evaluation, Veterans Affairs Connecticut Health System, United States.

7 FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, United States.


Objective: To provide guidance on the implementation of recommended American College of Rheumatology (ACR) rheumatoid arthritis (RA) disease activity and functional status assessment measures in telehealth settings.

Methods: An expert panel was assembled from the recently convened ACR RA disease activity and functional status measures working groups to summarize strategies for implementation of ACR recommended RA disease activity (Clinical Disease Activity Index [CDAI], 28-joint Disease Activity Score [DAS28-ESR/CRP], Patient Activity Scale [PAS-II], Simplified Disease Activity Index [SDAI], Routine Assessment of Patient Index Data 3 [RAPID3]) and functional status (Health Assessment Questionnaire-II [HAQ-II], Multidimensional Health Assessment Questionnaire [MDHAQ], PROMIS physical function 10-item short form [PROMIS PF-10]) measures in telehealth settings.

Results: Measures composed of patient-reported items (disease activity: PAS-II, RAPID3; functional status: HAQ-II, MDHAQ, PROMIS PF-10) require minimal modification for use in telehealth settings. Measures requiring formal joint counts (CDAI, DAS28-ESR/CRP, and SDAI) can be calculated using patient-reported swollen and tender joint counts. When the feasibility of lab testing is limited, CDAI can be used in place of the SDAI and scoring modifications of the DAS28-ESR/CRP without the acute phase reactant are available. Assessment of the validity of these modifications is limited. Implementation of these measures can be facilitated by electronic health record collection, mobile applications, and provider/staff administration during telehealth visits.

Conclusions: ACR recommended RA disease activity and functional status measures can be adapted for use in telehealth settings to support high-quality clinical care. Research is needed to better understand how telehealth settings may impact the validity of these measures.