{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T15:16:53Z","timestamp":1779895013423,"version":"3.53.1"},"reference-count":44,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T00:00:00Z","timestamp":1704844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"Netherlands Organization for Health Research and Development","doi-asserted-by":"publisher","award":["852004018"],"award-info":[{"award-number":["852004018"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ministry of Health, Welfare and Sport (Ministerie van Volksgezondheid, Welzijn en Sport)","award":["852004018"],"award-info":[{"award-number":["852004018"]}]},{"name":"Royal Dutch Society for Physical Therapy (KNGF)","award":["852004018"],"award-info":[{"award-number":["852004018"]}]},{"name":"Dutch Arthritis Society (ReumaNederland)","award":["852004018"],"award-info":[{"award-number":["852004018"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: For a subgroup of people with rheumatoid arthritis (RA) and severe disability, insight into their limitations is crucial for adequate treatment. Aim: To describe the extent and nature of functional limitations in people with RA and severe disability and to explore the associations of the extent of the functional limitations with patient characteristics, disease characteristics, and outcome measures. Methods: Baseline data of 215 participants in an RCT on the (cost-)effectiveness of longstanding physiotherapy were used. Functional limitations were assessed with the Health Assessment Questionnaire Disability Index (HAQ-DI). The total HAQ-DI including eight domain scores were calculated. Associations between high HAQ-DI scores (\u22652, yes\/no) and other variables were examined using the Student\u2019s t-test or Chi-squared test where appropriate. Results: The participants (90% women, age 58.8 \u00b1 12.8 years) had a mean HAQ-DI score of 1.7 \u00b1 0.5. The majority (56%) showed a moderate-to-severe disability in all domains. Higher HAQ-DI scores seemed to be associated with advanced age, longer disease duration, unemployment, joint replacements, and outcomes for daily functioning and physical quality of life, but not with measures of disease activity. Conclusions: Our findings indicate that a comprehensive assessment of all areas of daily activities in this subgroup is necessary in order to provide appropriate (non-)pharmacological care.<\/jats:p>","DOI":"10.3390\/jcm13020379","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T05:47:21Z","timestamp":1704865641000},"page":"379","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Extent and Nature of Functional Limitations According to the Health Assessment Questionnaire Disability Index in Patients with Rheumatoid Arthritis and Severe Functional Disability"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3235-7800","authenticated-orcid":false,"given":"Max M. H.","family":"Teuwen","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, 2300 RC Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria A. T.","family":"van Wissen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, 2300 RC Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilfred F.","family":"Peter","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, 2300 RC Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirkjan","family":"van Schaardenburg","sequence":"additional","affiliation":[{"name":"Center for Rehabilitation and Rheumatology, Reade, 1056 AA Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4352-2824","authenticated-orcid":false,"given":"Cornelia H. M.","family":"van den Ende","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Radboud UMC, 6500 GM Nijmegen, The Netherlands"},{"name":"Department of Research, Sint Maartenskliniek, 6500 GM Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maaike G. J.","family":"Gademan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, 2300 RC Leiden, The Netherlands"},{"name":"Department of Clinical Epidemiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salima F. E.","family":"van Weely","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, 2300 RC Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1002\/art.27584","article-title":"2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology\/European League against Rheumatism collaborative initiative","volume":"62","author":"Aletaha","year":"2010","journal-title":"Arthritis Rheum."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1007\/s00296-020-04731-0","article-title":"The global prevalence of rheumatoid arthritis: A meta-analysis based on a systematic review","volume":"41","author":"Almutairi","year":"2021","journal-title":"Rheumatol. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2023","DOI":"10.1016\/S0140-6736(16)30173-8","article-title":"Rheumatoid arthritis","volume":"388","author":"Smolen","year":"2016","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2050312117713647","article-title":"Quality of life in patients with established rheumatoid arthritis: A phenomenographic study","volume":"5","author":"Malm","year":"2017","journal-title":"SAGE Open Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1002\/acr.24369","article-title":"Systematic Literature Review of Residual Symptoms and an Unmet Need in Patients with Rheumatoid Arthritis","volume":"73","author":"Michaud","year":"2021","journal-title":"Arthritis Care Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1136\/ard-2022-223356","article-title":"EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update","volume":"82","author":"Smolen","year":"2023","journal-title":"Ann. Rheum. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1136\/annrheumdis-2020-217344","article-title":"EULAR definition of difficult-to-treat rheumatoid arthritis","volume":"80","author":"Nagy","year":"2021","journal-title":"Ann. Rheum. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1136\/annrheumdis-2021-220973","article-title":"EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis","volume":"81","author":"Nagy","year":"2022","journal-title":"Ann. Rheum. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1136\/annrheumdis-2011-200343","article-title":"The relationship between joint damage and functional disability in rheumatoid arthritis: A systematic review","volume":"71","author":"Bombardier","year":"2012","journal-title":"Ann. Rheum. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s12955-019-1127-8","article-title":"Health outcomes and unmet needs in patients with long-standing rheumatoid arthritis attending tertiary care in Greece: A cohort study","volume":"17","author":"Boumpas","year":"2019","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1093\/rheumatology\/36.5.551","article-title":"Measuring health-related quality of life in rheumatoid arthritis: Validity, responsiveness and reliability of EuroQol (EQ-5D)","volume":"36","author":"Hurst","year":"1997","journal-title":"Br. J. Rheumatol."},{"key":"ref_12","first-page":"231","article-title":"Health-related quality of life in early rheumatoid arthritis: Impact of disease and treatment response","volume":"8","author":"Kosinski","year":"2002","journal-title":"Am. J. Manag. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.semarthrit.2014.05.001","article-title":"The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: A systematic review and meta-analysis","volume":"44","author":"Matcham","year":"2014","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1136\/annrheumdis-2016-210602","article-title":"2016 update of the EULAR recommendations for the management of early arthritis","volume":"76","author":"Combe","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"888","DOI":"10.2340\/16501977-1191","article-title":"Goal-setting in multidisciplinary team care for patients with rheumatoid arthritis: An international multi-center evaluation of the contents using the International Classification of Functioning, Disability and Health as a reference","volume":"45","author":"Meesters","year":"2013","journal-title":"J. Rehabil. Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Teuwen, M.M.H., van Weely, S.F.E., Vliet Vlieland, T.P.M., Douw, T., van Schaardenburg, D., den Broeder, A.A., van Tubergen, A.M., van Wissen, M.A.T., van den Ende, C.H.M., and Gademan, M.G.J. (2023). Functional limitations of people with rheumatoid arthritis or axial spondyloarthritis and severe functional disability: A cross-sectional descriptive study. Rheumatol. Int., Epub ahead of print.","DOI":"10.1007\/s00296-023-05487-z"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1002\/art.1780230202","article-title":"Measurement of patient outcome in arthritis","volume":"23","author":"Fries","year":"1980","journal-title":"Arthritis Rheum."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1136\/ard.2006.059451","article-title":"Consensus Dutch Health Assessment Questionnaire","volume":"66","author":"Boers","year":"2007","journal-title":"Ann. Rheum. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"ii40","DOI":"10.1136\/ard.2004.028233","article-title":"The International Classification of Functioning, Disability and Health (ICF) Core Sets for rheumatoid arthritis: A way to specify functioning","volume":"63","author":"Stucki","year":"2004","journal-title":"Ann. Rheum. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1136\/ard.61.12.1055","article-title":"Ten year outcome in a cohort of patients with early rheumatoid arthritis: Health status, disease process, and damage","volume":"61","author":"Lindqvist","year":"2002","journal-title":"Ann. Rheum. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2027","DOI":"10.1007\/s00296-017-3833-z","article-title":"HAQ score is an independent predictor of sustained remission in patients with rheumatoid arthritis","volume":"37","author":"Lee","year":"2017","journal-title":"Rheumatol. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1007\/s10067-012-1937-0","article-title":"Potential of the HAQ score as clinical indicator suggesting comprehensive multidisciplinary assessments: The Swedish TIRA cohort 8 years after diagnosis of RA","volume":"31","author":"Thyberg","year":"2012","journal-title":"Clin. Rheumatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1002\/acr.22956","article-title":"Validity and Responsiveness of a 10-Item Patient-Reported Measure of Physical Function in a Rheumatoid Arthritis Clinic Population","volume":"69","author":"Wahl","year":"2017","journal-title":"Arthritis Care Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1002\/art.24065","article-title":"Rasch analysis of the Dutch Health Assessment Questionnaire disability index and the Health Assessment Questionnaire II in patients with rheumatoid arthritis","volume":"59","author":"Taal","year":"2008","journal-title":"Arthritis Rheum."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Heinimann, K., von Kempis, J., Sauter, R., Schiff, M., Sokka-Isler, T., Schulze-Koops, H., and M\u00fcller, R. (2018). Long-Term Increase of Radiographic Damage and Disability in Patients with RA in Relation to Disease Duration in the Era of Biologics. Results from the SCQM Cohort. J. Clin. Med., 7.","DOI":"10.3390\/jcm7030057"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1136\/ard.2009.118430","article-title":"Impact of comorbidity on physical function in patients with rheumatoid arthritis","volume":"69","author":"Radner","year":"2010","journal-title":"Ann. Rheum. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e1933","DOI":"10.1002\/pri.1933","article-title":"Effectiveness and cost-effectiveness of longstanding exercise therapy versus usual care in patients with axial spondyloarthritis or rheumatoid arthritis and severe limitations: The protocols of two parallel randomized controlled trials","volume":"27","author":"Teuwen","year":"2022","journal-title":"Physiother. Res. Int."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1002\/art.1780380106","article-title":"Validity and reliability of the twenty-eight-joint count for the assessment of rheumatoid arthritis activity","volume":"38","author":"Smolen","year":"1995","journal-title":"Arthritis Rheum."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"105","DOI":"10.5152\/eurjrheum.2020.19199","article-title":"Conversion among the 28-joint count activity indices for rheumatoid arthritis","volume":"7","author":"Leong","year":"2020","journal-title":"Eur. J. Rheumatol."},{"key":"ref_31","first-page":"304","article-title":"The use of PROMIS and assessment center to deliver patient-reported outcome measures in clinical research","volume":"11","author":"Gershon","year":"2010","journal-title":"J. Appl. Meas."},{"key":"ref_32","unstructured":"(2023, October 02). Healthmeasures: PROMIS Physical Functioning Scoring Manual. Available online: https:\/\/www.healthmeasures.net\/images\/PROMIS\/manuals\/Scoring_Manual_Only\/PROMIS_Physical_Function_Scoring_Manual_26May2022.pdf."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2731","DOI":"10.1007\/s11136-023-03422-0","article-title":"The use of PROMIS measures in clinical studies in patients with inflammatory arthritis: A systematic review","volume":"32","author":"Teuwen","year":"2023","journal-title":"Qual. Life Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1016\/S0895-4356(98)00097-3","article-title":"Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations","volume":"51","author":"Aaronson","year":"1998","journal-title":"J.Clin. Epidemiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med. Care"},{"key":"ref_36","first-page":"1","article-title":"The Stanford Health Assessment Questionnaire: Dimensions and practical applications","volume":"9","author":"Bruce","year":"2003","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1136\/ard.59.8.615","article-title":"Effect of intensive exercise on patients with active rheumatoid arthritis: A randomised clinical trial","volume":"59","author":"Breedveld","year":"2000","journal-title":"Ann. Rheum. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1007\/s00296-023-05349-8","article-title":"Difficult to treat rheumatoid arthritis in a comprehensive evaluation program: Frequency according to different objective evaluations","volume":"43","author":"Mareco","year":"2023","journal-title":"Rheumatol. Int."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1007\/s00296-014-3149-1","article-title":"The clinical burden of generalized osteoarthritis represented by self-reported health-related quality of life and activity limitations: A cross-sectional study","volume":"35","author":"Cuperus","year":"2015","journal-title":"Rheumatol. Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1136\/ard.2008.102137","article-title":"Measure of function in rheumatoid arthritis: Individualised or classical scales?","volume":"69","author":"Seror","year":"2010","journal-title":"Ann. Rheum. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e1914745","DOI":"10.1001\/jamanetworkopen.2019.14745","article-title":"Demographic Characteristics of Participants in Rheumatoid Arthritis Randomized Clinical Trials: A Systematic Review","volume":"2","author":"Strait","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Bala, S.V., Andersson, M.L.E., Forslind, K., Svensson, B., and Hafstr\u00f6m, I. (2021). Reported disability in relation to observed activity limitation, grip strength and physical function in women and men with rheumatoid arthritis. BMC Rheumatol., 5.","DOI":"10.1186\/s41927-021-00184-5"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1093\/rheumatology\/34.10.951","article-title":"Discordance between objective and subjective assessment of functional ability of patients with rheumatoid arthritis","volume":"34","author":"Hazes","year":"1995","journal-title":"Br. J. Rheumatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1002\/art.21589","article-title":"Impact of shoulder, elbow, and knee joint involvement on assessment of rheumatoid arthritis using the American College of Rheumatology Core Data Set","volume":"53","author":"Tanaka","year":"2005","journal-title":"Arthritis Rheum."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/2\/379\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:43:40Z","timestamp":1760103820000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/2\/379"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,10]]},"references-count":44,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["jcm13020379"],"URL":"https:\/\/doi.org\/10.3390\/jcm13020379","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,10]]}}}