Health Assessment Questionnaire – Disability Index and Knee injury and Osteoarthritis Outcome Score

Date:  Thursday, April 17, 2014
Time:  6:00pm – 7:30pm Eastern Time
Speakers:  Marie Westby, UBC

Presented by : Canadian Physiotherapy Association

Cost:          Free for CPA Members.

$75 for non-members


As the Canadian population ages, physiotherapists will see a greater number of patients with arthritis conditions in both public and private practice settings.

Being the most widely used clinical tool, physiotherapists will benefit from having knowledge in the use and interpretation of the Health Assessment Questionnaire-Disability Index (HAQ-DI) to inform clinical decision-making and enhance communication with interdisciplinary colleagues. The wide spread use of the HAQ-DI in research trials also enables physiotherapists to compare their patients’ values with those reported after varied exercise and other rehabilitation interventions. The Knee injury and Osteoarthritis Outcome Score (KOOS) captures aspects of physical functioning and participation that are meaningful to patients with knee-related pathology and amenable to physiotherapy interventions. Understanding the strengths and weaknesses of both outcome measures will assist physiotherapists in their choice of relevant and feasible tools for their patients with arthritis.

The HAQ-DI is part of a larger instrument developed in 1978 at Stanford University, originally targeting individuals with rheumatoid arthritis (RA). It has since been validated with a wide variety of arthritis and non-arthritis conditions (e.g. HIV/AIDS), and in studies of normal aging. The HAQ-DI is the most commonly used tool in arthritis clinical practice and informs the use and eligibility for certain RA medications in many provinces. The HAQ-DI consists of 20 items (8 categories) and captures information about an individual’s ability to perform day-to-day activities over the past week. It also includes a numeric rating of pain severity and patient’s overall health. The HAQ is simple to apply, score and interpret and is universally used among arthritis healthcare providers. There are few if any barriers to routinely using the HAQ-DI in clinical practice.

The KOOS was developed in Sweden in the 1990’s to assess individuals’ opinions about their knee and related problems due to post-traumatic osteoarthritis (OA) and injuries that may lead to OA (e.g., ACL or meniscal injury). The KOOS has since been validated in older adults before and after knee replacement surgery, tibial osteotomy and non-surgical interventions. It is based on the WOMAC Osteoarthritis Index, but includes two additional subscales: Sports/Recreation and Quality of Life. Each of the 42 items is rated on a 5-point Likert scale and reflects the previous week. The KOOS is reliable, responsive and freely available online; however, it may take up to 10 minutes to complete and 5 minutes to score and interpret, making it less ideal for regular use by busy clinicians.

In this session, discussion around the HAQ-DI will focus on its use for individuals presenting to a physiotherapist with early or chronic RA. Administration, scoring and interpretation of the KOOS will address individuals with early to advanced knee OA. A basic understanding of OA and RA will be of benefit for physiotherapists participating in this session.


Marie is a physiotherapist with 25 years of experience in arthritis care. For her PhD, she developed best practice recommendations for rehabilitation assessment, treatment and outcome measurement after hip and knee arthroplasty. She teaches in the University of BC MPT program and arthritis continuing education courses on use of outcome measures in rheumatology.

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