Rheumatology International

, Volume 38, Issue 7, pp 1267–1275 | Cite as

Exploring the relation between impairment rating by DAS-28 and body function, activity participation, and environmental factors based on ICF hand core set in the patient with rheumatoid arthritis

  • Elif Gür Kabul
  • Ummuhan Baş Aslan
  • Bilge Başakçı ÇalıkEmail author
  • Murat Taşçı
  • Veli Çobankara
Validation Studies


Hand problems associated with rheumatoid arthritis lead to subjective impairment, activity limitation, and restrictions on participation. This relation is very complex. Assessment of individuals’ activities is important to determine how hand problems affect not only body functions but also daily life activities. The aim of this study was to link and allocate items of disability questionnaires with ICF components based on ICF hand core set. The other objective was to examine the relationship between impairment and ICF components determined on the basis of disability questionnaires in participants with rheumatoid arthritis. Impairment was evaluated by use of Disease Activity Score-28. Disability questionnaires were Disabilities of Arm, Shoulder and Hand Questionnaire, Michigan Hand Outcomes Questionnaire, Duruoz Hand Index, and Arthritis Impact Measurement Scales 2 (n = 100). Items of disability questionnaires were linked with ICF hand core set as a result of three expert opinions. Michigan Hand Outcomes Questionnaire covered the highest number of body function categories and Arthritis Impact Measurement Scales 2 covered the highest number of ICF hand core set. For all questionnaires, while impairment (Disease Activity Score-28) had moderate correlation with subjective impairment (body function scores) and activity/participation; subjective impairment had high and moderate correlation with activity participation. Arthritis Impact Measurement Scale 2 is the most appropriate to perform a more comprehensive biopsychosocial assessment. Clinician’s assessments and impairment levels reported by patients with rheumatoid arthritis are interrelated. Impairment levels reported by patients with rheumatoid arthritis are also affected by environmental factors.


Rheumatoid arthritis Outcome measures Disability ICF DAS28 



The authors are grateful for the support of the Caroline Jane Walker, who has made her English editing and Hande Senol and Pervin Demir, who have made their statistical editing.

Author contributions

EGK, UBA, and BBC designed the study. MT and VC searched databases and performed the selection of studies; EGK, UBA, and BBC wrote the manuscript; EGK, UBA, and BBC analyzed the data; and UBA, BBC, and VC contributed to writing and critically uprising the manuscript and approved the last version.


This study did not receive any specific grant from funding agencies.

Compliance with ethical standards

Conflict of interest

Author Elif Gur Kabul, Author Ummuhan Bas Aslan, Author Bilge Başakcı Calik, Author Murat Tasci, and Author Veli Cobankara declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

296_2018_4060_MOESM1_ESM.docx (37 kb)
Supplementary material 1 (DOCX 36 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Physical Therapy and RehabilitationPamukkale UniversityDenizliTurkey
  2. 2.Department of RheumatologyMedical Faculty of Pamukkale UniversityDenizliTurkey

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