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McMaster Toronto Arthritis Patient Preference Questionnaire

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Purpose

The McMaster Toronto Arthritis Patient Preference Questionnaire (MACTAR) is a semi-structured interview assessing activity limitation and participation restriction, consisting of a baseline interview and a follow-up interview for patients with RA, myositis, and osteoarthritis of the hip-and-knee

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Instrument Details

Acronym MACTAR

Area of Assessment

Activities of Daily Living
Life Participation
Quality of Life

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Populations

Musculoskeletal Conditions
Orthopedic Surgery
Back Pain
Arthritis

Key Descriptions

  • ● Baseline interview and a follow-up interview
    ● Interviews contain predefined questions on general health, physical function, social function and emotional function
    ● Rated on a five grade Likert Scale from 1 (poor health) to 5 (good health)
    ● Patients are asked to state five activities of daily living that are limited due to RA and rank the 5 activities starting with most important to improve.
    ● Baseline interview usually not scored; scoring of follow-up interview is done to calculate change scores
    ● Scoring approaches vary; most common approach is summary scoring using the formula ∑([6 - rank] x change score), where highest ranked activity is weighted 5 and lowest is ranked 1

Number of Items

● Baseline interview made up of five (5) questions designed to solicit a list of activities affected by the patient’s condition
● Additional questions seek clarification on the patient’s priorities (ranking activities most important to the patient); usually results in identification and ranking of five (5) activities
● Follow up interview assesses changes in the priority activities (e.g., worse, better, the same)

Equipment Required

  • Interview guide

Time to Administer

10-15 minutes

Required Training

Training Course

Required Training Description

Interviewers should be trained to administer the interview although type and approach to training is not reported in the literature.

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

PCOM Georgia Physical Therapy Program: 

Leeanne-Rose Bagaoisan

Rayna Green

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living

Considerations

  • MACTAR requires a subjective calculation of change based on patient preferences which may lack stability due to its subjective nature.
  • The functional status questions in the MACTAR are standardized and are often not important to the patient.
  • Long-term follow up questions include baseline activities that are not as important as the patient’s disability status changes.
  • MACTAR may be more suited for monitoring changes in function of patients over short periods of time due to the complexity of the scoring system.

Orthopedic Surgery

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Standard Error of Measurement (SEM)

Total Hip Arthroplasty: (Wright & Young, 1997a; n= 78; mean age= 62.2 (25-87) years) -- calculated from SD of change score (8) and post-operative correlation (ICC) for inter-rater reliability (0.78)

  • SEM for entire group (n=78): 3.75

Minimal Detectable Change (MDC)

Total Hip Arthroplasty: (Wright and Young, 1997a) -- calculated from SD of change score (8) and post-operative correlation (ICC) for inter-rater reliability (0.78)

  • MDC for entire group (n= 78): 10.40 (95% CI)

Interrater/Intrarater Reliability

Total Hip Arthroplasty: (Wright and Young, 1997a)

  • Excellent inter-rater reliability: (ICC 0.78)

Criterion Validity (Predictive/Concurrent)

Total Hip Arthroplasty: (Wright and Young, 1997a) -- Concurrent; comparison with disease specific measures and subscales on the SF -36

  • Adequate correlation with Harris Hip Scale (rho = 0.50)
  • Excellent correlation with Western Ontario and McMaster Osteoarthritis scale (WOMAC) Disability/Function subscale (rho = 0.66
  • Adequate correlation with WOMAC Pain subscale (rho = 0.39)
  • Adequate correlation with WOMAC Stiffness subscale (rho = 0.37)
  • Excellent correlation with SF-36 Physical Functioning subscale (rho = 0.66)
  • Excellent correlation with SF-36 Physical Health subscale (rho = 0.61)
  • Poor correlation with SF-36 Emotional Problems subscale (rho = 0.30)
  • Adequate correlation with SF-36 Energy/Fatigue subscale (rho = 0.45)
  • Poor correlation with SF-36 Mental Health subscale (rho = 0.28)
  • Adequate correlation with SF-36 Social Functioning subscale (rho = 0.56)
  • Adequate correlation with SF-36 Pain subscale (rho = 0.58)
  • Poor correlation with SF-36 General Health subscale (rho = 0.30)
  • Excellent correlation with the Patient-Specific Index (PASI) (rho = 0.65)

Construct Validity

Total Hip Arthroplasty: (Wright and Young, 1997b, n = 78, mean age = 62.2)

  • Excellent correlation with the PASI (rho = 0.61 - 0.64)

Responsiveness

Total Hip Arthroplasty: (Wright and Young, 1997a)

  • Standardized response mean (SRM = 4.9)

Arthritis

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Standard Error of Measurement (SEM)

Rheumatoid Arthritis : (Heimans et. al, 2013 n= 610; Early remission group - age= 52 +/- 14 years; symptom duration: 17 (9 to 30) weeks; Arm 1 - age = 48 +/-14 years, symptom duration: 22 (9 to 40) weeks; Arm 2 - age = 51 +/- 14 years, symptom duration: 21 (8 - 29) weeks; OP group - age = 54 +/- 14 years, symptom duration: 18 (9 - 42) weeks)

  • Early remission: SEM = 0.229 (calculated using group mean and square root of n)
  • Arm 1: SEM = 0.471 (calculated using group mean and square root of n)
  • Arm 2: SEM = 0.464  (calculated using group mean and square root of n)
  • OP group: SEM = 0.736  (calculated using group mean and square root of n)

Rheumatoid arthritis : (Brodin et al, 2017, age=57 years)

  • SEM= 2.3-4.3  (n=8)

Minimal Detectable Change (MDC)

Rheumatoid arthritis : (Brodin et al, 2017, age=57 years)

  • Reported as SDD (smallest detectable difference) = 6.2 - 11.7

Test/Retest Reliability

Rheumatoid Arthritis (Munters et. al, 2014, n = 45, mean age 59 years, duration of diagnosis = 10 years)

  • Weighted Kappa = 0.59

Criterion Validity (Predictive/Concurrent)

Rheumatoid Arthritis (Munters et. al, 2014, n = 45, mean age 59 years, duration of diagnosis = 10 years)

  • Excellent correlation with the Disease Activity Score (DAS28) (rho = -0.65)
  • Excellent correlation with pain ratings (rho = 0.61)
  • Excellent correlation with global assessment of patients’ well being (PGA) (rho = -0.61)
  • Adequate correlation with the Stanford Health Assessment Questionnaire Disability Index (HAQ) (rho = -0.51)
  • Adequate correlation with the Shoulder Function Assessment (SFA) (rho = 0.38)
  • Poor correlation with the Timed-stands Test (TST) (rho = -0.19)

Osteoarthritis (Barten et al, 2012; n = 192, mean age 64.7 (7.9))

Concurrent Validity

  • Adequate correlation with change scores on the physical function subscales of the WOMAC (rho = -0.40)
  • Poor correlation with change scores on the physical function subscale of the SF-36 (rho = 0.27)
  • Adequate correlation with SF-36 General Health subscale (rho = 0.44)
  • Excellent correlation with the Patient Global Assessment (PGA) (rho = 0.69)

Predicitive Validity

  • Excellent prediction (AUC = 0.90)

 

Osteoarthritis (Sanchez et al, 2016; mean age = 65.3 (10.9) years, mean pain duration = 6.7 (7.8) years)

  • Adequate correlation with WOMAC (r = 0.4)
  • Adequate correlation with pain ratings on NRS (r = 0.4)
  • Adequate correlation with global assessment on NRS (r = 0.4)
  • Adequate correlation with functional impairment ratings on NRS (r = 0.5)
  • Poor correlation with Lequesne Index (r = 0.3)
  • Poor correlation with the Hospital Anxiety & Depression Scale - Anxiety (HADa) (r =- 0.2)
  • Poor correlation with the HADd (depression) (r = 0.3)
  • Poor correlation with the FABQ-Physical Activity scale (r = 0.1)
  • Poor correlation with the Satisfaction with Life Scale (SWLS) (r = -0.3)

Construct Validity

Rheumatoid Arthritis: (Verhoeven et al, 2000, mean age = 50 years)

  • Excellent correlation with Health Assessment Questionnaire (r = -0.73)
  • Excellent correlation with Arthritis Impact Measurement Scale (AIMS) mobility scale (r = 0.61)
  • Adequate correlation with grip strength (r = 0.46)
  • Excellent correlation with AIMS pain scale (r = -0.71)
  • Adequate correlation with AIMS self-efficacy scale (r= 0.55)

Content Validity

Rheumatoid Arthritis (Verhoeven et al, 2000, mean age = 50 years))

  • Assessed by comparison of items with the HAQ by two independent judges; Cohen’s kappa used to assess interrater reliability of agreement between judges. (values for Cohen’s kappa not reported)

Osteoarthritis (Barten et al, 2012; n = 192, mean age 64.7 (7.9))

  • Compared impaired activities identified by patients with items on the WOMAC and SF-36 Physical Function subscales
  • All items on the two comparison instruments were represented on the list of impaired activities identified on the MACTAR
  • 27% of activities identified by patients on the MACTAR were not included in the WOMAC; 41% on the SF-36

Back Pain

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Criterion Validity (Predictive/Concurrent)

Chronic Low Back Pain: (Sanchez et. al, 2011; n= 100;  mean age- 54.2 (15.2) years; mean disease duration 89.6 (85))

  • Excellent correlation with scores on the Quebec Back Pain Disability Questionnaire (QUEBEC) (rho = 0.61)
  • Adequate correlation with scores on global handicap VAS scores (rho = 0.53)
  • Adequate correlation with scores on sciatic pain VAS (rho = 0.43)
  • Adequate correlation with scores on LBP VAS (rho = 0.39)
  • Adequate correlation with scores on the Fear Avoidance Behavior Questionnaire (FABQ) (rho = 0.39)

Responsiveness

Chronic Low Back Pain: (Sanchez et. al, 2011; n= 100;  mean age- 54.2 (15.2) years; mean disease duration 89.6 (85))

  • ES = 0.37 (SRM = 0.25) - considering priorities defined by subjects at baseline
  • ES = 0.06 (SRM = 0.04) - considering shifts in priorities at 6 months
  • ES = 1.00 (SRM = 0.66) - considering baseline priorities for subjects whose condition improved
  • ES = 0.60 (SRM = 0.38) - considering shifts in baseline priorities for subjects whose condition improved
  • ES = 0.09 (SRM = 0.02) - considering baseline priorities for subjects whose condition did not improve
  • ES = 0.009 (SRM = 0.008) - considering shifts in baseline priorities for subjects whose condition did not improve
  • ES = -0.26 (SRM = -0.21) - considering baseline priorities for subjects whose condition deteriorated
  • ES = -0.58 (SRM) = -0.46 - considering shifts in baseline priorities for subjects whose condition deteriorated

Musculoskeletal Conditions

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Test/Retest Reliability

Polymyositis and dermatomyositis: (Munters et al. 2011; n= 28; mean age- 57 (28-74) years; mean disease duration- 9 years (1-32)

  • Excellent test-retest reliability (ICC = 0.83)
  • Weighted Kappa = 0.68

Criterion Validity (Predictive/Concurrent)

Polymyositis and dermatomyositis (Munters et al. 2011)

  • Excellent correlation with SF-36 Mental Health subscale (rho = -0.73)
  • Excellent correlation with SF-36 Social Functioning subscale (rho = -0.70)
  • Excellent correlation with SF-36 Emotional subscale (rho = -0.67)
  • Adequate correlation with Health Assessment Questionnaire (HAQ) (rho = 0.57
  • Adequate correlation with Myositis Activities Profile (MAP) (rho = 0.51)
  • Adequate correlation with Manual Muscle Test (MMT) (rho = -0.46)
  • Poor correlation with the Functional Index -2 (FI-2) (rho = -0.29)
  • Poor correlation with Myositis Damage Index Global (MDI) (rho = 0.11)
  • Poor correlation with physicians’ assessment of global disease activity (MYOACT Global) (rho = 0.13)
  • Poor correlation with physicians’ assessment of global extra skeletal muscle disease activity (MYOACT Extra) (rho = 0.03)
  • Poor correlation with serum levels of creatine phosphokinase (rho = 0.14)

Bibliography

Barten, D., Pisters, M., Takken, T., & Veenhof, C. (2012). Validity and responsiveness of the dutch McMaster toronto arthritis patient preference questionnaire (MACTAR) in patients with osteoarthritis of the hip or knee. The Journal of Rheumatology, 39, 1064-73. doi:10.3899/jrheum.110876

Brodin, N., Grooten, W. J. A., Stråt, S., Löfberg, E., & Alexanderson, H. (2017). The McMaster toronto arthritis patient preference questionnaire (MACTAR): A methodological study of reliability and minimal detectable change after a 6 week-period of acupuncture treatment in patients with rheumatoid arthritis Springer Science and Business Media LLC. doi:10.1186/s13104-017-2991-0

Bulthuis, Y., ssaers-Bakker, K. W., Taal, E., Rasker, J., Oostveen, J., van 't Pad Bosch, P, et al. (2007). Arthritis patients show long-term benefits from 3 weeks intensive exercise training directly following hospital discharge. Rheumatology (Oxford, England), 46(11), 1712-1717. doi:10.1093/rheumatology/kem236

Bulthuis, Y., Mohammad, S., Braakman‐Jansen, L. M. A., Drossaers‐Bakker, K. W., & van de Laar, Martin A. F. J. (2008). Cost‐effectiveness of intensive exercise therapy directly following hospital discharge in patients with arthritis: Results of a randomized controlled clinical trial. Arthritis and Rheumatism, 59(2), 247-254. doi:10.1002/art.23332

Heimans, L., Wevers-de Boer, Kirsten V C, Koudijs, K. K. M., Visser, K., Goekoop-Ruiterman, Y. P., Harbers, J. B., et al. (2013). Health-related quality of life and functional ability in patients with early arthritis during remission steered treatment: Results of the IMPROVED study. Arthritis Research & Therapy, 15(5), R173. doi:10.1186/ar4361

Clinch J, Tugwell P, Wells G, & Shea B. (2001). Individualized functional priority approach to the assessment of health related quality of life in rheumatology. Journal of Rheumatology, 28(2), 445-451. Retrieved from MEDLINE database. Retrieved from http://www.jrheum.org/content/28/2/445.abstract

Katz, P. P. (2003). Measures of adult general functional status: The barthel index, katz index of activities of daily living, health assessment questionnaire (HAQ), MACTAR patient preference disability questionnaire, and modified health assessment questionnaire (MHAQ). Arthritis Care and Research, 49(5), S15-S27.

Munters, LA., van Vollenhoven, R. F., & Alexanderson, H. (2011). Patient preference assessment reveals disease aspects not covered by recommended outcomes in polymyositis and dermatomyositis. ISRN Rheumatology, 2011, 463124-5. doi:10.5402/2011/463124

Munters LA, Brodin N, Lofberg E, Strat S, Alexanderson H. (2014). Disabilities of importance for patients to improve - using a patient preference tool in rheumatoid arthritis. Disability and Rehabilitation, 36 (21), 1762 - 1767.

Sanchez, K., Papelard, A., Nguyen, C., Rannou, F., Revel, M., & Poiraudeau, S. (2010). 084 mcmaster-toronto arthritis patient preference disability questionnaire (mactar) sensitivity to change in disabling chronic low back pain: Influence of shifts in patients priorities over time. Osteoarthritis and Cartilage, 18, S43-S44. doi:10.1016/S1063-4584(10)60111-2

Tugwell, P., Bombardier, C., Buchanan, W. W., Goldsmith, C. H., Grace, E., & Hanna, B. (1987). The MACTAR patient preference disability questionnaire: An individualized functional priority approach for assessing improvement in physical disability in clinical trials in rheumatoid arthritis. Journal of Rheumatology, 14(3), 446-451. Retrieved from MEDLINE database. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/3305931

Verhoef, J., Toussaint, P. J., Zwetsloot‐Schonk, J. H. M., Breedveld, F. C., Putter, H., & VlielanD, Theodora P. M. Vliet. (2007). Effectiveness of the introduction of an international classification of functioning, disability and health–based rehabilitation tool in multidisciplinary team care in patients with rheumatoid arthritis. Arthritis and Rheumatism, 57(2), 240-248. doi:10.1002/art.22539

Verhoeven, A. C., Boers, M., & van der Linden, S. (2000). Validity of the MACTAR questionnaire as a functional index in a rheumatoid arthritis clinical trial. Journal of Rheumatology, 27(12), 2801-2809.

Wright, J. G., & Young, N. L. (1997a). A comparison of different indices of responsiveness. Journal of Clinical Epidemiology, 50(3), 239-246. doi:10.1016/S0895-4356(96)00373-3

Wright, J., & Young, N. (1997b). The patient-specific index: Asking patients what they want. Journal of Bone and Joint Surgery. American Volume, 79(7), 974-83. doi:10.2106/00004623-199707000-00003

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