McMaster-Toronto Arthritis Patient Preference Disability Questionnaire

Abstract

The McMaster-Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR) is a specialized instrument designed to measure changes in functional status related to chronic disease, particularly in patients suffering from arthritis. The core strength of the MACTAR lies in its patient-centric approach, focusing on five specific areas of functioning that the patient identifies as personally important. In addition to these personalized domains, the scale assesses broader changes in quality of life, physical functioning, social functioning, and overall emotional state. Structured as a semi-structured interview, the MACTAR consists of two distinct parts: a baseline interview, which establishes the patient’s priorities, and a follow-up interview, which measures the degree of change. While highly sensitive to detecting even minor changes in functional status, its application is limited by the necessity for highly trained interviewers and its relatively complex scoring methodology.

Keywords

MACTAR, arthritis, patient preference, functional disability, quality of life measurement, musculoskeletal disorders, semi-structured interview, patient-reported outcome.

Authors

Tugwell P, Bombardier C, Buchanan W, et al. (1987); Dutch Version: Verhoeven A (1997/2000).

Purpose

The primary purpose of the MACTAR is to quantify the degree of change in disease-related functioning from the perspective of the patient, specifically targeting individuals with conditions affecting the musculoskeletal system, such as arthritis. Unlike standardized instruments that use fixed item sets, the MACTAR prioritizes the individual patient’s experience by allowing them to nominate the areas of functioning that are most significant to their daily life.

This approach ensures that the measurement of clinical improvement or deterioration is relevant to the patient’s personal goals and perceived limitations. It is particularly valuable in clinical trials and longitudinal studies where detecting small yet meaningful shifts in functional status over time is crucial for evaluating treatment efficacy.

Construct

The MACTAR measures the construct of Patient-Defined Disability and Functional Change. This construct encompasses the impact of a chronic condition on the individual’s ability to perform activities and participate socially, filtered through the patient’s subjective appraisal of importance. It moves beyond purely objective physical measures by incorporating dimensions of health-related quality of life, including physical, social, and emotional functioning.

The scale operationalizes this construct by identifying five specific areas (activities) that the patient finds difficult due to their condition but considers vital for their well-being. The subsequent follow-up assessment then measures the degree to which these specific self-identified limitations have improved or worsened. This emphasis on patient preference ensures high relevance and sensitivity to individual therapeutic responses.

Validity

The source content indicates that the MACTAR is particularly effective at detecting small changes in functional status, suggesting high responsiveness (a form of known-groups or criterion validity in longitudinal settings). This responsiveness is considered a major advantage, making it suitable for monitoring subtle treatment effects.

However, specific details regarding internal consistency, content validity, or detailed criterion validity statistics (e.g., correlation coefficients with established scales) were not provided in the source material. Its validity is heavily supported by its conceptual design, which ensures high face validity and ecological relevance by centering the measurement on patient priorities.

Reliability

Detailed psychometric data on test-retest reliability or inter-rater reliability (despite requiring trained interviewers) are not available in the provided source description. The inherent complexity of the scoring and the requirement for baseline data at follow-up interviews suggest that procedural reliability is paramount.

Factor Analysis

The structure of the MACTAR, which combines five patient-defined items with broader, standardized domains (physical, social, emotional functioning), does not lend itself easily to traditional exploratory factor analysis across the core personalized disability items. No specific factor analysis results are detailed in the source content.

Instrument

Test Type: Questionnaire (Structured Interview)

Format: Semi-structured interview, administered in two parts (baseline and follow-up).

Language Available: Original English; Dutch version available.

Population Group: Adults, Elderly.

Age Group: Adult population (typically 18+).

Population Details: Individuals diagnosed with conditions affecting the musculoskeletal system, specifically those with bone, joint, or cartilage disorders, such as rheumatoid arthritis.

Test Methodology: The instrument requires trained interviewers due to the semi-structured format and complex scoring system. It measures five patient-prioritized areas of functional limitation, alongside general measures of physical, social, and emotional functioning, all assessed from the patient’s perspective.

Keywords

Musculoskeletal assessment, patient-reported outcome, disability questionnaire, MACTAR, longitudinal measurement, functional limitation, personalized assessment.

Authors

Author ORCID Identifier: Information not provided in the source material.

Affiliation Email addresses: Information not provided in the source material.

Correspondence Address: Information not provided in the source material.

Permissions & Fee and Test Year

The original version of the MACTAR was published in 1987 by Tugwell, Bombardier, Buchanan, et al. The Dutch version was established by Verhoeven in 1997/2000. Information regarding current usage fees or specific licensing permissions for the scale was not provided in the source material.

Reference’s

• Tugwell, P., Bombardier, C., Buchanan, W. W., et al. (1987). The MACTAR Patient Preference Disability Questionnaire—An index of functional capacity in rheumatoid arthritis. Arthritis and Rheumatism, 30(4), 449-452.
• Verhoeven, A. (1997/2000). Nederlandse versie van de McMaster-Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR). [Dutch version documentation.]

Items of the McMaster-Toronto Arthritis Patient Preference Disability Questionnaire

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The MACTAR is a semi-structured interview, and the five core disability items are generated by the patient during the baseline interview, making the item list dynamic and unique to each respondent. The full instrument and explanatory notes provide detailed instructions for eliciting these items and for scoring the follow-up responses.

The explanatory form (Toelichtingsformulier) can be downloaded here: Toelichtingsformulier.

The original PDF of the measurement instrument (Meetinstrument) can be downloaded here: Meetinstrument.