Measuring impairments of functioning and health in patients with axial spondyloarthritis by using the ASAS Health Index and the Environmental Item Set: translation and cross-cultural adaptation into 15 languages

U Kiltz; D van der Heijde; A Boonen; W Bautista-Molano; R Burgos-Vargas; P Chiowchanwisawakit; T Duruoz; B El-Zorkany; I Essers; I Gaydukova; P Géher; L Gossec; S Grazio; J Gu; M A Khan; T J Kim; W P Maksymowych; H Marzo-Ortega; V Navarro-Compán; I Olivieri; D Patrikos; F M Pimentel-Santos; M Schirmer; F van den Bosch; U Weber; J Zochling; J Braun

doi:10.1136/rmdopen-2016-000311

Measuring impairments of functioning and health in patients with axial spondyloarthritis by using the ASAS Health Index and the Environmental Item Set: translation and cross-cultural adaptation into 15 languages

RMD Open. 2016 Oct 4;2(2):e000311. doi: 10.1136/rmdopen-2016-000311. eCollection 2016.

Authors

U Kiltz¹, D van der Heijde², A Boonen³, W Bautista-Molano⁴, R Burgos-Vargas⁵, P Chiowchanwisawakit⁶, T Duruoz⁷, B El-Zorkany⁸, I Essers³, I Gaydukova⁹, P Géher¹⁰, L Gossec¹¹, S Grazio¹², J Gu¹³, M A Khan¹⁴, T J Kim¹⁵, W P Maksymowych¹⁶, H Marzo-Ortega¹⁷, V Navarro-Compán¹⁸, I Olivieri¹⁹, D Patrikos²⁰, F M Pimentel-Santos²¹, M Schirmer²², F van den Bosch²³, U Weber²⁴, J Zochling²⁵, J Braun¹

Affiliations

¹ Rheumazentrum Ruhrgebiet , Herne , Germany.
² Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
³ Division of Rheumatology, Department of Internal Medicine , Maastricht University Medical Center , Maastricht , The Netherlands.
⁴ Rheumatology Department, Faculty of Medicine , HMC/UMNG , Bogota , Colombia.
⁵ Department of Rheumatology , Hospital General de Mexico and Universidad Nacional Autonoma de Mexico , Mexico City , Mexico.
⁶ Mahidol University , Bangkok , Thailand.
⁷ PM&R Department, Rheumatology Division , Marmara University, School of Medicine , Istanbul , Turkey.
⁸ Rheumatology Department , Cairo University , Cairo , Egypt.
⁹ Saratov State Medical University , Saratov , Russian Federation.
¹⁰ Semmelweis University , Budapest , Hungary.
¹¹ Department of Rheumatology , Sorbonne Universités, UPMC Univ, Paris 06, Institut Pierre Louis d'Epidémiologie et de, Santé Publique, GRC-UPMC 08 (EEMOIS); AP-HP,Pitié Salpêtrière Hospital , Paris , France.
¹² Sisters of Mercy University Hospital , Zagreb , Croatia.
¹³ Department of Rheumatology , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China.
¹⁴ Case Western Reserve University Cleveland , Cleveland, Ohio , USA.
¹⁵ Department of Rheumatology , Chonnam National University Medical School and Hospital , Gwangju , South Korea.
¹⁶ Division of Rheumatology, Department of Medicine , University of Alberta , Edmonton, Alberta , Canada.
¹⁷ Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Alberton Hospital , Leeds , UK.
¹⁸ University Hospital La Paz , Madrid , Spain.
¹⁹ Rheumatology Department of Lucania , San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera , Potenza , Italy.
²⁰ Metropolitan Hospital , Athens , Greece.
²¹ NOVA Medical School and CEDOC, Chronic Diseases, NOVA University of Lisbon , Lisboa , Portugal.
²² Department of Internal Medicine VI , Medical University of Innsbruck , Innsbruck , Austria.
²³ Ghent University Hospital , Ghent , Belgium.
²⁴ King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
²⁵ Menzies Institute for Medical Research , Hobart, Tasmania , Australia.

Abstract

Introduction: The Assessments of SpondyloArthritis international society Health Index (ASAS HI) measures functioning and health in patients with spondyloarthritis (SpA) across 17 aspects of health and 9 environmental factors (EF). The objective was to translate and adapt the original English version of the ASAS HI, including the EF Item Set, cross-culturally into 15 languages.

Methods: Translation and cross-cultural adaptation has been carried out following the forward-backward procedure. In the cognitive debriefing, 10 patients/country across a broad spectrum of sociodemographic background, were included.

Results: The ASAS HI and the EF Item Set were translated into Arabic, Chinese, Croatian, Dutch, French, German, Greek, Hungarian, Italian, Korean, Portuguese, Russian, Spanish, Thai and Turkish. Some difficulties were experienced with translation of the contextual factors indicating that these concepts may be more culturally-dependent. A total of 215 patients with axial SpA across 23 countries (62.3% men, mean (SD) age 42.4 (13.9) years) participated in the field test. Cognitive debriefing showed that items of the ASAS HI and EF Item Set are clear, relevant and comprehensive. All versions were accepted with minor modifications with respect to item wording and response option. The wording of three items had to be adapted to improve clarity. As a result of cognitive debriefing, a new response option 'not applicable' was added to two items of the ASAS HI to improve appropriateness.

Discussion: This study showed that the items of the ASAS HI including the EFs were readily adaptable throughout all countries, indicating that the concepts covered were comprehensive, clear and meaningful in different cultures.

Keywords: Ankylosing Spondylitis; Outcomes research; Spondyloarthritis.