Measurement properties of the ASAS Health Index: results of a global study in patients with axial and peripheral spondyloarthritis

Uta Kiltz¹, Désirée van der Heijde², Annelies Boonen³, Nurullah Akkoc⁴, Wilson Bautista-Molano⁵, Ruben Burgos-Vargas⁶, James Cheng-Chung Wei⁷, Praveena Chiowchanwisawakit⁸, Maxime Dougados⁹, M Tuncay Duruoz¹⁰, Bassel Kamal Elzorkany¹¹, Inna Gaydukova¹², Lianne S Gensler¹³, Michele Gilio¹⁴, Simeon Grazio¹⁵, Jieruo Gu¹⁶, Robert D Inman¹⁷, Tae-Jong Kim¹⁸, Victoria Navarro-Compan¹⁹, Helena Marzo-Ortega²⁰, Salih Ozgocmen²¹, Fernando Pimentel Dos Santos²², Michael Schirmer²³, Simon Stebbings²⁴, Filip E Van den Bosch^{25

26}, Astrid van Tubergen³, Juergen Braun¹

Affiliations

¹ Rheumazentrum Ruhrgebiet, Herne, Germany.
² Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
³ Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.
⁴ Izmir, Turkey.
⁵ School of Medicine, Universidad Militar Nueva Granada and Rheumatology Department, Hospital Militar, Bogotà, Colombia.
⁶ Hospital General de Mexico Universidad Nacional Autónoma, Mexico.
⁷ Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Institute of Medicine, Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
⁸ Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand.
⁹ Department of Rheumatology, Servicio de Reumatologia, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, H, Paris, France.
¹⁰ PMR Department, Rheumatology Division, Marmara University School of Medicine, Istanbul, Turkey.
¹¹ Rheumatology Department, Cairo University, Cairo, Egypt.
¹² North-Western State Medical University named after I I Mechnikov, St. Petersburg, Russian Federation.
¹³ Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA.
¹⁴ Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera and PhD Scholarship in Life Sciences, Department of Health Sciences, University of Catanzaro 'Magna Graecia', Catanzaro, Italy.
¹⁵ Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
¹⁶ University of Guangzhou, Guangzhou, China.
¹⁷ Spondylitis, University of Toronto, Toronto, Ontario, Canada.
¹⁸ Chonnam National University Medical School and Hospital, South Korea.
¹⁹ University Hospital La Paz, IdiPaz, Madrid, Spain.
²⁰ NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
²¹ Department of Rheumatology, Medicalpark Gaziosmanpasa Hospital, Istanbul, Turkey.
²² Universidade Nova De Lisboa, Lisbon, Portugal.
²³ Department of Internal Medicine, Innsbruck Medical University, Clinic II, Innsbruck, Austria.
²⁴ Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
²⁵ VIB Center for Inflammation Research, Unit for Molecular Immunology and Inflammation, Department of Internal Medicine, Ghent University, Ghent, Belgium.
²⁶ Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.

PMID: 29858176
DOI: 10.1136/annrheumdis-2017-212076

Free article

Observational Study

Measurement properties of the ASAS Health Index: results of a global study in patients with axial and peripheral spondyloarthritis

Uta Kiltz et al. Ann Rheum Dis. 2018 Sep.

Free article

. 2018 Sep;77(9):1311-1317.

doi: 10.1136/annrheumdis-2017-212076. Epub 2018 Jun 1.

Authors

Affiliations

¹ Rheumazentrum Ruhrgebiet, Herne, Germany.
² Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
³ Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.
⁴ Izmir, Turkey.
⁵ School of Medicine, Universidad Militar Nueva Granada and Rheumatology Department, Hospital Militar, Bogotà, Colombia.
⁶ Hospital General de Mexico Universidad Nacional Autónoma, Mexico.
⁷ Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Institute of Medicine, Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
⁸ Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand.
⁹ Department of Rheumatology, Servicio de Reumatologia, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, H, Paris, France.
¹⁰ PMR Department, Rheumatology Division, Marmara University School of Medicine, Istanbul, Turkey.
¹¹ Rheumatology Department, Cairo University, Cairo, Egypt.
¹² North-Western State Medical University named after I I Mechnikov, St. Petersburg, Russian Federation.
¹³ Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA.
¹⁴ Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera and PhD Scholarship in Life Sciences, Department of Health Sciences, University of Catanzaro 'Magna Graecia', Catanzaro, Italy.
¹⁵ Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
¹⁶ University of Guangzhou, Guangzhou, China.
¹⁷ Spondylitis, University of Toronto, Toronto, Ontario, Canada.
¹⁸ Chonnam National University Medical School and Hospital, South Korea.
¹⁹ University Hospital La Paz, IdiPaz, Madrid, Spain.
²⁰ NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
²¹ Department of Rheumatology, Medicalpark Gaziosmanpasa Hospital, Istanbul, Turkey.
²² Universidade Nova De Lisboa, Lisbon, Portugal.
²³ Department of Internal Medicine, Innsbruck Medical University, Clinic II, Innsbruck, Austria.
²⁴ Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
²⁵ VIB Center for Inflammation Research, Unit for Molecular Immunology and Inflammation, Department of Internal Medicine, Ghent University, Ghent, Belgium.
²⁶ Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.

PMID: 29858176
DOI: 10.1136/annrheumdis-2017-212076

Abstract

Objectives: To evaluate construct validity, interpretability, reliability and responsiveness as well as determination of cut-off points for good and poor health within the original English version and the 18 translations of the disease-specific Assessment of Spondyloarthritis international Society Health Index (ASAS HI) in 23 countries worldwide in patients with spondyloarthritis (SpA).

Methods: A representative sample of patients with SpA fulfilling the ASAS classification criteria for axial (axSpA) or peripheral SpA was used. The construct validity of the ASAS HI was tested using Spearman correlation with several standard health outcomes for axSpA. Test-retest reliability was assessed by intraclass correlation coefficients (ICCs) in patients with stable disease (interval 4-7 days). In patients who required an escalation of therapy because of high disease activity, responsiveness was tested after 2-24weeks using standardised response mean (SRM).

Results: Among the 1548 patients, 64.9% were men, with a mean (SD) age 42.0 (13.4) years. Construct validity ranged from low (age: 0.10) to high (Bath AnkylosingSpondylitisFunctioning Index: 0.71). Internal consistency was high (Cronbach's α of 0.93). The reliability among 578 patients was good (ICC=0.87 (95% CI 0.84 to 0.89)). Responsiveness among 246 patients was moderate-large (SRM=-0.44 for non-steroidal anti-inflammatory drugs, -0.69 for conventional synthetic disease-modifying antirheumatic drug and -0.85 for tumour necrosis factor inhibitor). The smallest detectable change was 3.0. Values ≤5.0 have balanced specificity to distinguish good health as opposed to moderate health, and values ≥12.0 are specific to represent poor health as opposed to moderate health.

Conclusions: The ASAS HI proved to be valid, reliable and responsive. It can be used to evaluate the impact of SpA and its treatment on functioning and health. Furthermore, comparison of disease impact between populations is possible.

Keywords: ankylosing spondylitis; outcomes research; spondyloarthritis.

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Conflict of interest statement

Competing interests: None declared.

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Measurement properties of the ASAS Health Index: results of a global study in patients with axial and peripheral spondyloarthritis

Affiliations

Measurement properties of the ASAS Health Index: results of a global study in patients with axial and peripheral spondyloarthritis

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Other Literature Sources

Research Materials