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Clinical Trial
. 2020 Feb;18(2):285-294.
doi: 10.1111/jth.14651. Epub 2019 Nov 13.

Validity and reliability of the Colorado Adult Joint Assessment Scale in adults with moderate-severe hemophilia A

Sharon M Funk  1 , Sylvia Engelen  2 , Katy Benjamin  3 , Olga Moshkovich  3 , Brittany Gentile  4 , Nikki Church  2 , Walter Hong  2 , Dianne Thornhill  1 , Marilyn J Manco-Johnson  1
Affiliations
Clinical Trial

Validity and reliability of the Colorado Adult Joint Assessment Scale in adults with moderate-severe hemophilia A

Sharon M Funk et al. J Thromb Haemost. 2020 Feb.

Abstract

Background: The Colorado Adult Joint Assessment Scale (CAJAS) is designed to assess joint health in adults with hemophilia. The CAJAS comprises nine items (swelling, muscle atrophy, axial deformity, crepitus, range of motion, contracture, instability, strength, gait) and assesses six joints.

Objective: To assess CAJAS content validity and psychometric properties.

Patients/methods: Data were obtained from the Trial to Evaluate the Effect of Secondary Prophylaxis With rFVIII Therapy in Severe Hemophilia A Adult and/or Adolescent Subjects Compared to That of Episodic Treatment (SPINART) study and a separate CAJAS validation study. CAJAS assessments in SPINART were performed by physical therapists (PTs) from the United States, Romania, Bulgaria, and Argentina. In the validation study, content validity was assessed from interviews with six PTs at three US hemophilia centers; cultural equivalence was assessed with seven non-US PTs from SPINART. Reliability data were collected from 30 subjects at four US centers. Test-retest reliability was evaluated by having the same PT perform CAJAS examinations at two visits, 7-10 days apart. Inter-rater reliability was assessed by comparing CAJAS scores of two different PTs performing separate examinations of the same patient several hours apart at the same visit. Psychometric properties were assessed using SPINART and validation study data.

Results: The CAJAS demonstrated good content validity. Test-retest reliability was high (intraclass correlation coefficient, 0.98), as was inter-rater reliability (intraclass correlation coefficient, 0.88). Internal consistency reliability was strong (α = .90). The CAJAS demonstrated good convergent/divergent validity, known-groups validity, and ability to detect change.

Conclusions: The CAJAS is a valid and reliable measure of joint health in adults with moderate-severe hemophilia and is appropriate for use in clinical practice.

Keywords: adult; hemophilia; joints; psychometrics; validity and reliability.

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Conflict of interest statement

Sharon Funk developed and Marilyn J. Manco‐Johnson implemented the use of the CAJAS, which will be copyrighted. Sharon Funk was a paid consultant on the Bayer‐sponsored SPINART study. Marilyn J. Manco‐Johnson has received honoraria for advisory board participation from Bayer, Baxter BioScience, Biogen Idec, CSL Behring, and Novo Nordisk and has received research grant funding from Bayer. Nikki Church is an employee of Bayer. Sylvia Engelen and Walter Hong were employees of Bayer at the time this study was conducted. Olga Moshkovich is an employee of ICON, an external vendor contracted for this research by Bayer. Katy Benjamin was an employee of ICON at the time this study was conducted. Brittany Gentile was an employee of ICON at the time this study was conducted and is a current employee of Roche/Genentech; the views and opinions expressed in this article are the author's own and do not necessarily reflect those of Roche/Genentech. Dianne Thornhill has no disclosures to address.

Figures

Figure 1
Figure 1
Conceptual framework of the Colorado Adult Joint Assessment Scale. All items are measured for the left and right elbows, knees, and ankles with the exception of Axial Deformity and Gait, which are measured for the left and right knees and ankles only. ROM, range of motion
See this image and copyright information in PMC

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