Adaptation of Chinese and English versions of the Ankylosing Spondylitis quality of life (ASQoL) scale for use in Singapore

Abstract

BackgroundTo cross-culturally adapt and validate the Singapore Chinese and Singapore English versions of the Ankylosing Spondylitis Quality of Life (ASQoL) scales.MethodsTranslation of the ASQoL into Singapore Chinese and English was performed by professional and lay translation panels. Field-testing for face and content validity was performed by interviewing ten Chinese speaking and ten English speaking axial spondyloarthritis (AxSpA) patients. AxSpA patients (either Chinese or English speaking) were invited to take part in validation surveys. The Health Assessment Questionnaire (HAQ), Short Form Health Survey (SF-36), Bath Indices, and other measures of disease activity were used as comparator scales for convergent validity. A separate sample of AxSpA patients were invited to participate in a test-retest postal study, with 2 weeks between administrations.ResultsThe cross-sectional study included 183 patients (77% males, 82% English speaking), with a mean (SD) age of 39.4 (13.7) years. The ASQoL had excellent internal consistency (Cronbach’s alpha = 0.88), and correlated moderately with all the comparator scales. The ASQoL was able to distinguish between patients grouped by disease activity and perceived general health. The ASQoL fulfilled the Rasch model analysis for fit, reliability and unidimensionality requirements. No significant differential item functioning was noted for gender, age below or above 50 years, and language of administration. Test–retest reliability was good (r = 0.81).ConclusionsThe ASQoL was adapted into Singapore Chinese and English language versions, and shown to be culturally relevant, valid and reliable when used with combined samples of AxSpA patients who speak either Chinese or English.

Validity and reliability of the Assessment of Spondyloarthritis International Society Health Index in English‐speaking patients with axial spondyloarthritis in Singapore

“…34 (ii) Score of ASAS HI is positively and moderately correlated with summary score of PGA. 2,35 (iii) Score of ASAS HI is negatively and highly correlated with summary score of EQ-5D-5L 15 and SF-36 PCS. 15 (iv) Score of ASAS HI is negatively and moderately correlated with summary score of SF-36 MCS.…”

“… Score of ASAS HI is positively and highly correlated with summary score of BASDAI, BASFI, HAQ‐DI, pain, WPAI absenteeism, presenteeism, work productivity loss, and activity impairment Score of ASAS HI is positively and moderately correlated with summary score of PGA Score of ASAS HI is negatively and highly correlated with summary score of EQ‐5D‐5L and SF‐36 PCS …”

“…We conducted cognitive debriefing interviews (CDIs) with English‐speaking patients with axSpA to assess the cultural relevance, acceptability and comprehensiveness of questionnaire items and instructions in English . Patients with axSpA were chosen by the attending clinician to represent a range of gender, age, disease activity, and education level.…”

“…We conducted cognitive debriefing interviews (CDIs) with Englishspeaking patients with axSpA to assess the cultural relevance, acceptability and comprehensiveness of questionnaire items and instructions in English. 2,18 Patients with axSpA were chosen by the attending clinician to represent a range of gender, age, disease activity, and education level. The patients completed the English version of ASAS HI in the presence of a trained interviewer, who observed and made note of any difficulties or hesitation in answering the items.…”

“…Axial spondyloarthritis (axSpA) is a chronic autoimmune disease primarily affecting the spine, joints, and entheses. 1,2 Patients with axSpA may experience pain, stiffness, fatigue, and limited spinal mobility, 3 which often result in significant limitations in function, activities, and social participation. [4][5][6] Hence, the management of patients generally focuses on improving their quality of life, through reducing symptoms and improving function.…”