Patient reported outcomes in inflammatory arthritis: Validity, reliability and sensitivity to change of the arabic combined questionnaire for functional impairment and quality of life assessment
Background Rheumatoid arthritis is a chronic, progressive disease characterized by pain, physical impairment, fatigue, disability, psychiatric changes, increased co-morbidity as well as ability to work. The combined inflammatory arthritis questionnaire for patients with inflammatory arthritis  has the advantage of being patients' driven as it was developed using Rasch analysis for ordered response options and item pools of questions for functional disability and quality of life, content analysis and semi structured group discussion. Objectives To test the reliability, validity and sensitivity to change of a translated version of the combined inflammatory arthritis questionnaire (CIAQ) for patients with inflammatory arthritis. Methods A cohort of 284 patients (146 RA, 86 psoriatic arthritis, 52 patients with inflammatory bowel disease associated arthritis) were recruited and asked to participate in the study. The questionnaire includes: 10-items scale to assess functional impairment (CIAQ-FI), and 10-items to assess quality of life (CIAQ-QoL). The patient should respond using one of the four standard response options: 0=without any difficulty, 1=with some difficulty, 2=with much difficulty and 3=unable to do. The mean score for each of the functional disability as well as quality of life indices is calculated and the total score ranged from 0-3. After translation and re-translation of the questionnaire, it was administered to the patients and tested for internal consistency, reliability. Construct validity was assessed by correlating the score of the questionnaire to parameters of disease activity namely, the joint count (both tender and swollen), Pain score, Patient and Physician Global assessment, Fatigue score, Arabic-HAQ, psychological score, grip strength, duration of morning stiffness, DAS score, ESR and CRP as well as the occupational status. Sensitivity to change of the developed Arabic CIAQ after 6-months of therapy was also assessed. Results The Arabic-CIAQ questionnaires showed accepted validity as it correlated significantly with clinical parameters of disease activity, DAS-28 score, as well as CRP (p<0.01). CIAQ-for functional disability was as well as HAQ or better correlated to clinical disease outcomes. The Arabic-CIAQ was also reliable (Cronbach's alpha for CIAQ-FI was 0.96), compared to 0.91 for Arabic- HAQ, and had no misfitting items. Cronbach's alpha for CIAQ-QoL was 0.92. In addition, both the CIAQ-FI and CIAQ-QoL were sensitive to change. A significant correlation (p<0.01) was observed in percentage change and effect size of both CIAQ-FI and CASQ-QoL with those of disease activity parameters and DAS-28 score. Conclusions The Arabic-CIAQ is reliable and valid for assessment of functional impairment and quality of life in inflammatory arthritis patients. The CIAQ is well accepted by patients speaking Arabic language, sensitive to change, easy to administer and score, and feasible to monitor the impact of management.
El Miedany, Y., et al., Patient reported outcomes in inflammatory arthritis: Validity, reliability and sensitivity to change of the arabic combined questionnaire for functional impairment and quality of life assessment. Annals of the Rheumatic Disease, 20
Measure does not require training
Less than 5 min