About article

Translation and cross-cultural adaptation of the ASAS health index and the environmental item set into 15 languages

Article type: Published abstract


Introduction. The ASAS Health Index (ASAS HI) is a unidimensional questionnaire measuring health and impairment in functioning in patients with spondyloarthritis (SpA). The ASAS HI is accompanied by a multidimensional item set aiming at measuring environmental factors (EF Item Set). The ASAS HI contains 17 dichotomous items addressing categories of pain, emotional functions, sleep, sexual function, mobility, self care, and community life and the EF Item Set contains 9 dichotomous items addressing categories of support/relationships, attitudes and health services. The aim is to translate and adapt the ASAS HI and the EF Item Set cross-culturally into 15 languages with 17 versions. Methods. Translation and cross-cultural adaptation was done in 20 countries using forward-backward procedure in 5 steps: translation, synthesis of translation, back translation, expert committee review and field testing in patients with axial SpA. We paid attention to include patients across a broad spectrum of sociodemographic background (age, gender, education). Results. The ASAS HI and EF Item Set was translated into Arabic, Chinese, Croatian, Dutch/Flemish, French, German, Greek, Hungarian, Italian, Korean, Portuguese, Russian, Spanish (Colombia, Mexico, Spain), Thai, and Turkish. 206 patients, 59.7% male, mean (SD) age 42.4 (13.9) years, 65% AS patients, 35% with non-radiographic axSpA, mean (SD) BASDAI 3.8 (2.3) with axSpA underwent qualitative interviews during field testing in 23 countries (19 non- English speaking countries, 4 English-speaking countries). Interviews showed the English questionnaire and the translations to be clear, relevant and comprehensive. All versions were accepted with minor modifications. Completion times for ASAS HI and for EF Item Set were respectively, 2.6±1.6 and 2.1±1.5 (mean ± SD) minutes. Discussions. The ASAS HI and the EF Item Set were successfully translated into 15 languages with 17 versions. This study showed the ASAS HI items to be readily adaptable throughout countries, indicating the concepts covered may be meaningful in many cultures. In the other hand, more difficulties were experienced with the contextual factors indicating these concepts may be more culturedependent. By investigating patients with axSpA with and without peripheral manifestations it could be shown that the ASAS HI and the EF Item Set are valid to be applied in patients with all forms of SpA.

Full citation

Kiltz U, Van Der Heijde D, Boonen A, Bautista W, Burgos-Vargas R, Chiowchanwisawakit P, et al. Translation and cross-cultural adaptation of the ASAS health index and the environmental item set into 15 languages. Clinical and Experimental Rheumatology. 201


Methods Condition Gender Age Country Setting Sample size
spondyloarthritis Both 42.4 +/-13.9 Healthcare Facility 206

Number of items

17 items


Measure does not require training

Required time

Less than 5 min

© 2021 | Privacy Policy
All Rights Reserved

Notify me for new AHM projects / news

Contact Us

Articles last updated: December 2020