Abstract
The Bath Ankylosing Spondylitis Functional Index (BASFI), disease activity index (BASDAI), and Global assessment (BASG) are the most commonly used instruments to assess patients suffering from ankylosing spondylitis (AS). The aim of this study was to translate, adapt, and validate these instruments into the Arabic language. Seventy-three AS patients were included in this study. One question in the BASFI questionnaire was changed to suit the Arabic culture. Also, the VAS in the questionnaires was transformed to numerical rating scales from 0 to 10. After modification, translation, and retranslation of the questionnaires, it was administered and tested for internal consistency, reliability, and construct validity. Magnetic resonance imaging (MRI) of the spine and sacroiliac joints was carried out for 69 patients; scores for disease activity and chronicity were also assessed. The adapted and translated questionnaires demonstrated acceptable comprehensibility scores with a mean of 9.3. Intraclass correlation coefficients for reliability and internal consistency was 0.973 for BASG, whereas standardized alpha ranged between 0.807 and 0.976. The modified item 9 in the BASFI demonstrated a good correlate to the principal component (0.883). When validated, all three questionnaires showed a significant correlation with enthesitis, BAS-radiology index, MRI imaging scores for activity and chronicity, C-reactive protein (CRP), and morning stiffness duration. The Arabic version of the BASFI, BASDAI, and BASG, showed adequate reliability and validity in patients with AS. The measurement properties were comparable to versions in other languages indicating that the questionnaires can be used for evaluation of AS Arabic-speaking patients.
Similar content being viewed by others
References
Braun J, Bollow M, Remlinger G, Eggens U, Rudwaleit M, Distler A (1998) Prevalence of spondyloarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 41:58–67
Boonen A, Chorus A, Midema H, van der Heijde D, van der Tempel H, van der Linden S (2001) Employment, work disability and work days lost in patients with ankylosing spondylitis: a cross sectional study of Dutch patients. Ann Rheum Dis 60:353–358
Van der Heijde D, Dougados M, Davis J, Weisman M, Maksymowych W, Braun J, Hallegua D, Bruckel J (2005) Assessment in ankylosing spondylitis international working group/spondylitis association of America recommendation for conducting clinical trials in ankylosing spondylitis. Arthritis Rheum 52(2):386–394
Van der Heijde D, Calin A, Dougados M, Khan MA, van der Linden S, Bellamy N (1999) Selection of instruments in the core set for DC-ART, SMARD, physical therapy and clinical record keeping in ankylosing spondylitis: progress report of the ASAS working Group. J Rheumatol 26:951–954
Schipper H, Clinch JJ, Olweny CL (1996) Quality of life studies: definitions and conceptual issues. In: Spilker B (ed) Quality of life and pharmacoeconomics in clinical trials. 2nd edn. Lippincott-Raven Publishers, Philadelphia, pp 11–23
Moncur C (2003) Ankylosing spondylitis measures. Arthritis Rheum 49(5S):S197–S209
Van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum 27:361–368
Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291
Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21:2281–2285
Jones SD, Steiner A, Garrett SL, Calin A (1996) The bath ankylosing spondylitis patient global score (BAS-G). Br J Rheumatol 31:66–71
Heuft-Dorenbosch L, Spoorengerg A, van Tubergen A, Landewe R, van ver Tempel H, Mielant H (2003) Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 62(2):127–132
Guillemin F, Bombardier C, Beaton D (1993) Cross cultural adaptation of health related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 46:1417–1432
Hernandez-Cruz B, Cardiel MH (1998) Intra-observer reliability of commonly used outcome measures in rheumatoid arthritis. Clin Exp Rheumatol 16:459–462
Van Tubergen A, Debats I, Ryser L (2002) The use of numerical rating scale as an answer modality in ankylosing spondylitis specific questionnaires. Arthritis Care Res 47:242–248
Mackay K, Mack C, Brophy S, Calin A (1998) The Bath Ankylosing Spondylitis Radiology Index (BASRI). A new validated approach to disease assessment. Arthritis Rheum 41(12):2263–2270
Braun J, van der Heijde D (2002) Imaging in ankylosing spondylitis. Best Pract Res Clin Rheumatol 16:573–604
Maksymowych WP, Inman RD, Salonen D, Dhillon SS, Williams M, Stone M, Conner-Spady B, Palsat J, Lambert RG (2005) Spondyloarthritis research Consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis. Arth Rheumatism 53(5):703–709
Spoorenberg A, van der Heijde D, de Klerk E, Dougados M, de Vlam K, Mielant H (1999) Comparative study of the usefulness of the Bath Ankylosing Spondylitis Functional Index and the Dougados functional Index in the assessment of ankylosing spondylitis. J Rheumatol 26:961–965
Keikkila S, Vitanen JV, Kautiainen H, Kauppi M (2002) Functional long term changes in patients with spondyloarthropathy. Clin Rheumatol 21:119–122
Claudepierre P, Sibilia J, Goupille P, Flipo RM, Wendling D, Eulry F (1997) Evaluation of a French version of the Bath Ankylosing Spondylitis disease activity index in patients with spondyloarthropathy. J Rheumatol 24:1954–1957
Eyres S, Tennant A, Kay L, Waxman R, Helliwell PS (2002) Measuring disability in ankylosing spondylitis: comparing of Bath ankylosing spondylitis functional index with revised Leeds disability questionnaire. J Rheumatol 29:979–986
Cronstedt H, Waldner A, Stenstrom CH (1999) Swedish version of the Bath ankylosing spondylitis functional index: reliability and validity. Scand J Rheumatol 28:1–9
Calin A, Nakache JP, Guegen A, Zeidler H, Meilants H, Dougados M (1999) Outcome variables in ankylosing spondylitis: evaluation of the relevance and discriminant capacity. J Rheumatol 26:975–979
Dougados M, Geugen A, Nakache JP, Mery A, Amor B (1988) Evaluation of a functional index and an articular index in ankylosing spondylitis. J Rheumatol 15:302–307
Abbott CA, Hellliwell PS, Chamberlain MA (1994) Functional assessment in ankylosing spondylitis: evaluation of a new self administered questionnaire and correlation with anthropometric variables. Br J Rheumatol 33:1060–1066
Pedersen OB, Hansen GO, Svendsen AJ, Ejstrup L, Junker P (2007) Adaptation of the Bath measures on disease activity and function in ankylosing spondylitis into Danish. Scand J Rheumatol 36:22–27
Cardiel MH, Londono JD, Gutierrez C, Pacheco-Tena C, Mellado JV, Burgos-Vargas R (2003) Translation, cross-cultural adaptation and validation of the Bath ankylosing spondylitis functional index, the Bath ankylosing spondylitis disease activity index and the Dougados functional index in a Spanish speaking population with spondyloarthopathies. Clin Exp Rheumatol 21:451–458
Braun J, Baraliakos X, Golder W, Brandt J, Rudwaleit M, Listing J (2003) Magnetic resonance imaging examination of the spine in patients with ankylosing spondylitis before and after successful therapy with infliximab. Arthritis Rheum 48:1126–1136
Spoorenberg A, de Vlam K, van der Heijde D, de Klerk E, Dougados M, Mielants H (1999) Radiologic scoring methods in ankylosing spondylitis: reliability and sensitivity to change over one year. J Rheumatol 26:997–1002
El Miedany Y, El Rasheed AH (2002) Is anxiety a more common disorder than depression in patients with rheumatoid arthritis. Joint Bone Spine 69:300–306
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary Fig. 1
(GIF 121 kb)
Supplementary Fig. 2
(GIF 121 kb)
Supplementary Fig. 3
(GIF 119 kb)
Supplementary Fig. 4
(GIF 17.0 kb)
Supplementary Fig. 5
(GIF 50.2 kb)
Rights and permissions
About this article
Cite this article
El Miedany, Y., Youssef, S., Mehanna, A. et al. Defining disease status in ankylosing spondylitis: validation and cross-cultural adaptation of the Arabic Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Bath Ankylosing Spondylitis Global score (BASG). Clin Rheumatol 27, 605–612 (2008). https://doi.org/10.1007/s10067-007-0755-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-007-0755-2