Cross-Cultural and Construct Validity of the Animated Activity Questionnaire to Assess Activity Limitations in Patients with Hip and Knee Osteoarthritis in Different Languages

Wilfred Peter¹, Henrica de Vet², Maarten Boers³, Jaap Harlaar⁴, Leo D. Roorda⁵, Rudolf Poolman⁶, Vanessa Scholtes⁷, Martijn P.M. Steultjens⁸, Gordon Hendry⁹, Ewa M. Roos¹⁰, Francis Guillemin¹¹, Maria Grazia Benedetti¹², Lorenzo Cavazutti¹², Antonio Escobar Martinez¹³, Hanne Dagfinrud¹⁴ and Caroline Terwee¹⁵, ¹Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands, ²EMGO Institute, VU Medical Centre, Amsterdam, Netherlands, ³Epidemiology & Biostatistics, VU Univ Medical Center F-wing, Amsterdam, Netherlands, ⁴Dep of Rehabilitation Medicine and MOVE research institute, VU University Medical Center, Amsterdam, Netherlands, ⁵Amsterdam Rehabilitation Research Center | Reade, Amsterdam, the Netherlands, Amsterdam, Netherlands, ⁶Orthopedic department, Joint Reserach, OLVG, Amsterdam, Netherlands, ⁷Department of Orthopedics, Joint Research, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands, ⁸Rehabilitation Medicine, VU University Medical Center, Amsterdam, Netherlands, ⁹School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom, ¹⁰Inst Sports and Biomechanics, University of Southern Denmark, Odense, Denmark, ¹¹University of Lorraine, Nancy, France, ¹²Physical Medicine and Rehabilitation Unit, Istituto Ortopedico Rizzoli, Bologna, Italy, ¹³Health Service Research Network on Chronic Diseases (REDISSEC), Basurto University Hospital, Bilbao, Spain, ¹⁴Department of Rheumatology /National Advosory Unit for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, ¹⁵Dep of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Hip, Knee, osteoarthritis and patient-reported outcome measures

Session Information

Date: Sunday, November 13, 2016

Title: Quality Measures and Quality of Care - ARHP Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: The computerized Animated Activity Questionnaire (AAQ) assesses activity limitations in hip and knee osteoarthritis (HKOA), and consists of video animations from which patients can choose the animation that best matches their own performance. Application of the AAQ in international studies requires good cross-cultural validity, i.e. minimal Differential Item Functioning (DIF) across countries. The aim of this study was to evaluate cross-cultural and construct validity of the AAQ in 7 languages.

Methods: Patients in 7 European countries completed the AAQ on a computer. Ordinal logistic regression analysis was used to evaluate DIF across languages (Dutch versus 6 other languages). DIF is defined as follows: if a patient in a country has the same level of activity limitation as a patient in the Netherlands (the reference country in which the AAQ is developed), he/she should score the same on each item of the AAQ. If there is a statistical significant difference between countries, there is DIF. Construct validity was assessed by testing correlations between the AAQ and a Patient Reported Outcome Measures (PROM) and performance-based tests. Analyses were adjusted for sex, age, weight, height, and affected joint. The influence of each individual item with DIF on the total score was calculated by means of comparing the correlation between AAQ score with and without the DIF item. A Spearman’s correlation of 0.95 or less was interpreted as important influence of the DIF of that item on the total AAQ score.

Results: Data of 1239 patients were available. Compared to Dutch (n=279), none of the 17 items showed DIF in English (n=202), French (n=193), 1 item showed uniform DIF in Spanish (n=99) and Norwegian (n=62), and 2 items showed uniform DIF in Danish (n=201). For Italian (n=203) versus Dutch however, 6 items showed uniform DIF, and 1 item showed non-uniform DIF, indicating some problems with the cross-cultural validity between these countries. In all the languages, the occurrence of DIF did not influence the total score with correlations of 0.98-0.99 in comparing AAQ scores with and without DIF item(s). All the translated versions remain comparable with the original Dutch version. With regard to construct validity, the correlations with PROM (0.74) and performance-based tests (0.36-0.68) were partly as expected (> 0.60).

Conclusion: The AAQ, a new construct that can be placed on the continuum between PROMs and performance-based tests showed a good overall cross-cultural validity, and seems to have great potential for international use in research and daily clinical practice in many languages.

Disclosure: W. Peter, None; H. de Vet, None; M. Boers, None; J. Harlaar, None; L. D. Roorda, None; R. Poolman, None; V. Scholtes, None; M. P. M. Steultjens, None; G. Hendry, None; E. M. Roos, None; F. Guillemin, None; M. G. Benedetti, None; L. Cavazutti, None; A. Escobar Martinez, None; H. Dagfinrud, None; C. Terwee, None.

To cite this abstract in AMA style:

Peter W, de Vet H, Boers M, Harlaar J, Roorda LD, Poolman R, Scholtes V, Steultjens MPM, Hendry G, Roos EM, Guillemin F, Benedetti MG, Cavazutti L, Escobar Martinez A, Dagfinrud H, Terwee C. Cross-Cultural and Construct Validity of the Animated Activity Questionnaire to Assess Activity Limitations in Patients with Hip and Knee Osteoarthritis in Different Languages [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/cross-cultural-and-construct-validity-of-the-animated-activity-questionnaire-to-assess-activity-limitations-in-patients-with-hip-and-knee-osteoarthritis-in-different-languages/. Accessed .

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