Background/Purpose: The unpredictable and uncontrollable course of rheumatic diseases has made them an interesting area of study in the learned helplessness and health outcomes literature. The Arthritis Helplessness Index (AHI), a 15-item self-report measure of helplessness, was developed to address a gap in the understanding of psychological correlates of rheumatoid arthritis (RA). The AHI was initially conceptualized as a unidimensional measure, however subsequent factor analytic studies identified two subscales: Helplessness and Internality. Though developed and validated in RA patients, the AHI and its adaptation, the Rheumatology Attitudes Index (RAI), have been used across rheumatic conditions, including among patients with systemic sclerosis (SSc). The present study examines the reliability and validity of the AHI among SSc patients.
Methods: A sample of patients (N= 208) with physician-confirmed SSc completed the AHI as part of participation in the University of California Los Angeles (UCLA) Scleroderma Quality of Life Study. Baseline data from the study were used to explore the structural validity of the measure via confirmatory and exploratory factor analytic methods. Internal consistency reliability was evaluated with Cronbach’s alpha, and convergent validity was explored via Pearson product-moment correlations with measures of depression (CES-D), mental and physical functioning (SF-36v2 Physical and Mental Component Scores, HAQ-DI) and pain (SF-36v2 Bodily Pain).
Results: Because confirmatory factor analysis failed to demonstrate a tenable one or two factor solution, exploratory factor analysis using a geomin-rotated matrix was undertaken to examine the structure of the AHI among SSc patients. A revised two-factor model fit well both statistically (c2 [19, N = 208] = 22.32, p = .269), and descriptively (CFI = .985, RMSEA = .029, SRMR = .032). Nine items were retained in the final solution, with the original five Helplessness items comprising Factor 1, Helplessness, and four of the original seven Internality items comprising Factor 2, Internality. Internal consistency reliability was marginal for both subscales (five-item Helplessness factor: a = .634; four-item Internality Subscale a = .634), and convergent validity was supported by significant correlations of AHI scores in the expected directions with the CES-D, SF-36v2 relevant subscale scores, and the HAQ-DI.
Conclusion: The present study derived a revised version of the AHI for use among patients with SSc. Several items that were appropriate for RA patients (e.g., regarding flares) dropped out of the revised version of the measure, suggesting that helplessness is not identical between the two conditions. Although the updated two-factor structure of the shortened nine-item measure fit the data well, it is unlikely that the present measure fully captures the construct of helplessness in SSc. Until future revisions of the measure incorporating patient involvement and input are completed, it is recommended that research examining helplessness in SSc use the updated 9-item, two-factor structure identified in the Arthritis Helplessness Index-Scleroderma version (AHI-SSc).
Disclosure:
S. Gholizadeh,
None;
S. D. Mills,
None;
R. S. Fox,
None;
P. J. Clements,
None;
S. Kafaja,
None;
V. L. Malcarne,
None;
D. E. Furst,
Abbott, Actelion, Amgen, BMS, Janssen, Gilead, GSK, NIH, Novartis, Pfizer, Roche/Genentech, UCB,
5;
D. Khanna,
Actelion, Bayer, Biogen-Idec, BMS, DIGNA, Genentech/Roche, Gilead, InterMune, Merck, Sanofi-Aventis, United Therapeutics,
5,
Patient Health Organization,
6,
Scleroderma Foundation,
6,
K23/K24,
2.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/reliability-and-validity-of-the-arthritis-helplessness-index-in-systemic-sclerosis/