Background/Purpose:

The Satisfaction with Appearance Scale (SWAP) was originally developed to evaluate body image dissatisfaction (BID) among burn victims, and was later adapted for use in patients with systemic sclerosis (SSc).  A short form of the measure (Brief-SWAP) was derived from the full version. Both measures yield factor-analytically derived subscales.  Although both versions have been validated for use in SSc, their factor structures have never been compared for use with patients with limited versus diffuse SSc.  Because these groups may have very different appearance issues, the purpose of the current study was to determine the comparability of the factor structures of 1) the SWAP and 2) the Brief-SWAP for patients with limited versus diffuse SSc.

Methods:

Participants were adults participating in the UCLA Scleroderma Quality of Life Study with rheumatologist-diagnosed limited (n = 103) or diffuse (n = 82) SSc.  The 14-item SWAP evaluated BID, and the six items that comprise the Brief-SWAP were taken from the full measure.  Prior research has shown that the SWAP has four subscales evaluating Social Distress, Facial Features, Non-facial Features, and Perceived Social Impact; the Brief-SWAP has two subscales evaluating Social Discomfort and Dissatisfaction with Appearance.  Multiple group confirmatory factor analysis was used to determine if the factor structures of the SWAP and the Brief-SWAP were the same for individuals with limited and diffuse SSc.  Both statistical (chi squared [χ²]), and descriptive (RMSEA, CFI, SRMR) indicators of model fit were considered.  For RMSEA and SRMR, values < .08 and < .05 were considered to indicate acceptable and good model fit, respectively.  For CFI, values > .90, and > .95 were considered to indicate acceptable and good model fit, respectively.   A model was determined to fit well if at least two of the three descriptive fit indices met the criteria for acceptable model fit.

Results:

For the 14-item SWAP, the four factors satisfactorily fit the data from persons with diffuse SSc (χ² [71, N = 82] = 120.271, p < .001; RMSEA = .092, CFI = .923, SRMR = .075), but not from persons with limited SSc (χ² [71, N = 103] = 199.547, p < .001; RMSEA = .133, CFI = .873, SRMR = .070), suggesting that the commonly used subscales might not be informative for persons with limited disease.  In contrast, for the Brief-SWAP, fit indicators supported the two hypothesized factors for persons with either limited or diffuse disease.  Interestingly, the variance in scores on the two factors was greater for persons with limited SSc.  This indicated that severity of BID, as measured by the Brief-SWAP, varied more widely in persons with limited disease, versus those with diffuse disease, in the present sample.

Conclusion:

The four-factor structure of the 14-item SWAP may not evaluate BID among patients with limited SSc as well as it does among patients with diffuse SSc.  Conversely, the two-factor model of the Brief-SWAP, which evaluates Social Discomfort and Dissatisfaction with Appearance, was found to function equivalently across disease subtypes when measuring BID.  Therefore, the two-factor structure of the Brief-SWAP can be confidently used to measure body image dissatisfaction in patients with either limited or diffuse SSc.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-validity-of-the-satisfaction-with-appearance-scale-and-the-brief-satisfaction-with-appearance-scale-for-patients-with-limited-and-diffuse-systemic-sclerosis/