COSMIN database

Patient-assessed health in ankylosing spondylitis: a structured review

Haywood, K. L., Garratt, A. M., and Dawes, P. T.
OBJECTIVE: To review evidence relating to the measurement properties for all disease-specific, multi-item, patient-assessed health instruments in patients with ankylosing spondylitis (AS).

METHODS: Systematic literature searches were made to identify instruments, using predefined criteria relating to reliability, validity, responsiveness and precision.

RESULTS: Twelve AS-specific and three arthritis-specific instruments met the inclusion criteria. Three AS-specific instruments that measure health-related quality of life (HRQL) were reviewed. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Dougados Functional Index (DFI) had the greatest amount of evidence for reliability, validity and responsiveness across a range of settings. Four instruments lacked evidence for test-retest or internal consistency reliability. Most were assessed for validity through comparisons with other instruments, global judgements of health, mobility or clinical and sociodemographic variables. Most were assessed for responsiveness through mean score changes. Three instruments lacked evidence of responsiveness.

CONCLUSION: This review provides a contribution to AS assessment. AS-specific multi-item measures specific to the assessment of pain, stiffness, fatigue and global health were not identified; where assessed, these domains were largely measured with single-item visual analogue scales. Single items may provide a limited reflection of these important domains. The BASFI and DFI remain the instruments of choice for functional assessment. HRQL is recommended as a core assessment domain. Further concurrent evaluation is recommended.
Rheumatology (Oxford)
1462-0324 (Print)
Publication year:
Biological and physiological variables:
Biological and physiological variables
Symptom status:
Physical state
Functional status:
Physical functioning
General health perceptions / HRQoL:
Health-related quality of life
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
2 - Interviews
AIMS2 - Arthritis Impact Measurement Scales 2   
AIMS - Arthritis Impact Measurement Scales (Also short AIMS and shortened AIMS)
AS-AIMS2 - Ankylosing Spondylitis Arthritis Impact Measurement Scales 2
ASAQ - Assessment in Ankylosing Spondylitis Questionnaire
ASQoL - Ankylosing Spondylitis Quality of Life
BASDAI - Bath Ankylosing Spondylitis Disease Activity Index
BASFI - Bath Ankylosing Spondylitis Functional Index
BAS-G - Bath Ankylosing Spondylitis Global score
Body Chart
DFI - Dougados Functional Index
HAQ - Health Assessment Questionnaire (versions:MHAQ - Modified HAQ; HAQ-II)   
HAQ-S - Health Assessment Questionnaire for the spondyloarthropathies [alias HAQ-S-stiffness]
PET - Problem Elicitation Technique
PGI - Patient Generated Index
RLDQ - Revised Leeds Disability Questionnaire