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Singh G, Athreya BH, Fries JF, Goldsmith DP. Measurement of health status in children with juvenile rheumatoid arthritis. Arthritis Rheum. 1994;37(12):1761-1769. doi:10.1002/art.1780371209

Validation of the childhood health assessment questionnaire in active juvenile systemic lupus erythematosus

This study aims to verify the psychometric properties of CHAQ applied to children and adolescents with cerebral palsy.

This study assesses the relative responsiveness of a modified CHAQ version, the VASCHAQ as compared to the original CHAQ-30 and revised CHAQ-38, as well as the parent-patient, physician-patient, and physician-parent concordance.

Cross-cultural adaptation and Psychometric Evaluation of the CHAQ in 32 Countries.

Validation of the Arabic version of the CHAQ for measuring functional status in children with juvenile idiopathic arthritis

Cross-cultural adaptation and validation of an Argentine Spanish version of the CHAQ, including parents of 70 patients with JIA and 21 healthy children (controls) in the validation phase.

The CHAQ is a validated questionnaire comprising specific items used to evaluate juvenile idiopathic arthritis in children and adolescents and has been considerably applied to patients with current mobility restrictions due to other chronic diseases such as pediatric spondyloarthropathies, spina bifida, joint hypermobility syndrome, and systemic lupus erythematosus. The questionnaire measures functional capacity and independence during the last week of daily life activities. It is made up of eight domains, each including 4 levels of difficulty. CHAQ also presents two visual analogue scales for pain evaluation and overall well-being evaluation

It is made up of eight domains: dressing, arising, eating, walking, reach, grip, hygiene and activities. Three components are evaluated for each area. The question with the greatest score in each domain is used as the score for that domain.

For each domain there is a 4 level difficulty scale that is scored from 0 to 3, corresponding to "without any difficulty" (0), "with some difficulty" (1), "with much difficulty" (2), and "unable to do" (3). Highest scoring item in each category determines the score for that category. If the respondent indicates the need for assistance or the use of an aid to perform a task, the minimum score for the category is 2.

Discomfort is determined by the presence of pain and its severity in the past week, rated on a doubly anchored horizontal visual analog scale (with anchors of “no pain” and “very severe pain”). The questionnaire also includes a doubly anchored visual analog scale to measure the patient’s or parent’s global assessment of arthritis.

There are some versions of the CHAQ. The CHAQ-38 contains the same items and response options as the original CHAQ-30, with an additional 8 more challenging questions in the Activities domain. The summary score for the CHAQ-38 was calculated by averaging all question scores, with no consideration for the domain structure.

The VASCHAQ contains the same items as the CHAQ-38 but functional ability is answered relative to “other kids my age.” Each question is answered on a 10-cm VAS, with scores ranging from 0, or the worst functional ability, to 100, or the best functional ability, for each question. The VASCHAQ does not use the domain structure, and does not inquire about a child’s need for aids and devices or help from others. The average of the 38 questions is taken as the overall score for the VASCHAQ. If a question does not apply to the child, it is marked as “not applicable” and is excluded from the score calculation.

Lam et al determined that the VASCHAQ demonstrated the best ability to discriminate, between patient and control groups, and scores differed the least from a normal distribution. In recent studies the addition of 8 more challenging questions and the removal of domain scoring reduced the ceiling effect in both patient and control groups. Peters et al compared responsiveness among different versions of CHAQ. All questionnaires demonstrated large responsiveness; however, the VASCHAQ was found to be about 25% more responsive than both the original CHAQ-30 and CHAQ-38.