Detailled Information)

Name of the Instrument/Tool Health Assessment Questionnaire for the Spondyloarthropaties (HAQ-S)
First Description

Daltroy LH, Larson MG, Roberts NW, Liang MH. A modification of the Health Assessment Questionnaire for the spondyloarthropathies. J Rheumatol 1990;17(7):946–50.

Year 1990
Concept of constructs Physical function
Population/Disease Disease specific
Originally developed for Ankylosing spondylitis (AS), Axial Spondyloarthritis
Other rheumatic diseases
where can be applied (only if validated)
Additional population with no rheumatic diseases No
Language: Originally published in English
Available in Language English, Turkish, Spanish, Finnish, Portuguese
Author/s Daltroy LH
Title A modification of the Health Assessment Questionnaire for the spondyloarthropathies.
Journal J Rheumatol
Year 1990
Vol 17
Num 7
Pages 946-50
Country United States
Language English
Other references of interest
Brief Description

Comparative responsiveness of 3 functional indices in ankylosing spondylitis.

Brief Description

Validity and sensitivity to change of spondylitis specific measures of functional disability.

Brief Description

Brief description: Measurement of patient outcome in arthritis - HAQ-DI article.

Instrument/Tool Translations References
Brief Description

A modification of the Health Assessment Questionnaire for the spondyloarthropathies (original English version).

Brief Description

Factors related to change in global health after group physical therapy in ankylosing spondylitis (Dutch).

Brief Description

Continuation of group physical therapy is necessary in ankylosing spondylitis: results of a randomized controlled trial (Dutch).

Correspondence to Professor Mathew Liang
Address 5 Francis Street, Department of Rheumatology Brigham & Women’s Hospital, Boston, MA 02115
Website ---
Available ---

The HAQ 20-item disability scale is available at The 5 extra questions are outlined in the original HAQ-S manuscript

Type Of Measure Questionnaire
Brief Description

Patient self-administered questionnaire used to assess the physical functioning of an individual with ankylosing spondylitis/axial SpA. The HAQ-S is an adaptation of the Health Assessment Questionnaire (HAQ) that includes five items specific to axSpA

Number of Items 25 items (20 from HAQ-DI and 5 unique to HAQ-S)
Range 0-3
Responses options/scale Yes
Responses are 0 = able to do with no difficulty; 1 = able to do with some difficulty; 2 = able to do with much difficulty; and 3 = unable to do.
Developed for Both
Method of administration Self-administered
Recommendations to score

Score each category by the highest score within that category. Do not score if 25% items are missing. If any "aids or devices" and/or "help from another person" item is checked, upscore to “2” the category to which they apply (unneeded if the score is already "2" or "3"). The total score is = (sum of the categories / number of answered categories). Do not score if >2categories are missing.

Score Interpretation ---
Cut-off points ---
Cut-off points applied to ---
Smallest detectable change if described ---
Smallest detectable change applied to ---
Completion time by the patient - minutes
Scoring time by the assessor - minutes
Training to score Need to get used to the scoring.
Strengths Useful in clinical practice & research, Widely used
Limitations Floor effect
Limitations >=5 European languages (English)
Observations ---
A. Internal Consistency Not Tested
Cronbach's (Describe) ---
B. Reliability intraobserver or test-retest Tested
Continuous scores: intraclass
correlation coefficient (ICC)
Dichotomus: Cohen kappa (Describe)

Test–retest showed stability between time 1 and time 3, with Pearson’s correlation coefficient given as r = 0.92. ICC not reported.

C. Reliability interobserver or Measurement error Not Tested
Standard error of measurement (SEM),
smallest detectable change (SDC) or
Limits of agreement (LoA) (Describe)
A. Content validity: face validity Tested
Expert opinion (relevance and
comprehensiveness) (Describe)

The existing HAQ-DI was adapted for use in spondylarthritis patients by adding 5 disease-specific items, determined by the investigators (methods not given).


The original HAQ was felt to show good face validity related to the difficulties with activities of daily living reported by a group of 300 British AS patients.

B. Construct Validity:
Structural validity
Not Tested
Brief Description ---
Hypotheses-testing Tested
Brief Description

HAQ-S is highly correlated with the original HAQ-DI (Spearman’s correlation coefficient 0.96), and moderately correlated with other measures of physical functioning, the Dougados Functional Index (r = 0.64) and the generic instrument, Arthritis Impact Measurement Scales (r = 0.80). Correlations are less strong with physical limitations (including cervical rotation, r = -0.50; Schober’s test, r = -0.36).

Cross-cultural validity Not Tested
Brief Description ---
C. Criterion validity Not Tested
Comparison with a 'gold standard' Continuous scores:
correlations, ROC curves Dichotomus:
Sensitivity & Specificity (Describe)
Responsiveness Tested
Ability to detect change over
time Multiple methods (Describe)

Responsiveness statistics for the HAQ-S show an effect size (ES) of 0.20 (moderate) and standardized response mean (SRM) of 0.28 for improvement, and an ES of 0.28 and SRM of 0.72 for deterioration in a cohort of AS patients treated with non-steroidal anti-inflammatory drugs.

Interpretability Tested
of responders with the highest/lowest
score Minimal important difference (MID) (Describe)

There is a floor effect with score clustering at the normal (0) end of the scale described.

Other Comments

This measure has been used in some registries to monitor axSpA symptoms

Outcome Measure

For further information, please contact the developers.


Document 1 HAQ-S_IEnglish in Appendix