|Name of the Instrument/Tool||Health Assessment Questionnaire for the Spondyloarthropaties (HAQ-S)|
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.
|Concept of constructs||Physical function|
|Originally developed for||Ankylosing spondylitis (AS), Axial Spondyloarthritis|
|Other rheumatic diseases
where can be applied (only if validated)
|Additional population with no rheumatic diseases||
|Language: Originally published in||English|
|Available in Language||English, Turkish, Spanish, Finnish, Portuguese|
|Title||A modification of the Health Assessment Questionnaire for the spondyloarthropathies.|
|Other references of interest|
Comparative responsiveness of 3 functional indices in ankylosing spondylitis.
Validity and sensitivity to change of spondylitis specific measures of functional disability.
Brief description: Measurement of patient outcome in arthritis - HAQ-DI article.
|Instrument/Tool Translations References|
A modification of the Health Assessment Questionnaire for the spondyloarthropathies (original English version).
Factors related to change in global health after group physical therapy in ankylosing spondylitis (Dutch).
Continuation of group physical therapy is necessary in ankylosing spondylitis: results of a randomized controlled trial (Dutch).
|DEVELOPER CONTACT INFORMATION|
|Correspondence to||Professor Mathew Liang|
|Address||5 Francis Street, Department of Rheumatology Brigham & Women’s Hospital, Boston, MA 02115|
The HAQ 20-item disability scale is available at http://patienteducation.stanford.edu/research/haq20.html. The 5 extra questions are outlined in the original HAQ-S manuscript
|DESCRIPTION OF THE INSTRUMENT|
|Type Of Measure||Questionnaire|
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)|
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.
|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.
|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||>=5 European languages (English)|
|A. Internal Consistency||Not Tested|
|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
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:
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|
|C. Criterion validity||Not Tested|
|Comparison with a 'gold standard' Continuous scores:
correlations, ROC curves Dichotomus:
Sensitivity & Specificity (Describe)
|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.
|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.
This measure has been used in some registries to monitor axSpA symptoms
For further information, please contact the developers.
HAQ-S_IEnglish in Appendix