Abstract
AimAdaptation of the Short QUestionnaire to Assess Health-enhancing physical activity (SQUASH) in order to improve measurement properties in axSpA patients. MethodsThe original SQUASH was adapted using a qualitative stepwise approach with in-depth interviews including healthcare professionals and patients. Content validity was explored by comparing modified-SQUASH (mSQUASH) and original SQUASH. Next, mSQUASH was validated according to the OMERACT filter. International Physical Activity Questionnaire (IPAQ) was used as comparator and tri-axial accelerometer as gold standard for criterion validity and classification accuracy of intensity. Construct validity was assessed using Spearman correlations with clinical outcome assessments. For test-retest reliability, intra-class correlation coefficients (ICCs) were calculated. Responsiveness was assessed using standardized response mean (SRM), stratified by Anchor method. ResultsThe mSQUASH measured a systematically higher activity count and had less missing values (8% vs. 16%) then SQUASH. mSQUASH correlated better with accelerometer compared to IPAQ (ρ = 0.60 vs. ρ = 0.34). Accelerometer measured most activity in light intensity, whereas mSQUASH and IPAQ predominately measured moderate intensity. Correlations with ASDAS, BASDAI, BASFI and ASQoL were better for mSQUASH then IPAQ. Test-retest reliability was good in both questionnaires. In contrast to IPAQ, responsiveness was in correspondence with self-reported changes in physical activity for mSQUASH (SRM -0.84 for improvement and 0.88 for decrease). The average completion time of the mSQUASH was 7 minutes. ConclusionsThe development of the mSQUASH resulted in an easy applicable, valid, reliable and responsive questionnaire for the assessment of daily physical activity in axSpA patients, which can be used in research and daily clinical practice.
Highlights
Axial spondyloarthritis is a chronic inflammatory rheumatic disease characterized by inflammatory back pain, structural spine changes and spinal stiffness
Regular physical activity is advised for all axSpA patients in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of axSpA
Since there is a need to asses the amount and type of daily physical activity in axSpA patients, both in daily clinical practice and in research, we investigated in previous research the validity and test-retest reliability of the Short QUestionnaire to Assess Healthenhancing physical activity (SQUASH) and the International Physical Activity Questionnaire (IPAQ) in axSpA patients [21]
Summary
Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease characterized by inflammatory back pain, structural spine changes and spinal stiffness. Regular physical activity is advised for all axSpA patients in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of axSpA. Activity improve general health and functional status in axSpA patients [1À7]. Seen from a patients’ perspective, physical activity is important because it promotes bodily consciousness and independence [8,9]. Physical activity is defined as all bodily movement that contributes to energy expenditure [10]. Positive health effects of regular physical activity include reducing the risk of obesity, type 2 diabetes, hypertension, cardiovascular disease, depression, osteoporosis, colon and breast cancer [11]. There is a known association between physical inactivity, such as sitting or lying down, and poor quality of life [12]
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