Animated Activity Questionnaire Research Articles

Suitability of the animated activity questionnaire for use as computer adaptive test: establishing the AAQ-CAT

PurposeThe animated activity questionnaire (AAQ) is a computer-based measure of activity limitations. To answer a question, patients choose the animation of a person performing an activity that matches their own level of limitation. The AAQ has not yet been tested for suitability to be applied as computer-adaptive test (CAT). Thus, the objective of this study was to develop and evaluate an AAQ-based CAT to facilitate the application of the AAQ in daily clinical care.MethodsPatients (n = 1408) with hip/knee osteoarthritis from Brazil, Denmark, France, The Netherlands, Norway, Spain, and the UK responded to all 17 AAQ items. Assumptions of item-response theory (IRT) modelling were investigated. To establish item parameters for the CAT, a graded response model was estimated. To evaluate the performance of post-hoc simulated AAQ-based CATs, precision, test length, and construct validity (correlations with well-established measures of activity limitations) were evaluated.ResultsUnidimensionality (CFI = 0.95), measurement invariance (R2-change < 2%), and IRT item fit (S-X2p > .003) of the AAQ were supported. Performing simulated CATs, the mean test length was more than halved (≤ 8 items), while the range of precise measurement (standard error ≤ 0.3) was comparable to the full AAQ. The correlations between original AAQ scores and three AAQ-CAT versions were ≥ 0.95. Correlations of AAQ-CAT scores with patient-reported and performance measures of activity limitations were ≥ 0.60.ConclusionThe almost non-verbal AAQ-CAT is an innovative and efficient tool in patients with hip/knee osteoarthritis from various countries, measuring activity limitations with lower respondent burden, but similar precision and construct validity compared to the full AAQ.

Cross-cultural validity of the Animated Activity Questionnaire for patients with hip and knee osteoarthritis: a comparison between the Netherlands and Brazil

BackgroundThe Animated Activity Questionnaire (AAQ) was developed in the Netherlands to assess activity limitations in individuals with hip/knee osteoarthritis (HKOA). The AAQ is easy to implement and minimizes the disadvantages of questionnaires and performance-based tests by closely mimicking real-life situations. The AAQ has already been cross-culturally validated in six other countries. ObjectiveTo assess the cross-cultural validity, the construct validity, the reliability of the AAQ in a Brazilian sample of individuals with HKOA, and the influence of formal education on the construct validity of the AAQ. MethodsThe Brazilian sample (N = 200), mean age 64.4 years, completed the AAQ and the Western Ontario and McMaster Universities Index (WOMAC). A subgroup of participants performed physical function tests and completed the AAQ twice with a one-week interval. The Dutch sample (N = 279) was included to examine Differential Item Functioning (DIF) between the scores obtained in the Netherlands and Brazil. For this purpose, ordinal regression analyses were used to evaluate whether individuals with the same level of activity limitations from the two countries (the Dutch as the reference group) scored similarly in each AAQ item. To evaluate the construct validity, correlation coefficients were calculated between the AAQ, the WOMAC domains, and the performance-based tests. To evaluate reliability, the Cronbach's alpha coefficient, the intraclass correlation coefficient, and the standard error of measurement (SEM) were calculated. ResultsThe AAQ showed significant correlations with all the WOMAC domains and performance-based tests (rho=0.46–0.77). The AAQ showed high internal consistency (Cronbach's alpha=0.94), excellent test-retest reliability (ICC2,1 = 0.98), and small SEM (2.25). Comparing to the scores from the Netherlands, the AAQ showed DIF in two items, however, they did not impact on the total AAQ score (rho=0.99). ConclusionOverall, the AAQ showed adequate cross-cultural validity, construct validity, and reliability, which enables its use in Brazil and international/multicenter studies.

The reliability and validity of the animated activity questionnaire in the Turkish population with knee and hip osteoarthritis

Aim of the workActivity limitation is one of the most common causes of disability in people with knee and hip osteoarthritis (OA). The present study aimed to determine the reliability and validity of the Turkish adaptation of Animated Activity Questionnaire (AAQ) in patients with hip and knee OA. Patients and methodsTwo hundred knee and hip OA patients aged 18–80 were assessed using the AAQ. Internal consistency and test–retest measurements were performed to determine reliability. A subgroup of 40 patients completed the AAQ again after seven days to determine test–retest reliability. In order to validate Turkish version of the AAQ, all patients completed the AAQ, the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score-Physical Function Shortform (KOOS-PS) and Hip Disability and Osteoarthritis Outcome Score-Physical Function Short form (HOOS-PS). Another subgroup of 136 patients performed the timed up and go (TUG) test, the 30-second chair stand test (CST), and the stair climbing test (SCT). ResultsThe Cronbach alpha value of the AAQ was 0.94, demonstrating high internal consistency. The test–retest score of the AAQ was 0.97, which was also high. The AAQ exhibited negative and moderate correlation with the WOMAC, KOOS-PS and HOOS-PS (0.59, −0.60, and −0.49, respectively). Stronger and high correlations were determined between the AAQ and TUG, CST, SCT tests (-0.74, 0.62, and −0.58, respectively). ConclusionThe study findings suggest that the AAQ is a reliable and valid tool for evaluating activity limitations in Turkish knee and hip OA patients.

Comparison of a video versus paper questionnaire on functional limitation in lower limb osteoarthritis

IntroductionThe video Animated Activity Questionnaire (AAQ) was developed to assess the impact of lower limb osteoarthritis (OA) on daily functional activities. The objective of the study was to compare the video and the HOOS/KOOS paper questionnaires and to assess the effect of order of administration.Material and methodsPatients recruited in the KHOALA cohort were randomized in two groups: AAQ questionnaire first (AAQ-first group) and HOOS (hip)/KOOS (knee) questionnaire first (H/KOOS-first group). Within group differences between AAQ and HOOS/KOOS scores were compared using a Student t-test. The Spearman correlation coefficient between AAQ score and HOOS/KOOS score was calculated in each group then compared, using Fisher z-transformation.ResultsAmong 200 randomized patients, 188 (65.8 years, 66.0% women) completed the questionnaires: 99 in the AAQ-first group and 89 in the H/KOOS-first group. The AAQ score was 85.9 (SD: 13.7) in the AAQ-first versus 87.8 (SD: 13.1) in the H/KOOS-first group (p = 0.34). The H/KOOS score was 72.5 (SD: 21.2) in the AAQ-first versus 73.5 (SD: 18.4) in the H/KOOS-first group (p = 0.71). The Spearman correlation coefficient between AAQ and H/KOOS in the AAQ-first was 0.84[0.77–0.89] and 0.73[0.61–0.81] in H/KOOS-first group. These correlations differed between groups significantly (p = 0.02).ConclusionThis study found video AAQ and paper HOOS/KOOS questionnaire highly correlated, with a moderate but significant effect of order administration of video and paper questionnaires evidencing a stronger correlation when the videos were viewed first.

Reliability of the Animated Activity Questionnaire for assessing activity limitations of patients with hip and knee osteoarthritis.

The aim of the study was to determine the internal consistency, test-retest reliability and measurement error of the Animated Activity Questionnaire (AAQ) for assessing activity limitations in hip and knee osteoarthritis (HKOA) patients. A total of 1,177 patients, from six countries (the Netherlands, UK, France, Denmark, Italy and Spain), completed the AAQ, a questionnaire consisting of videos displaying 17 activities with 3-5 levels of performance, from which patients choose the video that best matches their own performance. Unidimensionality was assessed by means of confirmatory factor analysis (CFA), using the following fit indices: the Tucker-Lewis index (TFI) >0.95, comparative fit index (CFI) >0.95, and root mean square error of approximation (RMSEA) <0.06. Cronbach's alpha was computed. In 238 patients who completed the AAQ twice, the intra-class correlation coefficient (ICC) was calculated for test-retest reliability. The standard error of measurement (SEM) and the smallest detectable change (SDC) were calculated as parameters of measurement error. The fit indices for unidimensionality were CFI 0.957, TLI 0.950, and RMSEA 0.144. Cronbach's alpha was 0.95. ICC for test-retest reliability was 0.93 (95% confidence interval 0.91 to 0.95), ranging from 0.85 to 0.98 across countries. SEM and SDC were 4.9 and 13.6, respectively, on a scale from 0 to 100, and ranging from 2.7 to 6.7, and from 7.5 to 18.4, respectively, across countries. The AAQ appeared to measure slightly more precisely in patients with knee problems and patients without prosthesis. The AAQ seemed to be unidimensional, and showed good internal consistency and test-retest reliability. The SDC indicated that changes in scores of at least 14% indicate real improvement in activity limitations.

Cross-Cultural and Construct Validity of the Animated Activity Questionnaire.

The Animated Activity Questionnaire (AAQ) assesses activity limitations in patients with hip/knee osteoarthritis and consists of video animations; the patients choose the animation that best matches their own performance. The AAQ has shown good validity and reliability. This study aims to evaluate cross-cultural and construct validity of the AAQ. Cross-cultural validity was assessed using ordinal logistic regression analysis to evaluate differential item functioning (DIF) across 7 languages. Construct validity was assessed by testing correlations between the AAQ and a patient-reported outcome measure (PROM) and performance-based tests. Data from 1,239 patients were available. Compared to the Dutch language (n = 279), none of the 17 items showed DIF in English (n = 202) or French (n = 193), 1 item showed uniform DIF in Spanish (n = 99) and Norwegian (n = 62), and 2 items showed uniform DIF in Danish (n = 201). In all these languages, the occurrence of DIF did not influence the total score, which remained comparable with the original Dutch version. For Italian (n = 203) versus Dutch, however, 6 items showed uniform DIF, and 1 item showed nonuniform DIF, indicating some problems with the cross-cultural validity between these countries. With regard to construct validity, the correlations with PROM (0.74) and performance-based tests (0.36-0.68) were partly as expected (>0.60). The AAQ, an innovative tool to measure activity limitations that can be placed on the continuum between PROMs and performance-based tests, showed a good overall cross-cultural validity, and seems to have great potential for international use in research and daily clinical practice in many European countries.

Cross-cultural validation of the computerized animated activity questionnaire to assess activity limitations in patients with hip and knee osteoarthritis

Purpose: The computerized Animated Activity Questionnaire (AAQ) for assessing activity limitations in hip and knee osteoarthritis (HKOA) consists of video animations from which patients can choose the animation that best matches their own performance. The AAQ has demonstrated good validity and reliability. Application of the AAQ in international studies, requires good cross-cultural validity, i.e., minimal Differential Item Functioning (DIF) across countries. The aim of this study was to evaluate cross-cultural validity. Methods: Patients in 7 European countries patients completed the AAQ on a computer. Ordinal logistic regression analysis was used to evaluate DIF across languages (Dutch versus 6 other languages). DIF is defined as follows: If a patient in a country has the same level of activity limitation as a patient in the Netherlands (the reference country in which the AAQ is developed), they should score the same on each item of the AAQ. If there is a statistical significant difference between countries, there is DIF. We used frequently described criteria in literature to assess DIF between countries. Criteria for non-uniform DIF were set as a statistical significance (p <0.001) pseudo R-square change according to Nagelkerke with a magnitude larger than 0.035 between the AAQ total score and the country variable (with Dutch as the reference group). Criteria for uniform DIF were set as a statistical significant (p <0.001) odds ratio (OR) of the country variable with a magnitude outside the interval 0.53-1.89. Analyses were adjusted for sex, age, weight, height, and affected joint. The influence of each individual item with DIF on the total score was calculated by means of comparing the correlation between AAQ score with and without the DIF item. A Spearman's correlation of 0.95 or less was interpreted as important influence of the DIF of that item on the total AAQ score. Results: Data of 1239 patients were available. Compared to Dutch (n = 279), none of the 17 items showed DIF in English (n = 202) and French (n = 193). Uniform DIF occurred in the activity 'walking outside' for Spanish versus Dutch (OR 0.28) and Norwegian versus Dutch (OR 0.16), with for both countries scores representing slightly worse functioning compared to Dutch. For Danish versus Dutch, DIF occurred in two items (walking outside on uneven terrain; OR 0.45, walking inside; OR 0.43), also representing slightly worse functioning compared to Dutch. In all these languages, the occurrence of DIF did not influence the total score with correlations of 0.98-0.99 in comparing AAQ scores with and without DIF item (s). For Italian (n = 203) versus Dutch, 6 items showed uniform DIF and 1 item showed non-uniform DIF, which makes it difficult to compare scores obtained in those two countries. Conclusions: Different language versions of the AAQ remain comparable with the original Dutch version except for the Italian version. The AAQ seems to have great potential for international use in research and daily clinical practice, especially in patients with low literacy and non-native speakers, because the use of video animations instead of written text. Future research will focus on responsiveness, interpretation of AAQ scores, and should explore explanations for DIF in Italy by means of qualitative research.

Development and testing of a computerized animated activity questionnaire (AAQ) for assessing activity limitations in patients with hip and knee osteoarthritis

Development and testing of a computerized animated activity questionnaire (AAQ) for assessing activity limitations in patients with hip and knee osteoarthritis

Validation of the Animated Activity Questionnaire (AAQ) for patients with hip and knee osteoarthritis: comparison to home-recorded videos.

A recently developed computerized Animated Activity Questionnaire (AAQ) uses video animations to measure limitations in basic daily activities in patients with hip or knee osteoarthritis (OA). The AAQ is less time and money consuming than performance-based tests and less burdensome for patients. Compared to patient-reported outcome measurements, the AAQ is less influenced by the perception of the patient. Previous validation studies of the AAQ showed promising results. Since the AAQ purports to measure activity limitations in real-life situations, this study aims to establish the construct validity of the AAQ by comparing the AAQ to home-recorded videos. Home-recorded videos of eleven basic activities performed by 22 OA patients were transformed into scores and subsequently correlated with the AAQ, the Hip disability and Knee injury Osteoarthritis Outcome Score (H/KOOS), and three performance-based tests (Stair Climbing Test, Timed Up and Go test, and the 30 s Chair Stand Test). The AAQ was expected to correlate highly with the home-recorded videos and the performance-based tests, and moderately with the H/KOOS. As hypothesized, the AAQ correlated highly with the home-recorded videos and performance-based tests (0.83 and, 0.73 respectively), but also unexpectedly highly with the H/KOOS (0.79). In conclusion, since the AAQ correlates highly with home-recorded videos, it seems to have potential as a measurement tool to assess limitations in activities close to the real-life situation, but this should be confirmed in a larger sample of patients.

Development and Preliminary Testing of a Computerized Animated Activity Questionnaire in Patients With Hip and Knee Osteoarthritis

To develop an Animated Activity Questionnaire (AAQ) based on video animations for assessing activity limitations in patients with hip/knee osteoarthritis (OA) that combines the advantages of self-reported questionnaires and performance-based tests without many of their limitations and to preliminarily assess its reliability and validity. We hypothesized that the AAQ would correlate highly with performance-based tests and moderately with self-reported questionnaires. Item selection was based on the pilot AAQ, prespecified conditions, the International Classification of Functioning, Disability, and Health core set for OA, existing measurement instruments, and focus groups of patients. Test-retest reliability was assessed in 30 of 110 patients. In 110 patients, correlations were calculated between the AAQ and the self-reported Hip Disability/Knee Injury and Osteoarthritis Outcome Score activities of daily living subscale (H/KOOS). In 45 of 110 patients, correlations with performance-based tests (stair climbing test, timed up and go test, and 30-second chair stand test) were calculated. In total, 17 basic daily activities were chosen for the AAQ. Video animations were made showing a person performing each activity with 3-5 different levels of difficulty. Patients were asked to select the level that best matched their own performance. Reliability was high (intraclass correlation coefficient 0.97 [95% confidence interval 0.93-0.98]); the AAQ correlated highly with performance-based tests (0.62), but higher with the H/KOOS (0.76) than expected. A computerized AAQ for assessing activity limitations was developed. Content validity was considered good. Preliminary validation results showed high reliability, but construct validity needs further study with a larger sample size. Continuing research will focus on construct validity and crosscultural validity.

FRI0224 A New Method to Assess Activity Limitations in Patients with Hip and Knee Osteoarthritis: the Animated Activity Questionnaire (AAQ): Part 1. Development, Validity and Reliability

BackgroundSelf-report questionnaires and performance-based tests correlate moderately in measuring activity limitations, indicating that they measure different aspects. Self-reports measure mainly the patients' perception which may lead to cross-cultural differences. Performance-based...

Development and Validation of the Computer-Administered Animated Activity Questionnaire to Measure Physical Functioning of Patients With Hip or Knee Osteoarthritis

Physical functioning of patients with hip or knee osteoarthritis is measured by self-report questionnaires and performance-based tests. However, performance-based tests often are not feasible. The aim of this study was to develop a computer-administered questionnaire (ie, the Animated Activity Questionnaire [AAQ]) to measure physical functioning in patients with hip or knee OA. By showing animations of activities, the influence of the patient's own reference frame is minimized. The AAQ measures the same aspects of physical functioning as performance-based tests do. This was a development and preliminary validation (cross-sectional) study. A pilot version of the AAQ was developed using motion capture to analyze the movement of a person performing 7 daily activities. Different animations of the same activity were made with 2 to 5 levels of difficulty. For each activity, participants were asked to choose one animation that best corresponds to their own way of performing the activity. A preliminary validation study was performed to compare the AAQ with validated self-report questionnaires (Knee Injury and Osteoarthritis Outcome Score, Hip Disability and Osteoarthritis Outcome Score, and questionnaires on walking, stair climbing, and rising and sitting down) and performance-based tests (walking, Timed "Up & Go" Test, Timed Stair Test) in 33 patients with hip or knee osteoarthritis. As expected, the AAQ showed a correlation above .70 (.79, 95% confidence interval=.61-.89) with the total score of the performance-based tests. On the subscore level, the results were partly as expected. Fifty-eight percent of the participants preferred the AAQ over self-report questionnaires and performance-based tests. The findings need to be replicated in larger samples of patients because the sample size of the study was rather small. The AAQ might be a good alternative for measuring physical functioning of patients with hip or knee osteoarthritis. The AAQ can easily be adapted for use in other patient populations. However, further development and validation are needed.

AB0794 Development of a computerized animated activity questionnaire (aaq) to measure activity limitations in patients with hip and knee osteoarthritis.

BackgroundSelf-report questionnaires and performance-based tests correlate moderately in measuring activity limitations, indicating that they are measuring different aspects. Self-reports measures mainly the patients’ perception which may lead to cross-cultural differences....