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Original Article
Available online 7 June 2021
Validation of a Spanish version of the Health Assessment Questionnaire-II to assess Mexican patients’ physical function with rheumatoid arthritis
Validación de una versión en español del Health Assessment Questionnaire-II para la evaluación de la capacidad funcional en pacientes mexicanos con artritis reumatoide
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Gabriel Horta-Baas
Servicio de Reumatología, Hospital General Regional 1, Delegación Yucatán, Instituto Mexicano del Seguro Social, Mérida, Yucatán, Mexico
Received 09 August 2020. Accepted 19 November 2020
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Tables (5)
Table 1. General characteristics of the study participants.
Table 2. Results of the confirmatory factor analysis and the exploratory factor analysis in the patients of sample 1.
Table 3. Correlation between the Health Assessment Questionnaire-II y Health Assessment Questionnaire-Disability Index scores with other clinical variables.
Table 4. Results of the fit of item response theory (IRT) models to the HAQ-II and comparison of their goodness-of-fit.
Table 5. Parameters estimated with the MGRM multidimensional graduated response model (MRGM), fit of the items and marginal reliability coefficient of the IRT.
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Abstract
Objective

To evaluate the validity, reliability, and performance of the Health Assessment Questionnaire-II (HAQ-II) Spanish version questionnaire to measure physical function.

Methods

A cross-sectional study of 496 patients with rheumatoid arthritis (RA), distributed in 2 samples. The construct validity was evaluated employing the confirmatory factor analysis (CFA) and the validity based on the relationship with other variables. Cronbach's alpha (α) and McDonald’s omega (ω) coefficient were used to determine reliability. Item performance was analysed by fitting different models of item response theory (IRT).

Results

The one-factor model presented a poor fit in the CFA; an exploratory factor analysis (AFE) was carried out, which suggested a 2-factor structure. The CFA in the second sample confirmed that the second-order model had a good fit to the data. The general factor explained more than 70% of the variance. The reliability indices showed adequate internal consistency (α = .92–.95; ω = .88–.93). Ninety-three percent of the contrasting hypotheses about the relationship of the HAQ-II scores with other variables were confirmed, demonstrating their convergent, divergent, and known group validity. The multidimensional graduated response model was the one that best predicted person's interaction with the items.

Conclusion

The Spanish version of the HAQ-II presents adequate validity and reliability for measuring Mexican patients' physical function with RA.

Keywords:
Functional Status Assessment
Disability evaluation
Clinimetrics
Psychometrics
Patient Reported Outcome Measures
Rheumatoid arthritis
Resumen
Objetivo

Evaluar la validez de constructo, fiabilidad y el funcionamiento de los ítems de una versión en español del Health Assessment Questionnaire-II (HAQ-II) para medir la capacidad funcional.

Métodos

Estudio transversal que incluyó 496 pacientes con artritis reumatoide, distribuidos en 2 muestras. La validez de constructo se evaluó mediante el análisis factorial confirmatorio y la validez basada en la relación con otras variables. Para determinar la fiabilidad se empleó el coeficiente alfa de Cronbach (α) y omega de McDonald (ω). El funcionamiento de los ítems se analizó mediante el ajuste a diferentes modelos de la teoría de respuesta al ítem.

Resultados

El modelo de 1 factor presentó un mal ajuste en el análisis factorial confirmatorio; se realizó un análisis factorial exploratorio que sugirió una estructura de 2 factores. El análisis factorial confirmatorio en la segunda muestra confirmó que el modelo de segundo orden presentó un buen ajuste a los datos. El factor general explicó más del 70% de la varianza. Los índices de fiabilidad mostraron una adecuada consistencia interna (α = .92–.95; ω = .88–.93). El 93% de las hipótesis contrastadas sobre la relación de las puntuaciones del HAQ-II con otras variables se confirmaron, lo cual demuestra su validez convergente, divergente y de grupos conocidos. El modelo de respuesta graduada multidimensional fue el que mejor predijo la interacción de las personas con los ítems.

Conclusión

La versión en español del HAQ-II presenta una adecuada validez y fiabilidad para la medición de la capacidad funcional en pacientes mexicanos con artritis reumatoide.

Palabras clave:
Capacidad funcional
Evaluación de la discapacidad
Clinimetría
Psicometría
Resultados reportados por el paciente
Artritis reumatoide

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