Page 109 - SPONDYLOARTHRITIS IN COLOMBIA -

(ICC >0.8) and a high internal consistency (Cronbach-α >0.9). The ASAS-HI was sensitive to pick up changes after starting a new pharmacological treatment. The SRM was higher than those seen in the original description of the instrument, a fact that could be explained by the higher baseline values on the instrument that could imply a higher probability of significant changes after effective treatment. Regarding construct validity, the translated version had good correlation (>0.6) with several clinical parameters used currently to assess function, disease activity and quality of life in patients with SpA. In addition, the instrument was discriminative regarding different thresholds of disease activity.
Some limitations need to be considered. First, when evaluating test-retest reliability, no external and objective measure was included to assess stability of the health condition. However, it is accepted that a seven-day period in a chronic disease is an appropriate interval to avoid a significant variability in health, on the one side, and avoid too much recall bias on the other side. Second, the Spanish-language version of the ASAS-HI validated in the current study is validated for the Colombian population. Regarding other Spanish-speaking populations, the use of this version may require additional cross-cultural adaptation and validation mainly due to linguistic variations and cultural differences. Two additional Spanish-versions of the ASAS-HI are available (Mexico and Spain) and were elaborated independently during the international validation project. The differences with these translated tools are restricted to a few changes in wording. For instance, the original English version asks about problems using toilet facilities. The word “toilet” was translated using different Spanish words in each country. In the same way, “exhausted” was translated using three different words having the same meaning. Similar findings were observed with the translation of the following words: “car”, “hair” and “flat ground”. Although these semantic differences may reflect the transcultural adaptation of the instrument in each country, the underlying concept to
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