Cardiel M H, Londoño J D, Gutiérrez E, Pacheco-Tena C, Vázquez-Mellado J, Burgos-Vargas R
Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.
Clin Exp Rheumatol. 2003 Jul-Aug;21(4):451-8.
The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Dougados Functional Index (DFI) are the most commonly used instruments to measure disease activity and functioning in ankylosing spondylitis (AS). The aim of this study was to translate, adapt and validate these instruments into the Spanish language.
The BASDAI, BASFI, and DFI questionnaires were translated into Spanish by three independent bilingual physicians who were familiar with the medical aspects of AS and by one professional translator. Two rheumatologists familiar with instrument validation, and who were aware of the purpose of the study, examined semantic, idiomatic and conceptual issues and produced by consensus unified versions of each instrument. English back-translations from the Spanish were done by a professional translator unaware of the original version. Both English versions were compared, and where needed, modifications to the Spanish versions were made. The Spanish versions were administered to 61 ambulatory patients with AS and to 80 patients with undifferentiated spondyloarthropathy for validation purposes. Reliability and responsiveness were measured in 28 patients participating in a physiotherapy program.
Reliability showed an acceptable 24-hour test-retest intraclass correlation coefficient (ICC)--BASFI ICC: 0.68, 95% CI: 0.29-0.85; BASDAI ICC: 0.74, 95% CI: 0.52-0.88 and DFI ICC: 0.87, 95% CI: 0.73-0.94. The construct validity of the instruments was evaluated, and BASDAI was correlated with disease activity measured by the total enthesis count (rs: 0.34); general well being in the last week (rs: 0.7); spinal pain (rs: 0.53) and duration of morning stiffness (rs: 0.64). BASFI correlated with Schöber's test (rs: -0.4); occipital-wall distance (rs: 0.38) and thoracic expansion (rs: -0.3). DFI correlated with Schöber's test (rs: -0.36); occipital-wall distance (rs: 0.29) and chest expansion (rs: -0.3). The correlation among DFI and BASFI was rs: 0.83. All instruments showed clinical responsiveness in the physiotherapy program (baseline and end of program; mean +/- SD): BASDAI: 6.25 +/- 1.97 and 3.07 +/- 2.04 (p = 0.0001); BASFI: 5.68 +/- 2.29 and 2.88 +/- 1.77 (p = 0.0001); DFI: 16 +/- 7.6 and 8.0 +/- 5.5 (p = 0.001) with effect sizes and standardized effect sizes > 1.
The Mexican Spanish versions of the BASDAI, BASFI, and DFI showed adequate reliability, validity and responsiveness to clinical change. These instruments can be used in the clinical evaluation of Spanish-speaking patients with AS.
巴斯强直性脊柱炎疾病活动指数（BASDAI）、巴斯强直性脊柱炎功能指数（BASFI）和杜加多斯功能指数（DFI）是测量强直性脊柱炎（AS）疾病活动度和功能的最常用工具。本研究的目的是将这些工具翻译成西班牙语，进行改编并验证。
由三位熟悉AS医学方面的独立双语医生和一位专业翻译人员将BASDAI、BASFI和DFI问卷翻译成西班牙语。两位熟悉工具验证且知晓研究目的的风湿病学家检查了语义、习语和概念问题，并通过共识得出了每个工具的统一版本。由一位不知道原始版本的专业翻译人员将西班牙语进行英文回译。对两个英文版本进行比较，必要时对西班牙语版本进行修改。为进行验证，将西班牙语版本应用于61例门诊AS患者和80例未分化脊柱关节病患者。在28例参加物理治疗项目的患者中测量了信度和反应性。
信度显示24小时重测组内相关系数（ICC）可接受——BASFI的ICC为0.68，95%可信区间为0.29 - 0.85；BASDAI的ICC为0.74，95%可信区间为0.52 - 0.88；DFI的ICC为0.87，95%可信区间为0.73 - 0.94。评估了这些工具的结构效度，BASDAI与通过总附着点计数测量的疾病活动度相关（rs：0.34）；与上周的总体健康状况相关（rs：0.7）；与脊柱疼痛相关（rs：0.53）以及与晨僵持续时间相关（rs：0.64）。BASFI与施伯试验相关（rs： - 0.4）；与枕墙距相关（rs：0.38）以及与胸廓活动度相关（rs： - 0.3）。DFI与施伯试验相关（rs： - 0.36）；与枕墙距相关（rs：0.29）以及与胸廓扩张相关（rs： - 0.3）。DFI与BASFI之间的相关性为rs：0.83。所有工具在物理治疗项目中均显示出临床反应性（基线和项目结束时；均值±标准差）：BASDAI：6.25±1.97和3.07±2.04（p = 0.0001）；BASFI：5.68±2.29和2.88±1.77（p = 0.0001）；DFI：16±7.6和8.0±5.5（p = 0.001），效应大小和标准化效应大小>1。
BASDAI、BASFI和DFI的墨西哥西班牙语版本显示出足够的信度、效度和对临床变化的反应性。这些工具可用于对说西班牙语的AS患者进行临床评估。
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