Ruangnopparut Ratthanin, Osiri Manathip, Suwannaroj Siraphop, Mahakkanukrauh Ajanee, Pongkulkiat Patnarin, Onchan Tippawan, Foocharoen Chingching
Division of Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
Clin Rheumatol. 2025 Jul 1. doi: 10.1007/s10067-025-07553-2.
The Scleroderma Health Assessment Questionnaire (S-HAQ), including the Disability Index (HAQ-DI) and six-symptom visual analog scales (VAS), assesses functional ability in systemic sclerosis (SSc). The Thai HAQ-DI has been validated, but not the S-HAQ VAS.
We aim to translate and culturally adapt the VAS for symptoms in S-HAQ and assess its validity and reliability.
The six VAS items, which assess pain, gastrointestinal symptoms, respiratory symptoms, Raynaud's phenomenon (RP), digital ulcers (DU), and overall disease activity interfering with daily activities, were translated into Thai and validated. Thirty SSc patients completed the translated questionnaire twice, with a one-week interval. Intraclass correlation (ICC) was used for test-retest reliability, and Spearman correlation was used to test the reliability of the associated clinical parameters and the S-HAQ VAS.
For the validity testing, the VAS for pain, respiratory symptoms, RP, DU, and overall disease activity showed significant correlations with the modified Rodnan skin score (mRSS) (Rho = 0.508, 0.550, 0.474, 0.492, and 0.557, respectively) and with the EuroQol visual analog scale (EQ VAS) (Rho = - 0.652, - 0.697, - 0.568, - 0.581, and - 0.668, respectively). Additionally, the World Health Organization functional class demonstrated significant correlations with both the VAS overall disease activity and the HAQ-DI (Rho = 0.473 and 0.460, respectively). The HAQ-DI showed significant correlations with all the S-HAQ VAS questions. The reliability testing indicated a strong ICC between two testing sessions for each VAS item in the S-HAQ, with coefficient values ranging from 0.777 to 0.940.
This study substantiates the utility of the Thai S-HAQ VAS as a valid measure for assessing function and disability in patients with SSc. The translated Thai version of the S-HAQ VAS exhibits high reliability, demonstrated by strong ICC between two testing sessions. Key Points • The Thai version of the Scleroderma Health Assessment Questionnaire (S-HAQ) visual analog scale (VAS) was successfully translated and culturally adapted. It provides a reliable and valid tool for assessing systemic sclerosis (SSc) symptoms and disability in native Thai patients. • Strong test-retest reliability was demonstrated for all six VAS items, with intraclass correlation (ICC) values ranging from 0.777 to 0.940 and the validity testing showed significant correlations between S-HAQ VAS scores and clinical parameters, including mRSS, EQ-VAS, and WHO functional class. • The availability of this validated tool enables Thai researchers to participate in international SSc clinical trials and comparative studies using standardized outcome measures, enhancing global research collaboration.
硬皮病健康评估问卷（S-HAQ），包括残疾指数（HAQ-DI）和六个症状的视觉模拟量表（VAS），用于评估系统性硬化症（SSc）患者的功能能力。泰语版HAQ-DI已得到验证，但S-HAQ VAS尚未得到验证。
我们旨在对S-HAQ中的症状视觉模拟量表进行翻译和文化调适，并评估其有效性和可靠性。
评估疼痛、胃肠道症状、呼吸道症状、雷诺现象（RP）、指端溃疡（DU）以及干扰日常活动的总体疾病活动度的六个VAS条目被翻译成泰语并进行验证。30例SSc患者间隔一周完成两次翻译后的问卷。组内相关系数（ICC）用于检验重测信度，Spearman相关系数用于检验相关临床参数与S-HAQ VAS的信度。
在效度检验中，疼痛、呼吸道症状、RP、DU以及总体疾病活动度的VAS与改良Rodnan皮肤评分（mRSS）（相关系数分别为0.508、0.550、0.474、0.492和0.557）以及欧洲五维度健康量表视觉模拟量表（EQ VAS）（相关系数分别为-0.652、-0.697、-0.568、-0.581和-0.668）均显示出显著相关性。此外，世界卫生组织功能分级与VAS总体疾病活动度以及HAQ-DI均显示出显著相关性（相关系数分别为0.473和0.460）。HAQ-DI与所有S-HAQ VAS问题均显示出显著相关性。信度检验表明，S-HAQ中每个VAS条目在两次测试之间具有很强的ICC，系数值范围为0.777至0.940。
本研究证实了泰语版S-HAQ VAS作为评估SSc患者功能和残疾情况的有效工具的实用性。翻译后的泰语版S-HAQ VAS具有很高的可靠性，两次测试之间的强ICC证明了这一点。要点 • 硬皮病健康评估问卷（S-HAQ）视觉模拟量表（VAS）的泰语版已成功翻译并进行了文化调适。它为评估泰国本土患者的系统性硬化症（SSc）症状和残疾情况提供了一个可靠且有效的工具。 • 所有六个VAS条目均显示出很强的重测信度，组内相关系数（ICC）值范围为0.777至0.940，效度检验表明S-HAQ VAS评分与临床参数（包括mRSS、EQ-VAS和WHO功能分级）之间存在显著相关性。 • 这个经过验证的工具的可用性使泰国研究人员能够参与使用标准化结局指标的国际SSc临床试验和比较研究，加强全球研究合作。
