ANKYLOSING SPONDYLITIS QUALITY OF LIFE (ASQoL)
To assess the impact of ankylosing spondylitis (AS) on the quality of life of individuals living in the United Kingdom (UK) and the Netherlands (NL) with emphasis on the ability of the person to fulfill his or her needs.
Consists of 18 items requesting a yes or no response to questions related to the impact of pain on sleep, mood, motivation, ability to cope, activities of daily living, independence, relationships, and social life.
Dr. L.C. Doward, Galen Research, Enterprise Research, Enterprise House, Manchester Science Park, Lloyd Street North, Manchester M15 6SE, UK. E-mail: .
English, Dutch (1,2).
Number of items in scale.
There are 18 items.
Patients with ankylosing spondylitis were recruited from 3 hospitals in northern England and from 3 in the southern NL. Subjects were interviewed in their own homes.
None recommended by authors.
WHO ICF Components.
Impairment, Activity limitation, Participation restriction.
Time to administer/complete.
Less than four minutes.
Instrument and pencil.
Minimal. Available at http://ard.bmjjournals.com/cgi/content/full/b2/1/20/DC1.
Dichotomous: yes or no (1 or 0). A score of 1 is given as a yes, indicating that AS has an adverse effect on QoL. All item scores are summed to a total score or index.
The range is 0–18.
Interpretation of scores.
High scores indicate worse quality of life.
Method of scoring.
Time to score.
Training to score.
Training to interpret.
Cronbach's alpha = 0.91 at time 1 and 0.92 at time 2 in the UK, 0.89 at time 1 and 0.90 in the NL.
Spearman rank correlation coefficient for the test-retest reliability of the 18 item ASQoL was r = 0.92 (n = 129 in UK) and r = 0. 91 (n = 119 in NL). Intraclass correlation coefficients (ICCs) were 0.92 (UK) and 0.91 (NL).
Face and content validity.
Derived from a series of interviews of patients with AS in both the UK and the NL.
ASQoL was compared with the responses on the Nottingham Health Profile (NHP) and the Bath Ankylosing Spondylitis Functional Index (BASFI) by subjects in the UK and the NL. The Leeds Disability Questionnaire (LDQ) was used for comparison in the UK and the Dougados Functional Index (DFI) was used in the NL. Spearman rank correlation coefficients were reported between the ASQoL and the NHP, BASFI, LDQ, and DFI as follows (reported coefficients are for UK time 1 and the NL time 1, respectively): NHP sections on physical mobility 0.78, 0.79; energy 0.74, 0.73; pain 0.81, 0.79; emotional reactions 0.72, 0.73; sleep 0.54, 0.59; social isolation 0.53, 0.50; BASFI 0.72, 0.75; LDQ 0.70 (UK only); DFI (NL only) 0.80.
Sensitivity/responsiveness to change.
Authors recommended future studies to determine the ability of the ASQoL to detect meaningful changes in quality of life.
Comments and Critique
Doward et al (1) stated that the ASQoL is a valuable tool to assess the impact of interventions for AS on the quality of life dimensions of a person with AS. The instrument was first introduced in 1999 by Reynolds et al (2) and has subsequently undergone extensive psychometric analysis for use in both UK populations and in the NL.
1. (Original) Doward LC, Spoorenberg A, Cook SA, Whalley D, Helliwell PS, Kay LJ, et al. Development of the ASQol: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis 2003;62:20–6.
2. Reynolds S, Doward LC, Spoorenberg A, Helliwell PS, McKenna SP, Tennant A, et al. The development of the Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL). Qual Life Res 1999;8:651.
Helliwell PS, Doward LC, Whalley D, Tennant A, McKenna S, Reynolds S, et al. Psychometric and scaling properties of a new quality of life instrument specific to ankylosing spondylitis (AS) [abstract]. Arthritis Rheum 1999;42 Suppl 9:S72.
Van Tubergen A, Landewé R, van der Heijde D, Hidding A, Wolter N, Asscher M, et al. Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum (Arthritis Care Res) 2001;45:430–8.