title: Cross cultural adaptation and validation of the Chinese Health Assessment Questionnaire for use in rheumatoid arthritis.
abstract: OBJECTIVE
  The Health Assessment Questionnaire - Disability Index (HAQ), used as a disability and outcome measurement in rheumatoid arthritis (RA), has been validated in several languages, but not in Chinese. Our aim was to validate the Chinese version of HAQ (Chinese-HAQ) to suit the needs of Chinese speaking patients with RA in an Asian setting.
  
  
  METHODS
  The original HAQ was modified in the context of Chinese culture and translated into Chinese by 2 translators aware of the objective of the questionnaire. The Chinese HAQ was self-administered by 42 patients with RA during their routine followup visit and one week later.
  
  
  RESULTS
  The test-retest reliability assessed using Spearman's correlation coefficient was 0.84. Between dimensions measured in the HAQ, the highest test-retest reliability was observed for walking (Spearman correlation coefficient rs=0.80) and the lowest was for eating (rs=0.54). The internal consistency of the scale using Cronbach's alpha was high at 0.86. In terms of criterion validity, the Chinese-HAQ score was found to correlate well with American College of Rheumatology functional status (rs=0.501, p=0.01). The Chinese-HAQ scores also correlated well with markers of disease activity such as patient's perception of pain measured on a visual analog scale (rs=0.55, p < 0.001), grip strength in mm Hg (rs=-0.55. p < 0.001 ), and physician's assessment of disease activity (rs=0.59, p < 0.001).
  
  
  CONCLUSIONS
  The Chinese HAQ is a reliable and valid instrument for studies measuring disability of patients with RA in Singapore.
authors.affiliation: Department of Rheumatology and Immunology, Tan Tock Seng Hospital, Singapore.
authors.forename: E T
authors.initials: ET
authors.lastname: Koh
authors.forename: A
authors.initials: A
authors.lastname: Seow
authors.forename: L Y
authors.initials: LY
authors.lastname: Pong
authors.forename: W H
authors.initials: WH
authors.lastname: Koh
authors.forename: L
authors.initials: L
authors.lastname: Chan
authors.forename: H S
authors.initials: HS
authors.lastname: Howe
authors.forename: T H
authors.initials: TH
authors.lastname: Lim
authors.forename: C K
authors.initials: CK
authors.lastname: Low
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D002681:China; D003431:Cross-Cultural Comparison; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires