Systematic Review and Appraisal of the Cross‐Cultural Validity of Functional Status Assessment Measures in Rheumatoid Arthritis

OBJECTIVE: We conducted a systematic review and appraisal of the cross‐cultural adaptation and cross‐cultural validity of the Health Assessment Questionnaire (HAQ) and its derivatives, and of the more recent Patient‐Reported Outcomes Measurement Information System (PROMIS) functional status assessment measures (FSAMs) in rheumatoid arthritis. METHODS: Four electronic medical databases were searched from inception until April 4, 2018 according to the Consensus‐Based Standards for the Selection of Health Measurement Instruments (COSMIN) group search strategy. Included studies were evaluated using the COSMIN tool for cross‐cultural validity and were scored as excellent, good, fair, or poor. RESULTS: Of 58 articles identified by our search strategy and 3 by manual search, 39 were included: 29 described the translation, cultural adaptation, or cross‐cultural validity of the HAQ disability index, 8 other HAQ derivatives, and 2 PROMIS measures, representing 22 languages. Of the 39 articles reviewed, 3 examined the cross‐cultural validity of translated versions. These studies were rated as follows: 2 as excellent, 3 good, 13 fair, and 21 poor. Two studies examining cross‐cultural validity noted differential item functioning (DIF) between Dutch and US populations for the HAQ‐II and PROMIS measures, and a third study found DIF between Turkish and UK populations on the HAQ, indicating cultural differences in questionnaire response. CONCLUSION: This review highlights a paucity of data on the cross‐cultural validity of FSAMs and the mostly poor‐ or fair‐quality methods by which they were translated and adapted, which needs to be considered when using these measures for multinational clinical trials and for day‐to‐day use in clinical practice.