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Reliability, validity and responsiveness of instruments to assess disabilities in personal care in patients with rheumatic disorders. A systematic review

R.A.H.M. Swinkels¹, P.U. Dijkstra², L.M. Bouter³

¹Free University Brussels, Faculty of Medicine and Pharmacology, Postgraduate Education Manual Therapy, Brussel, Belgium; ²Centre for Rehabilitation, University Hospital Groningen, Groningen; ³VU University Medical Centre, Institute for Research in Extramural Medicine, Amsterdam, The Netherlands.

ABSTRACT
Objectives
The first aim was to make an inventory of available instruments and questionnaires for the assessment of disabilities in personal care in patients with rheumatic disorders. The second aim was to investigate which of these instruments have acceptable methodological quality with regard to reliability, validity and responsiveness. The third aim was to investigate the assumption that convergent validity results in stronger correlations when validated against a more similar construct.

Methods
A computer-aided literature search (1982-2001) in several databases was performed to identify studies focusing on the clinimetric properties of instruments to assess impairments in function in patients with rheumatic disorders. Data were extracted in a standardised way and compared to a priori defined criteria.

Results
In total, 19 measurement instruments were included. Five out of these 19 were found to have acceptable reliability, while 12 had acceptable validity. Only three questionnaires met both criteria. Results concerning the responsiveness of these three questionnaires were conflicting. No difference was found in the strength of correlation between validation against the most similar construct versus validation against the least similar construct.

Conclusion
It is concluded that the Arthritis Impact Measurement Scale (AIMS) is the most suitable instrument for the assessment of disabilities in personal care.

Key words
Measurement instrument, personal care, rheumatic disorders, methodological quality, assessment, systematic review.

This study was supported by a grant from the Health Insurance Executive Board (CvZ), no. CURE/24101/97.
Please address correspondence to: R.A.H.M. Swinkels, Ulenpas 80, 5655 JD Eindhoven, The Netherlands.
E-mail: swinky@xs4all.nl