Development of an environmental contextual factor item set relevant to global functioning and health in patients with axial Spondyloarthritis

Uta Kiltz*, Annelies Boonen, Désirée van der Heijde, Wilson Bautista-Molano, Ruben Burgos Vargas, Praveena Chiowchanwisawakit, Bassel El-Zorkany, Inna Gaydukova, Pal Geher, Laure Gossec, Michele Gilio, Simeon Grazio, Jieruo Gu, Muhammad Asim Khan, Tae-Jong Kim, Walter P Maksymowych, Helena Marzo-Ortega, Victoria Navarro-Compán, Salih Ozgocmen, Dimos PatrikosFernando Manuel Pimentel-Santos, John Reveille, Michael Schirmer, Simon Stebbings, Filip Van den Bosch, Ulrich Weber, Juergen Braun

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


OBJECTIVE: To describe the development of an Environmental contextual factors (EF) Item Set (EFIS) accompanying the disease specific Assessment of SpondyloArthritis international Society Health Index (ASAS HI).

METHOD: First, a candidate item pool was developed by linking items from existing questionnaires to 13 EF previously selected for the ICF/ASAS Core Set. Second, using data from two international surveys, which contained the EF item pool as well as the items from the ASAS HI, the number of EF-items was reduced based on the correlation between the item and the ASAS HI sum score combined with expert opinion. Third, the final English EFIS was translated into 15 languages and cross-culturally validated.

RESULTS: The initial item pool contained 53 EF addressing 4 ICF EF-chapters: products and technology (e1), support and relationship (e3), attitudes (e4) and health services (e5). Based on 1754 responses of axial spondyloarthritis patients in an international survey, 44 of 53 initial items were removed based on low correlations to the ASAS HI or redundancy combined with expert opinion. 9 items of the initial item pool (range correlation 0.21-0.49) form the final EFIS. The EFIS was translated into 15 languages and field tested in 24 countries.

CONCLUSIONS: An EFIS is available complementing the ASAS HI and helps to interpret the ASAS HI results by gaining an understanding of the interaction between a health condition and contextual factors. The EFIS emphasizes the importance of support and relationships, as well as attitudes of the patient and health services in relation to self-reported health.

Original languageEnglish
Pages (from-to)2054-2062
Number of pages9
Issue number5
Early online date17 Sept 2021
Publication statusPublished - 5 May 2022


  • spondyloarthritis
  • contextual factors
  • outcome research
  • ASAS

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