Ankylosing Spondylitis Quality of Life

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The Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire is a patient-reported outcome (PRO) measure which assesses the quality of life of patients with ankylosing spondylitis.[1] The ASQoL is based on the needs-based quality of life model.[2] It is a self-administered questionnaire which contains 18 items[3] and takes up to four minutes to complete.[1]

Developed by Galen Research and published in 2003,[1] the ASQoL has been used in clinical studies worldwide. The content for the measure was drawn from qualitative interviews that were conducted with ankylosing spondylitis (AS) patients. The draft version of the ASQoL was created and then went through several stages of testing to ensure it had good face validity, content validity, reproducibility and construct validity.[1]


Language adaptations[edit]

The ASQoL was initially developed in UK English and Dutch, but to date a total of 37 language versions have been adapted. The language adaptations can be broken down into waves:

Wave Language Adaptation
First Wave US English, Canadian French, Canadian English, French, German, Italian, Spanish and Swedish[4]
Second Wave Argentinian Spanish, Belgian Flemish, Belgian French, US Spanish, Czech, Hungarian, Mexican Spanish, Turkish, Polish, New Zealand English and Brazilian Portuguese.[2]
Third Wave Bulgarian, Chilean Spanish, Greek, Croatian, Danish, Finnish, Swedish for Finland, Hebrew, Korean, Norwegian, Peruvian Spanish, Philippine Tagalog, Russian, Slovakian, UAE Arabic, Traditional Chinese-Taiwan, Simplified Chinese-China.[2]

Pharmaceutical use[edit]

Pharmaceutical companies began utilizing the ASQoL to test the effectiveness of newly developed TNF inhibitors, which aid in the treatment of ankylosing spondylitis.[5][6] Abbott has utilized the ASQoL to evaluate the impact of adalimumab[7][8] and other organizations like Wyeth and the Medical Research Council have used it to evaluate the effect of etanercept.[9][10]


Since the development of the ASQoL, several studies have been performed in order to evaluate and validate the measure. These studies include:

  • Validation studies for different language versions of the ASQoL which found good reliability and validity.[11][12][13]


  1. ^ a b c d Doward, L.C.; Spoorenberg, A.; Cook, S.A.; Whalley, D.; Helliwell, P.S.; Kay, L.J.; McKenna, S.P.; Tennant, A.; van der Heijde, D.; Chamberlain, M.A. (2003). "Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis". Annals of the Rheumatic Diseases. 62 (1): 20–26. doi:10.1136/ard.62.1.20. PMC 1754293Freely accessible. PMID 12480664. 
  2. ^ a b c McKenna, Stephen (2011). New developments in the Ankylosing Spondylitis Quality of Life (ASQoL) scale (PDF). Madrid, Spain.: International Society for Pharmacoeconomics and Outcomes Research (ISPOR) conference. Retrieved 2013-09-16. 
  3. ^ "Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL)". MAPI Research Trust. September 2009. Archived from the original on 2012-10-02. Retrieved 2013-09-16. 
  4. ^ Doward, L.C.; McKenna, S.P.; Meads, D.M.; Twiss, J.; Revicki, D.; Wong, R.L.; Luo, M.P. (2007-02-02). "Translation and validation of non-English versions of the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire". Health and Quality of Life Outcomes. Bio Med Central. 5 (7): 7. doi:10.1186/1477-7525-5-7.  open access publication – free to read
  5. ^ National Health Service (NHS). "Treating ankylosing spondylitis". NHS Choices. Retrieved 25 September 2013. 
  6. ^ "Anti TNF therapy". National Ankylosing Spondylitis Society (NASS). Retrieved 25 September 2013. 
  7. ^ van der Heijde, Desiree M.; Revicki, Dennis A.; Gooch, Katherine L.; Wong, Robert L.; Kupper, Hartmut; Harnam, Neesha; Thompson, Chris; Sieper, Joachim; the ATLAS Study Group (2009-08-17). "Physical function, disease activity, and health-related quality-of-life outcomes after 3 years of adalimumab treatment in patients with ankylosing spondylitis". Arthritis Research & Therapy. 11 (4): 1–12. doi:10.1186/ar2790. 
  8. ^ Davis Jr., John C.; Revicki, Dennis; van der Heijde, Desiree M.F.; Rentz, Anne M.; Wong, Robert L.; Kupper, Hartmut; Luo, Michelle P. (2007-08-15). "Health-related quality of life outcomes in patients with active ankylosing spondylitis treated with adalimumab: Results from a randomized controlled study". Arthritis Care & Research. 57 (6): 1050–1057. doi:10.1002/art.22887. 
  9. ^ Marzo-Ortega, Helena; McGonagle, Dennis; O'Connor, Philip; Emery, Paul (2001-09-26). "Efficacy of Etanercept in the Treatment of the Entheseal Pathology in Resistant Spondylarthropathy". Arthritis & Rheumatism. 44 (9): 2112–2117. doi:10.1002/1529-0131(200109)44:9<2112::AID-ART363>3.0.CO;2-H. 
  10. ^ Marzo-Ortega, H; McGonagle, D.; Haugeberg, G.; Green, M.J.; Stewart, S.P.; Emery, P. (2003). "Bone mineral density improvement in spondyloarthropathy after treatment with etanercept". Annals of Rheumatic Diseases. 62 (10): 1020–1021. doi:10.1136/ard.62.10.1020. PMC 1754338Freely accessible. PMID 12972490. 
  11. ^ Jenks, Katherine; Treharne, Gareth J.; Garcia, Jose; Stebbings, Simon (October 2010). "The Ankylosing Spondylitis Quality of Life Questionnaire: validation in a New Zealand cohort". International Journal of Rheumatic Disease. 13 (4): 361–366. doi:10.1111/j.1756-185X.2010.01554.x. 
  12. ^ Doward, Lynda C.; McKenna, Stephen P.; Meads, David M.; Twiss, James; Revicki, Dennis; Wong, Robert L.; Luo, Michelle P. (2007). "Translation and validation of non-English versions of the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire". Health and Quality of Life Outcomes. 5 (7): 1–10. doi:10.1186/1477-7525-5-7.  open access publication – free to read
  13. ^ Ariza-Ariza, R.; Hernandez-Cruz, B.; Lopez-Anteguera, G; Toyos, F.J.; Navarro-Sarabia, F. (2006). "Cross-cultural adaptation and validation of a Spanish version of a specific instrument to measure health-related quality of life in patients with ankylosing spondylitis". Reumatologia Clinica. 2 (2): 64–69. doi:10.1016/S1699-258X(06)73024-8. PMID 21794306.