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Adaptation and validation of the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire for use in Bulgaria

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Abstract

Rheumatoid arthritis (RA) is a chronic disease with an enormous impact on patients’ quality of life. The Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire is a disease-specific measure of QoL for individuals with rheumatoid arthritis. Our aim was to adapt and validate the RAQoL for use in Bulgaria. The development of a new language version of the RAQoL consisted of three stages: translation, field testing and psychometric evaluation. The dual-panel methodology, requiring two independent panels of Bulgarian speakers, was applied to translate the UK English version of the RAQoL into Bulgarian. Face and content validity of the translated questionnaire were assessed through cognitive debriefing interviews. Lastly, the RAQoL was administered on two occasions to a random sample of RA patients to evaluate reliability and validity. At the first occasion, the SF-36 was also administered for use as a comparator scale. The RAQoL was successfully adapted into Bulgarian and considered easy to understand, acceptable and comprehensive by RA patients. A psychometric study demonstrated that the new language version has excellent internal consistency (Cronbach’s alpha coefficients = 0.93 and 0.94) and test–retest reliability (a Spearman’s rank correlation coefficient = 0.97). Convergent validity was established by correlating scores on the RAQoL with a comparator measure, the SF-36. A strong correlation between RAQoL scores and the physical functioning section of the SF-36 was observed. Known group validity was established by the ability of the measure to distinguish between subgroups of patients, who differed according to their perceived general health, disease severity (p < 0.001) and whether they were experiencing a flare-up (p < 0.01). The new language version is recommended for use in future research studies, clinical trials and routine practice with Bulgarian RA patients.

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Acknowledgements

The authors would like to thank all participants in the bilingual and lay translation panels and all the patients for their participation.

Funding

This work is supported by the Bulgarian Ministry of Education and Science under the National Program for Research “Young Scientists and Postdoctoral Students”.

Author information

Authors and Affiliations

  1. Medical University of Sofia, Sofia, Bulgaria

    Daliya Tsvetanova Pencheva & Simeon Valentinov Monov

  2. University Clinical Hospital “St. Ivan Rilski”, Sofia, Bulgaria

    Daliya Tsvetanova Pencheva & Simeon Valentinov Monov

  3. Galen Research Ltd, Manchester, UK

    Alice Heaney & Stephen P. McKenna

  4. School of Health Sciences, University of Manchester, Manchester, UK

    Stephen P. McKenna

Authors
  1. Daliya Tsvetanova Pencheva
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  2. Alice Heaney
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  4. Simeon Valentinov Monov
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Contributions

Study concept and design: SPM and AH. Data collection: DTP and SVM. Statistical analysis and data interpretation: SPM and AH. DTP prepared the first version of the manuscript and all authors contributed to critical revision of the manuscript. All authors read and approved the final version.

Corresponding author

Correspondence to Daliya Tsvetanova Pencheva.

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The authors declare no conflict of interest.

Ethics approval

All procedures performed in the study are in accordance with the standards of the Human Research Ethics Committee of the University Clinical Hospital “St. Ivan Rilski” (approval reference number No. 1/03.06.2019) and the 1964 Helsinki Declaration and its later amendments.

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Pencheva, D.T., Heaney, A., McKenna, S.P. et al. Adaptation and validation of the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire for use in Bulgaria. Rheumatol Int 40, 2077–2083 (2020). https://doi.org/10.1007/s00296-020-04686-2

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