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Validity and reliability of the ten-item Connor–Davidson Resilience Scale (CD-RISC10) instrument in patients with axial spondyloarthritis (axSpA) in Singapore

  • Yu Heng Kwan
  • Amanda Ng
  • Ka Keat Lim
  • Warren Fong
  • Jie Kie Phang
  • Eng Hui Chew
  • Nai Lee Lui
  • Chuen Seng Tan
  • Julian Thumboo
  • Truls Østbye
  • Ying Ying Leung
Validation Studies
  • 15 Downloads

Abstract

We aimed to assess the validity and reliability of the ten-item Connor–Davidson Resilience Scale (CD-RISC10) in patients with axial spondyloarthritis (axSpA) in Singapore. We used cross-sectional data from 108 patients with axSpA recruited from a dedicated axSpA clinic in a Singapore tertiary referral hospital from 2017 to 2018. Analyses were guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) framework. Face validity was assessed through cognitive debriefing interviews (CDIs). Internal consistency was assessed through Cronbach’s alpha. Test–retest reliability was assessed through intraclass correlation (ICC). Measurement error was assessed through smallest detectable change (SDC). Construct validity was assessed through six a priori hypotheses through correlation of the CD-RISC10 score with other patient-reported outcome measures. Structural validity was assessed using confirmatory factor analysis (CFA). Fit indices evaluated were root-mean-square error of approximation (RMSEA), comparative fit index (CFI), Tucker–Lewis index (TFI), and standardized root-mean-squared residual (SRMR). Ten patients completed the CDIs and face validity was supported. Among 108 patients (median age: 37(21–77), 81.5% males, 93.5% Chinese), the CD-RISC10 demonstrated good internal consistency (Cronbach’s alpha = 0.94), and excellent test–retest reliability [ICC = 0.964 (95% CI 0.937–0.980)]. SDC was calculated as 1.88. Construct validity was established by meeting five out of the six a priori hypotheses. Structural validity was supported as CFA confirmed a one-factor model, with adequate fit statistics after adding three covariances (RMSEA = 0.077; CFI = 0.975; TLI = 0.964; SRMR = 0.036). This study supports the CD-RISC10 as a valid and reliable measure of resilience for use in patients with axSpA.

Keywords

Axial spondyloarthritis Resilience CD-RISC Validation Singapore 

Notes

Authors’ contributions

YHK, TO, WF, and JT conceived and designed this study. JKP, AN, WF, NLL and YYL acquired the data for this study. AN, KKL and YHK performed the analyses and prepared the first draft of the manuscript. CST advised the statistical analyses. KKL, CST, EHC, and NLL interpreted the results. All authors read, revised critically, and approved the final manuscript.

Funding/support

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no other conflict of interest to disclose.

Ethical approval

The SingHealth Centralised Institutional Review Board approved this research. All patients provided written informed consent to participate in this research.

References

  1. 1.
    Zeidler H, Amor B (2011) The Assessment in Spondyloarthritis International Society (ASAS) classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general: the spondyloarthritis concept in progress. Ann Rheumatic Dis 70(1):1–3.  https://doi.org/10.1136/ard.2010.135889 CrossRefGoogle Scholar
  2. 2.
    Ward MM (1999) Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res 12(4):247–255CrossRefGoogle Scholar
  3. 3.
    Perrotta FM, De Socio A, Scriffignano S, Lubrano E (2018) From clinical remission to residual disease activity in spondyloarthritis and its potential treatment implications. Expert Rev Clin Immunol 14(3):207–213.  https://doi.org/10.1080/1744666x.2018.1429918 CrossRefGoogle Scholar
  4. 4.
    Strand EB, Zautra AJ, Thoresen M, Odegard S, Uhlig T, Finset A (2006) Positive affect as a factor of resilience in the pain-negative affect relationship in patients with rheumatoid arthritis. J Psychosom Res 60(5):477–484.  https://doi.org/10.1016/j.jpsychores.2005.08.010 CrossRefGoogle Scholar
  5. 5.
    Sykes MP, Doll H, Sengupta R, Gaffney K (2015) Delay to diagnosis in axial spondyloarthritis: are we improving in the UK? Rheumatology 54(12):2283–2284.  https://doi.org/10.1093/rheumatology/kev288 CrossRefGoogle Scholar
  6. 6.
    Campbell-Sills L, Stein MB (2007) Psychometric analysis and refinement of the Connor–Davidson Resilience Scale (CD-RISC): validation of a 10-item measure of resilience. J Trauma Stress 20(6):1019–1028.  https://doi.org/10.1002/jts.20271 CrossRefGoogle Scholar
  7. 7.
    Connor KM, Davidson JR (2003) Development of a new resilience scale: the Connor–Davidson Resilience Scale (CD-RISC). Depression Anxiety 18(2):76–82.  https://doi.org/10.1002/da.10113 CrossRefGoogle Scholar
  8. 8.
    Notario-Pacheco B, Martínez-Vizcaíno V, Trillo-Calvo E, Pérez-Yus MC, Serrano-Parra D, García-Campayo J (2014) Validity and reliability of the Spanish version of the 10-item CD-RISC in patients with fibromyalgia. Health Qual Life Outcomes 12:14.  https://doi.org/10.1186/1477-7525-12-14 CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Cosco TD, Kaushal A, Richards M, Kuh D, Stafford M (2016) Resilience measurement in later life: a systematic review and psychometric analysis. Health Qual Life Outcomes.  https://doi.org/10.1186/s12955-016-0418-6 CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Windle G, Bennett KM, Noyes J (2011) A methodological review of resilience measurement scales. Health and Quality of Life Outcomes 9(1):8.  https://doi.org/10.1186/1477-7525-9-8 CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Rudwaleit M, Landewe R, van der Heijde D, Listing J, Brandt J, Braun J, Burgos-Vargas R, Collantes-Estevez E, Davis J, Dijkmans B, Dougados M, Emery P, van der Horst-Bruinsma IE, Inman R, Khan MA, Leirisalo-Repo M, van der Linden S, Maksymowych WP, Mielants H, Olivieri I, Sturrock R, de Vlam K, Sieper J (2009) The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheumatic Dis 68(6):770–776.  https://doi.org/10.1136/ard.2009.108217 CrossRefGoogle Scholar
  12. 12.
    Kiltz U, van der Heijde D, Boonen A, Cieza A, Stucki G, Khan MA, Maksymowych WP, Marzo-Ortega H, Reveille J, Stebbings S, Bostan C, Braun J (2015) Development of a health index in patients with ankylosing spondylitis (ASAS HI): final result of a global initiative based on the ICF guided by ASAS. Ann Rheumatic Dis 74(5):830–835.  https://doi.org/10.1136/annrheumdis-2013-203967 CrossRefGoogle Scholar
  13. 13.
    Thong ISK, Jensen MP, Miro J, Tan G (2018) The validity of pain intensity measures: what do the NRS, VAS, VRS, and FPS-R measure? Scand J Pain 18(1):99–107.  https://doi.org/10.1515/sjpain-2018-0012 CrossRefGoogle Scholar
  14. 14.
    Kwan YH, Fong WW, Lui NL, Yong ST, Cheung YB, Malhotra R, Ostbye T, Thumboo J (2016) Validity and reliability of the Short Form 36 Health Surveys (SF-36) among patients with spondyloarthritis in Singapore. Rheumatol Int 36(12):1759–1765.  https://doi.org/10.1007/s00296-016-3567-3 CrossRefGoogle Scholar
  15. 15.
    Leung YY, Png ME, Wee HL, Thumboo J (2013) Comparison of EuroQol-5D and short form-6D utility scores in multiethnic Asian patients with psoriatic arthritis: a cross-sectional study. J Rheumatol 40(6):859–865.  https://doi.org/10.3899/jrheum.120782 CrossRefGoogle Scholar
  16. 16.
    Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC (2010) The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res 19(4):539–549.  https://doi.org/10.1007/s11136-010-9606-8 CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Bruynesteyn K, Boers M, Kostense P, van der Linden S, van der Heijde D (2005) Deciding on progression of joint damage in paired films of individual patients: smallest detectable difference or change. Ann Rheumatic Dis 64(2):179–182.  https://doi.org/10.1136/ard.2003.018457 CrossRefGoogle Scholar
  18. 18.
    Jeong HS, Kang I, Namgung E, Im JJ, Jeon Y, Son J, Yu S, Kim S, Yoon S, Lyoo IK, Chung YA, Lim JH, Kim JE (2015) Validation of the Korean version of the Connor–Davidson Resilience Scale-2 in firefighters and rescue workers. Compr Psychiatry 59:123–128.  https://doi.org/10.1016/j.comppsych.2015.01.006 CrossRefGoogle Scholar
  19. 19.
    Fernandez AC, Fehon DC, Treloar H, Ng R, Sledge WH (2015) Resilience in organ transplantation: an application of the Connor–Davidson Resilience Scale (CD-RISC) with liver transplant candidates. J Pers Assess 97(5):487–493.  https://doi.org/10.1080/00223891.2015.1029620 CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Mukaka MM (2012) A guide to appropriate use of correlation coefficient in medical research. Malawi Med J 24(3):69–71PubMedCentralPubMedGoogle Scholar
  21. 21.
    Hu LT, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model 6(1):1–55.  https://doi.org/10.1080/10705519909540118 CrossRefGoogle Scholar
  22. 22.
    Fredrickson BL, Branigan C (2005) Positive emotions broaden the scope of attention and thought-action repertoires. Cognition Emot 19:313–332.  https://doi.org/10.1080/02699930441000238 CrossRefGoogle Scholar
  23. 23.
    Singapore Department of Statistics (2016) General Household Survey 2015. Department of Statistics, Ministry of Trade & Industry, Republic of Singapore, SingaporeGoogle Scholar
  24. 24.
    Ng X, Low AH, Chew LC, Chong YY, Fong KY, Lui NL, Sim E, Tan YK, Yoong J, Thumboo J (2013) Disease patterns of rheumatology outpatients seen in a tertiary hospital serving a multi-ethnic, urban Asian population in Singapore. Int J Rheumatic Dis 16(3):273–278.  https://doi.org/10.1111/1756-185x.12016 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Program in Health Services and Systems ResearchDuke-NUS Medical SchoolSingaporeSingapore
  2. 2.Department of Pharmacy, Faculty of ScienceNational University of SingaporeSingaporeSingapore
  3. 3.Department of Rheumatology and ImmunologySingapore General HospitalSingaporeSingapore
  4. 4.Duke-NUS Medical SchoolSingaporeSingapore
  5. 5.Department of Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  6. 6.Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingaporeSingapore

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