Rheumatology International

, Volume 39, Issue 1, pp 105–110 | Cite as

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

  • Yu Heng KwanEmail author
  • 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


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.


Axial spondyloarthritis Resilience CD-RISC Validation Singapore 


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.


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.


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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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