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Spanish transcultural adaptation and validation of the English version of the compliance questionnaire in rheumatology

A Correction to this article was published on 29 March 2018

This article has been updated


To perform a transcultural adaptation and validation of a Spanish version of the compliance questionnaire in rheumatology (sCQR). In this transversal study of transcultural adaptation of the sCQR, validity was evaluated in patients with rheumatoid arthritis (RA) and a minimum 6-month follow-up by determining compliance with the electronic prescription system in consuming steroids or nonbiologic disease-modifying antirheumatic drugs. A two-week retest was proposed to all patients. All patients completed the health assessment questionnaire (HAQ), and the Morisky-Green test was also performed. Reliability was analyzed using Cronbach’s alpha and the intraclass correlation coefficient (ICC). Convergent construct validity was tested in the electronic prescription system using discriminative analysis, and divergent construct validity was tested by comparing it to the HAQ. Sensitivity, specificity and ROC curves were evaluated for the sCQR and the Morisky-Green test. Of 123 recruited patients, 101 fulfilled the inclusion criteria, and 61 were on biologic therapy. 23 performed the retest. Test–retest reliability (ICC) was 0.76 (Cronbach’s alpha 0.86). Multiple regression analysis showed correlation with each item of the sCQR as independent variables (r2 = 0.60). No correlation was seen between total score punctuation of the sCQR and the HAQ (r2 = 0.22). Discriminative analysis weighting each sCQR item showed a cutoff point of − 0.9991 (sensibility and 58.8%, specificity 98.3%). The likelihood ratio of the sCQR to detect ≤ 80% adherence with electronic prescriptions was 35.3. The Morisky-Green test revealed sensibility and specificity were 29.4 and 83.3%, respectively. This study validates the transcultural adaptation of sCQR in RA patients. A high reliability of sCQR for measuring adherence was found. Its predictive value suggests that it could be used as a screening instrument.

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  • 29 March 2018

    In the original published article, the family name was incorrectly tagged for two co-authors. The correct family names of authors José Ramón Maneiro Fernández is Maneiro Fernández and Alejandro Souto Vilas is Souto Vilas.


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Authors and Affiliations



All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be submitted for publication. Dr. Salgado had full access to all data in the study and takes responsibility for its integrity and the accuracy of the data analysis. Study conception and design”: Dr. Salgado, Dr. Maneiro, Dr. Souto and Professor Gomez-Reino. Acquisition of data: Dr. Salgado, Dr. Maneiro and Dr. Souto. Analysis and interpretation of data: Dr. Salgado, Dr. Maneiro and Professor Gomez-Reino. Role of the study sponsor: Roche Spain had no role in the study design or in the collection, analysis or interpretation of the data, the writing of the manuscript or the decision to submit the manuscript for publication.

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Correspondence to Eva Salgado.

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Informed consent

The study was approved by the Ethical Committee of Clinical Investigation of Galicia (Spain), and informed consent was obtained from all individual participants included in the study.

Conflict of interest

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. J Gomez-Reino is on the Advisory Boards of BMS, Gilead, Pfizer, Roche, Regeneron, and UCB SA; has received lecture fees from BMS, Roche, Schering-Plough and Wyeth and has received research Grants from Roche and Pfizer. Dr. Salgado, Dr. Maneiro and Dr. Souto declare that they have no conflict of interest.

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Salgado, E., Fernández, J.R.M., Vilas, A.S. et al. Spanish transcultural adaptation and validation of the English version of the compliance questionnaire in rheumatology. Rheumatol Int 38, 467–472 (2018).

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  • Adherence
  • Compliance
  • Rheumatoid arthritis
  • Questionnaire
  • Spanish