Validation, Reliability, and Clinical Significance of the Arabic Version of Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire

Loay Aglan; Mohammed Kamal; Mona Mokhtar; Eman Kamel Abdelrahman; Sherine M Gaafar

doi:10.2174/0115733971292438240620064231

Validation, Reliability, and Clinical Significance of the Arabic Version of Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire

Curr Rheumatol Rev. 2024 Jun 28. doi: 10.2174/0115733971292438240620064231. Online ahead of print.

Authors

Loay Aglan¹, Mohammed Kamal², Mona Mokhtar², Eman Kamel Abdelrahman³, Sherine M Gaafar⁴

Affiliations

¹ Rheumatology and Rehabilitation Department, Aswan University, Egypt.
² Rheumatology and Rehabilitation Department Al-Azhar University, Egypt.
³ Internal Medicine Department, Port Said University, Port Said, Egypt.
⁴ Rheumatology and Rehabilitation Department, Mansoura University, Egypt.

PMID: 38952155
DOI: 10.2174/0115733971292438240620064231

Abstract

Background: Clinically relevant fatigue in rheumatoid arthritis (RA) patients significantly affects their quality of life. Almost all studies have assessed fatigue in this population using non-specific scales. The present multi-centric study aimed to assess the validity, reliability, and clinical significance of the Arabic version of the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF-MDQ).

Methods: The present cross-sectional multicentric study was conducted at Aswan, Mansoura, Port Said, and Al-Azhar University Hospitals over a 6-month duration. The study included 311 patients with RA diagnosed according to the 2010 criteria of the American College of Rheumatology. The Arabic version of BRAF-MDQ was developed to assess fatigue in these patients. All patients were subjected to careful history taking, thorough clinical assessment, and standard laboratory work-up. The obtained Arabic BRAF-MDQ was tested for construct validity, internal consistency, testretest reproducibility, and criterion validity. Construct validity was evaluated using factor analysis with the Kaiser Meyer Olkin tool of sampling adequacy and Bartlett's sphericity test. Internal consistency of subscales was assessed using Cronbach's alpha. Test-retest reproducibility was assessed after a 1-week interval using the intraclass correlation coefficient. Pearson's correlation coefficient was used to correlate numerical variables. Predictors of fatigue were identified using binary logistic regression analysis.

Results: The present study included 311 RA patients. Construct validity assessment showed a high loading of questionnaire items within the proposed construct subscales with a KMO measure of sphericity of 0.927 and Bartlett's test of sphericity p-value < 0.001. Internal consistency assessment showed adequate Cronbach's alpha of Arabic BRAF-MDQ subscales. Total Arabic BRAFMDQ had excellent criterion validity, as indicated by the high correlations with MAFS (r=0.95, p < 0.001) and SF-36 vitality subscale (r=-0.91, p < 0.001). Clinically significant fatigue was identified in 214 patients (68.8%). Multivariate logistic regression analysis revealed age (OR (95% CI): 1.07 (1.02-1.12), p < 0.001), disease duration (OR (95% CI): 1.82 (1.43-2.33), p < 0.001), DAS28CRP (OR (95% CI): 8.62 (4.63-16.02), p < 0.001), and mHAQ (OR (95% CI): 3.85 (1.07-13.9), p = 0 .039) as significant predictors of fatigue development in the studied patients.

Conclusion: The Arabic version of the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire is a valid, consistent, and reliable tool for the assessment of fatigue in Egyptian rheumatoid arthritis patients. Clinically significant fatigue was identified in 214 patients (68.8%). Further, risk factors for fatigue included older age, longer disease duration, and higher disease activity.

Keywords: BRAF-MDQ.; Fatigue; rheumatoid arthritis.