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OP0102-HPR Cross-Cultural Validity of the Animated Activity Questionnaire (AAQ) that Assesses Activity Limitations in Patients with HIP or Knee Osteoarthritis
  1. W.F. Peter1,2,
  2. R. de Vet2,
  3. M. Boers3,
  4. J. Harlaar4,
  5. L.D. Roorda1,
  6. R.W. Poolman5,
  7. V.A. Scholtes5,
  8. J. Boogaard6,
  9. H. Buitelaar6,
  10. M. Steultjens7,
  11. E.M. Roos8,
  12. F. Guillemin9,
  13. M.G. Benedetti10,
  14. A.E. Martinez11,
  15. H. Dagfinrud12,
  16. C.B. Terwee2
  1. 1Amsterdam Rehabilitation Research Center, Reade
  2. 2Dept. of Epidemiology and Biostatistics EMGO Institute for Health and Care Research
  3. 3Amsterdam Rheumatology & Immunology Center
  4. 4Dept. of Rehabilitation medicine and MOVE research institute, VU University Medical Center
  5. 5Dept. of Orthopedics, Joint Research, Onze Lieve Vrouwe Gasthuis
  6. 6Patient research partner, Amsterdam, Netherlands
  7. 7Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, United Kingdom
  8. 8Institute of Sports Science and Clinical Biomechanics, Odense, Denmark
  9. 9University of Lorraine, Nancy, France
  10. 10Istituto Ortopedico Rizzoli, Bologna, Italy
  11. 11Basurto University Hospital, Bilbao, Spain
  12. 12National Advisory Unit for Rehabilitation in Rheumatology, Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway


Background The Animated Activity Questionnaire (AAQ) measures activity limitations in hip and knee osteoarthritis (HKOA), and demonstrated good validity and reliability [1]. The AAQ shows stylized video animations of different levels of activity performance. Patients are asked to choose which video best matches their own performance. Accordingly, for international studies, the AAQ should show minimal Differential Item Functioning (DIF) across countries, which means that patients from different countries with the same level of activity limitations should have the same score on each item.

Objectives To evaluate cross-cultural validity of the AAQ.

Methods In 7 European countries patients were asked to complete the AAQ. An example of an item of the AAQ is shown on: Ordinal logistic regression was used to evaluate DIF across languages (Dutch versus 6 other languages). As a criterion for uniform DIF we used an odds ratio outside the interval 0.53–1.89. An significant interaction term (p-value <0.05) between translation item score and original Dutch score was considered as non-uniform DIF. Analyses were adjusted for sex, age, and affected joint.

Results Data available were from: Netherlands (N=279), Denmark (N=109), France (N=121), Italy (N=203), United Kingdom (N=142), Norway (N=62), and Spain (N=37). Compared to Dutch, none of the 17 items showed DIF in Danish and French; uniform DIF occurred in 1 item for Norwegian versus Dutch and English versus Dutch; for Spanish versus Dutch 1 item showed uniform DIF, and 1 item showed non-uniform DIF; for Italian versus Dutch 3 items showed uniform DIF, and 3 items showed non-uniform DIF.

Conclusions Cross-cultural validity of the AAQ looks promising. Further analyses with more data per country are needed and currently collected. Since minimal translation is needed for the AAQ, cross-cultural differences will mainly be based on cultural differences. The AAQ seems to have great potential for international use in research and daily clinical practice.


  1. Peter WF et al. Development and preliminary testing of a computerized animated activity questionnaire in patients with hip and knee osteoarthritis. Arthritis Care Res (Hoboken). 2015 Jan;67(1):32-9.

Acknowledgements Funding: EULAR Patient Reported Outcome research grant.

Disclosure of Interest None declared

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