Construct validity and reliability of the Thai version of the Brief Illness Perception Questionnaire and its association with overall functioning and health in patients with ankylosing spondylitis

Construct validity and reliability of the Thai version of the Brief Illness Perception Questionnaire and its association with overall functioning and health in patients with ankylosing spondylitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Construct validity and reliability of the Thai version of the Brief Illness Perception Questionnaire and its association with overall functioning and health in patients with ankylosing spondylitis Praveena Chiowchanwisawakit, Woraphat Ratta-apha, Nutwara Meannui This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4840802/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives This cross-sectional study investigated the construct validity and reliability of a Thai-language version of the Brief Illness Perception Questionnaire (Thai-BIPQ) and its association with health in ankylosing spondylitis (AS) patients, as measured by the ASAS–Health Index (ASAS-HI) Methods AS patients receiving treatment at Siriraj Hospital were recruited. Reliability was assessed using Cronbach’s alpha coefficient and the intraclass correlation coefficient (ICC). Construct validity was determined by Spearman correlation with the Ankylosing Spondylitis Disease Activity Score (ASDAS), ASAS-HI, and Hospital Anxiety and Depression Scale (HADS). Linear regression was used to analyze the associations between the ASAS-HI (dependent variable) and the Thai-BIPQ (independent variable). Results We recruited 61 patients, 63.9% male, with a mean age of 47.9 years and a mean disease duration of 16 years. The median Thai-BIPQ score was 2. Cronbach’s alpha was 0.53 but increased to 0.73 after deleting the items “timeline,” “treatment control,” and “coherence.” The ICC was 0.95 with no missing data. The Thai-BIPQ showed moderate correlations with the ASDAS, ASAS-HI, and HADS (Spearman’s rho 0.44–0.56). According to multivariate regression, Thai-BIPQ ( P = 0.006) and ASDAS ≥ 2.1 ( P < 0.001) were positively associated with the ASAS-HI. Conclusions The Thai-BIPQ is a valid, reliable, and feasible tool for evaluating illness perception in AS patients. Low disease activity and positive illness perception are associated with better functionality and health. Further research is necessary to explore strategies for modifying illness perceptions in AS patients. Ankylosing spondylitis ASAS-HI General health Illness belief Illness perception BIPQ Key-points The Thai version of the Brief Illness Perception Questionnaire (Thai-BIPQ) is a validated tool for assessing illness perception in patients with ankylosing spondylitis. Positive illness perception, as measured by the Thai-BIPQ, is associated with excellent functioning and health, as well as low or inactive disease activity. INTRODUCTION Axial spondyloarthritis (axSpA), of which ankylosing spondylitis (AS) is a prototype, is a chronic inflammatory disease characterized by clinical manifestations including inflammatory back pain, peripheral arthritis, enthesitis, and extra-musculoskeletal symptoms such as uveitis and inflammatory bowel diseases [ 1 ]. The progression of AS often leads to pain, fatigue, deformity, and limited function in the spine and peripheral joints, significantly reducing health-related quality of life (HRQoL) [ 1 ]. The primary treatment objective is to maximize HRQoL by controlling disease activity to achieve inactive or low levels and restoring normal function [ 2 ]. Adherence to both nonpharmacological and pharmacological treatments is essential [ 2 , 3 ]. In addition to disease activity, HRQoL is influenced by patient adaptation and environmental factors [ 4 ]. The Assessment of Spondyloarthritis International Society–Health Index (ASAS-HI) tool was developed to evaluate overall functioning and health, which included body functions, activities, and participation, in spondyloarthritis patients as per the International Classification of Functioning, Disability and Health [ 5 ]. The ASAS-HI is available in 30 languages, including Thai, and has been validated as reliable, interpretable, and responsive for assessing overall functioning and health [ 6 – 8 ]. In line with the common-sense self-regulatory model [ 9 ], illness beliefs significantly influence physical and psychological adaptation to illness. Understanding these beliefs is valuable for predicting mental and physical outcomes and treatment adherence in patients with chronic diseases [ 10 ]. Initially, the revised illness perception questionnaire (IPQ-R) [ 11 ], adapted from Leventhal’s self-regulatory model [ 9 ], was used to assess illness perception and adaptation. However, with 84 questions, the IPQ-R may be impractical for routine clinical use [ 11 ]. To address this issue, the Brief Illness Perception Questionnaire (BIPQ) [ 12 ], a simplified nine-item scale derived from the IPQ-R, can be used instead. Validated in patients with chronic conditions such as asthma, hypertension, and diabetes [ 12 ], the BIPQ has demonstrated good psychometric properties, including validity and reliability, in more than 36 countries, including Thailand [ 13 , 14 ]. Despite the relevance of illness perception in chronic conditions, research on its value in axSpA and AS is limited [ 15 – 17 ]. The IPQ-R has been linked to HRQoL and work productivity loss in axSpA patients [ 15 ]. Additionally, the BIPQ has been associated with disease activity [ 18 ] and medication adherence [ 3 ] in AS patients. However, the BIPQ has yet to be validated in axSpA and AS populations. Existing validation studies for the BIPQ have focused on nonspecific back pain [ 19 , 20 ], which presents different clinical manifestations and burdens than AS [ 1 ]. Therefore, this study aimed to investigate the construct validity and reliability of a Thai-language version of the BIPQ (Thai-BIPQ) in AS patients. Additionally, the study examined the relationships between Thai-BIPQ scores and the ASAS-HI. This research fills a gap in understanding the role of illness perception in AS. METHODS Study design and setting This cross-sectional study consecutively enrolled Thai patients over 18 years of age who were diagnosed with AS by a rheumatologist according to the modified New York criteria [ 21 ]. Participants were recruited from the outpatient clinics of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, between April 21, 2021, and October 31, 2022. Siriraj Hospital is a 2300-bed national tertiary care center. All eligible patients were invited to participate, with refusal to complete the questionnaire being the sole exclusion criterion. Ethics statement The study protocol was approved by the Siriraj Institutional Review Board (Si-159/2021), and written informed consent was obtained from all participants. All procedures adhered to the principles of the Declaration of Helsinki and its later amendments. Thai Brief Illness Perception Questionnaire The original developers of the BIPQ permitted us to use the Thai version [ 12 ]. The Thai-BIPQ consists of 8 items, each rated on a 10-point scale (0 = “no/best” to 10 = “highest/worst”). Items 3, 4, and 7 are reverse scored. The 8 items are shown at Table 1 . The “cognitive illness representation” is calculated by summing the scores for items 1 to 5 (range 0–50), while the “emotional illness representation” is obtained by summing the scores for two of the items (items 6 and 8; range 0–20). The total BIPQ score, ranging from 0 to 80, represents the perceived severity of the illness by summing the scores of all 8 items. A higher total BIPQ score indicates a more threatening view of the illness. There is also an additional ninth item. It is an open-ended question that asks patients to list the three most important causal factors in their illness [ 12 ]. Table 1 Thai Brief Illness Perception Questionnaire and variables for convergent validity hypothesis Item Question Validity hypothesis 1. Consequences How much does your illness affect your life? ASDAS, PGA, pain, PhGA, BASFI, ASAS-HI, activity impairment, EQ-5D index* 2. Timeline How long do you think your illness will continue? Not available 3. Personal control How much control do you feel you have over your illness? Not available 4. Treatment control How much do you think your treatment can help your illness? MTB* 5. Identity How much do you experience symptoms from your illness? Not available 6. Illness concerns How concerned are you about your illness? HADS (anxiety subscale), PGA, pain, ASDAS, and ASAS-HI, EQ-5D* 7. Coherence How well do you feel you understand your illness? Not available 8. Emotional response How much does your illness affect you emotionally (e.g., does it make you angry, scared, or depressed) HADS-A Total Thai-BIPQ score ASDAS, PGA, PhGA, BASFI, ASAS-HI, activity impairment, HADS-A, EQ-5D* Regarding validity hypothesis, * variables were negatively and the others were positively associated with Thai-BIPQ. Abbreviations: ASAS-HI , The Assessment of Spondyloarthritis International Society Health Index; ASDAS , Ankylosing Spondylitis Disease Activity Score; BASFI , Bath Ankylosing Spondylitis Functional Index; EQ5D , the EuroQoL-5 dimensions, 5 level index; HAD-A , anxiety according to Hospital Anxiety and Depression Scale; activity impairment , percentage of activity impairment according to Work Productivity and Activity Impairment; MTB , the medication taking behavior measure for Thai patients; PGA , Patient Global Assessment; PhGA Physician Global Assessment; Thai-BIPQ , Thai version of the Brief Illness Perception Questionnaire Data collection Patients underwent face-to-face interviews and medical record reviews to obtain baseline characteristics. These included age, sex, education level, and marital status. Current and past medications were documented, including nonsteroidal anti-inflammatory drugs as well as conventional and biologic disease-modifying antirheumatic drugs. Additionally, lifestyle factors such as smoking status, alcohol consumption, exercise habits, and cannabis use were recorded. Patient-reported outcome (PRO) data were collected using Thai versions of validated tools. These included the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) [ 21 ], Bath Ankylosing Spondylitis Functional Index (BASFI) [ 21 ], EQ-5D-5L [ 22 ], and ASAS-HI [ 6 , 7 ]. Additional measures encompassed Patient Global Assessment (PGA), pain assessment, and the Work Productivity and Activity Impairment questionnaire [ 23 ]. The Hospital Anxiety and Depression Scale (HADS) [ 24 ], Medication Taking Behavior Measure for Thai Patients (MTB) [ 25 ], Rheumatic Disease Comorbidity Index [ 26 ], and Patient Acceptable Symptom State (PASS) [ 27 ] were also utilized. EQ-5D-5L scores were calculated, with 0 and 1 representing “dead” and “perfect health,” respectively [ 22 ]. Total MTB scores ranged from 4 to 24 [ 23 ]. Participants completed the questionnaires independently or with assistance from a trained research assistant. Serum C-reactive protein levels or erythrocyte sedimentation rates were collected to calculate the ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP) or the ankylosing spondylitis disease activity score with erythrocyte sedimentation rate (ASDAS-ESR). Both measures are referred to simply as “ASDAS” [ 24 ]. Physical examination Spinal mobility, including cervical rotation, chest expansion, and the Schober test, was measured according to ASAS recommendations [ 25 ]. Assessments were performed by either an investigator (P.C.) or a trained research assistant (N.M.), both of whom were blinded to the PRO data. The interrater reliability of the mobility measurements between PC and NM was excellent, with an intraclass correlation coefficient (ICC) of 0.98 (95% CI 0.98–0.98). The Physician Global Assessment (PhGA; 0 [worst]–10 [best]) was rated by a treating physician who was also blinded to the PRO data. Statistical analysis The sample size was calculated based on the primary objective of detecting a moderate correlation between the total BIPQ score and the ASAS-HI score. Without previous reports on this correlation, we assumed a correlation coefficient of 0.5. This resulted in a required sample size of 52 with 90% power to detect a significant correlation at a two-sided 0.01% significance level. Continuous variables were compared using Student’s t test or the Mann–Whitney U test, depending on distribution, for comparisons between two groups. Categorical variables were compared using Pearson’s chi-squared test or Fisher’s exact test, as appropriate. A P value 0.7 indicating adequate consistency [ 26 ]. Test-retest reliability was assessed in 31 stable patients using ICC in a two-way mixed model for absolute agreement. A value > 0.7 indicated acceptable concordance for self-assessment over a 4–14 day interval after the baseline [ 27 ]. We used two methods to assess the construct validity of the total Thai-BIPQ score: convergent validity and known-group validity. To assess convergent validity, we evaluated correlations using Spearman's rank correlation coefficient (r s ), hypothesizing 20 moderate positive correlations and 4 moderate negative correlations (Table 1 ). The correlation strengths were interpreted based on established guidelines [ 26 ]. Coefficients below 0.1 were considered not correlated, while those between 0.10 and 0.39 were deemed weakly correlated. Moderate correlations were defined as coefficients ranging from 0.40 to 0.69. Strong correlations were identified by coefficients between 0.70 and 0.89, and very strong correlations were indicated by coefficients from 0.90 to 1.00. Convergent validity was considered good if more than 75% of the hypotheses were confirmed [ 27 ]. To examine known-group validity, we compared the total Thai-BIPQ scores between patient groups based on different health statuses. We used the ASAS-HI to differentiate between good health (score ≤ 5) and non-good health (score > 5) [ 6 ]. Additionally, we utilized the ASDAS to distinguish between low disease activity (ASDAS < 2.1) and high disease activity (ASDAS ≥ 2.1) [ 28 ]. This study employed linear regression analysis to evaluate the relationship between the ASAS-HI score and the total Thai-BIPQ score. It also examined the relationship between the ASAS-HI score and other pertinent factors: age, sex, disease duration, marital status, and an ASDAS score ≥ 2.1. Variables with P < 0.1 in univariate analysis, along with the total Thai-BIPQ score, were further examined using multivariate linear regression via the enter method. Multicollinearity among independent variables was assessed using the variance inflation factor in the multivariate regression model. The adjusted R 2 was utilized to gauge the proportion of variance in the ASAS-HI accounted for by the independent variables, thereby evaluating the model’s validity. All the statistical analyses were conducted using PASW Statistics, version 18 (SPSS Inc., Chicago, IL, USA). RESULTS Sixty-one patients were recruited, comprising 35 (57.4%) in the good-health group and 26 (42.6%) in the non-good-health group. All participants had attained at least a primary school education, with 59 (96.7%) identifying as Buddhist and 35 (57.4%) being married. Among the participants, 11 (18.0%) reported out-of-pocket health expenditures, and 2 (3.3%) reported cannabis use. There were no statistically significant differences in these factors between the good-health and non-good-health groups. The good-health group exhibited lower utilization of nonsteroidal anti-inflammatory drugs, enhanced spinal flexibility (cervical rotation and lumbar flexion), a higher proportion of patients achieving PASS, lower disease activity, better function, superior HRQoL, and a lower percentage of overall work and activity impairment than did the non-good-health group ( P < 0.05; Table 2 ). Although the proportions of patients receiving treatment with conventional or biologic disease-modifying antirheumatic drugs were lower in the good-health group, these differences did not reach statistical significance. Table 2 Demographic and clinical characteristics of study participants Characteristics All (n = 61) Good health* (n = 35) Non-good health* (n = 26) P Age, mean (SD), y 47.9 (11.8) 47.8 (13.6) 48.0 (9.3) 0.956 Male, n (%) 39 (63.9) 24 (68.6) 15 (57.7) 0.382 Duration of AS, y 16 (12.5) 15 (15) 18 (10.5) 0.742 Primary school education, n (%) 10 (16.4) 5 (14.3) 5 (19.2) 0.386 Married, n (%) 35 (57.4) 22 (62.9) 13 (50.0) 0.315 Incurred out-of-pocket health expenditures 11 (18.0) 7 (20.0) 4 (15.4) 0.504 Employed, n (%) 44 (72.1) 26 (74.3) 18 (69.2) 0.775 Active tobacco use, n (%) 3 (5.0) 2 (5.7) 1 (3.8) 1.00 Active alcohol consumption, n (%) 16 (26.2) 14 (40.0) 2 (7.7) 0.007 Engages in regular exercise 43 (72.9) 27 (77.1) 16 (66.7) 0.374 Current NSAID users, n (%) 28 (45.9) 10 (28.6) 18 (69.2) 0.002 cDMARD user, n (%) 51 (83.6) 27 (77.1) 24 (92.3) 0.114 bDMARD user, n (%) 13 (21.3) 6 (17.1) 7 (26.9) 0.356 RDCI score 0 (1) 0 (1) 0 (1) 0.596 Cervical rotation, degrees 65 (30) 70 (21.9) 60 (30.0) 0.032 Chest expansion, cm 4 (1.8) 4.8 (2.1) 4 (2.0) 0.061 Schober test, cm 4 (3.2) 4.3 (3) 2.5 (3.5) 0.034 Physician Global Assessment 1 (2) 1 (1) 2 (3) 0.002 Patient Global Assessment 2 (2.5) 1 (2) 4 (4) < 0.001 Pain 2 (3) 1 (2) 3.5 (4.3) < 0.001 BASDAI 1.8 (2.15) 0.8 (1.8) 2.8 (3.1) < 0.001 ASDAS 1.8 (1.1) 1.5 (0.83) 2.4 (1.3) < 0.001 BASFI 1 (3) 0 (2) 3 (2) < 0.001 EQ-5D-5L, mean (SD) 0.88 (0.2) 0.96 (0.6) 0.79 (0.1) < 0.001 PASS, n (%) 47 (77) 31 (88.6) 16 (61.5) 0.013 Overall work impairment, % 10 (30) 0 (10) 30 (52.7) < 0.001 Activity impairment, % 10 (25) 10 (10) 30 (43) < 0.001 Thai-BIPQ, mean (SD) 27.1 (9.7) 23.9 (9.8) 31.3 (7.9) 0.003 Values are presented as median (interquartile range), unless otherwise specified. * “Good health” and “non-good health” groups refer to patients with an ASAS-HI score of ≤ 5 and > 5, respectively. Abbreviations: AS, ankylosing spondylitis; ASAS-HI, Assessment of Spondyloarthritis International Society–Health Index; ASDAS, Ankylosing Spondylitis Disease Activity Score; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; bDMARD, biologic disease modifying antirheumatic drug; cDMARD, conventional disease modifying antirheumatic drug; EQ-5D-5L, EuroQoL 5 dimension, 5 level; n, number; NSAIDs, non-steroidal anti-inflammatory drugs; PASS, Patient Acceptable Symptom State; RDCI, Rheumatic Disease Comorbidity Index; SD, standard deviation; Thai-BIPQ, Thai version of the Brief Illness Perception Questionnaire Thai-BIPQ questionnaire results The median total Thai-BIPQ score was 27 (interquartile range [IQR] 12.5, range 5–51; Table 3 ). Among the individual items, “timeline” had the highest median score (8), followed by “personal control”, with a median of 5; the 6 remaining items had medians ≤ 2. There were no missing data for items 1 through 8. However, item 9 was completed by only 15 participants (24.6%), with 3 (20.0%) attributing their condition to hereditary factors and all 15 (100.0%) citing stress and lifestyle factors. Table 3 Thai-BIPQ scores by ASAS-HI and ASDAS status in patients with ankylosing spondylitis Thai-BIPQ All n = 61 ASAS-HI ≤ 5 n = 35 ASAS-HI > 5 n = 26 ASDAS < 2.1 n = 39 ASDAS ≥ 2.1 n = 22 Consequences# 2 (4, 0–10) 2 (3) 4 (4)* 2 (3) 4 (4)* Timeline# 8 (5, 0–10) 7 (7) 10 (2)* 8 (7) 10 (2)** Personal control# 5 (4, 1–10) 4 (4) 6 (2.3)** 4 (4) 6 (2.5) Treatment control# 1 (2, 0–6) 2 (3) 1 (1.3) 1 (2) 1 (1.3) Identity# 1 (2, 0–10) 0 (2) 1 (2) 1 (2) 1 (2) Illness concerns# 2 (3.5, 0–10) 2 (2) 3 (3)** 2 (2) 3 (5.3)* Understanding# 2 (3, 0–10) 2 (5) 2 (3.3) 2 (3) 2 (3) Emotional response# 2 (3.5, 0–10) 2 (3) 3 (3.5)** 2 (3) 3 (5.3) Cognitive illness representation 18 (8.5, 2–30) 16 (6) 21.5 (6.8)* 16 (7) 21.5 (5.8)* Emotional illness representation 5 (5, 0–20) 4 (5) 7 (7)** 4 (5) 7 (8.8)** Total score 27 (12.5, 5–51) 25 (11) 31 (13.5)* 25 (13) 31.5 (14.3)* Values are presented as median (interquartile range, range). # The scores for each item of the Thai version of the Brief Illness Perception Questionnaire ranged from 0 (“no/best”) to 10 (“highest/worst”), with items 3, 4, and 7 reverse scored. “Cognitive illness representation” is the summation of the Thai-BIPQ scores for consequences, timeline, personal control, treatment control, and identity. “Emotional illness representation” is the summation of the Thai-BIPQ scores for illness concerns and emotional response. “Total score” is the summation of the Thai-BIPQ scores for consequences, timeline, personal control, treatment control, identity, illness concerns, understanding, and emotional response. The item and total scores of the Thai-BIPQ were compared between the ASAS-HI ≤ 5 vs. ASAS-HI > 5 patient groups, and the ASDAS < 2.1 vs. ASDAS ≥ 2.1 patient groups. * P 0.01 to P < 0.05. Abbreviations: ASAS-HI, Assessment of Spondyloarthritis International Society–Health Index; ASDAS, Ankylosing Spondylitis Disease Activity Score; Thai-BIPQ, Thai version of the Brief Illness Perception Questionnaire Construct validity of the Thai-BIPQ questionnaire The Thai-BIPQ questionnaire demonstrated favorable convergent validity, confirming 21 out of 24 hypotheses (Table 4 ). Three hypotheses did not meet the prespecified criteria: two (“consequences”–BASFI, and “illness concerns”–ASAS-HI) showed weak associations, while one (“treatment control”–MTB) lacked any correlation. A moderate correlation was observed between the total Thai-BIPQ score and most PRO and PhGA measures (r s 0.43–0.58; Table 4 ). Various associations were observed between the individual Thai-BIPQ items and the PRO/PhGA measures. The items “consequences” and “illness concerns” showed similar correlation patterns with the PROs and PhGA as the total Thai-BIPQ score did, albeit with some weaker correlations. Conversely, the items “treatment control” and “understanding” did not correlate with any PRO or PhGA measure. Table 4 Spearman correlations between Thai-BIPQ items and various health assessments Health assessment tool Thai version of the Brief Illness Perception Questionnaire Consequences Timeline Personal control Treatment control Identity Illness concerns Coherence Emotional response C E Total score ASDAS .57 ** .35 ** .31 * − .20 .14 .47 ** .13 .29 * .56 ** .40 ** .56 ** BASDAI .49 ** .23 .28 * − .13 .24 .55 ** .19 .38 ** .47 ** .51 ** .58 ** PGA .49 ** .21 .25 − .11 .19 .43 ** .04 .30 *! .44 ** .40 ** .45 ** Pain .49 ** .20 .23 − .08 .21 .42 ** .02 .29 * .44 ** .38 ** .44 ** PhGA .46 ** .22 .22 − .24 .29 * .46 ** .02 .36 ** .41 ** .46 ** .49 ** BASFI .36 ** .33 ** .14 − .07 .25 * .29 * .08 .37 ** .43 ** .37 ** .43 ** EQ-5D-5L − .44 ** − .28 * − .28 * .13 − .28 * − .43 ** − .05 − .37 ** − .47 ** − .44 ** − .47 ** Impairment .48 ** .28 * .34 ** − .09 .22 .39 ** .02 .42 ** .52 ** .46 ** .51 ** HADS-A .39 ** .05 .07 − .07 .16 .57 ** .00 .44 ** .26 * .55 ** .44 ** HADS-D .30 * .18 .19 − .12 .22 .45 ** .07 .39 ** .32 * .45 ** .44 ** MTB − .09 .03 − .08 .06 .05 .06 .14 − .08 − .04 − .01 .01 ASAS-HI .51 ** .42 ** .29 * − .21 .26 * .39 ** − .09 .39 ** .57 ** .43 ** .49 ** * Correlation was significant at the 0.05 level (two-tailed). ** Correlation was significant at the 0.01 level (two-tailed). “Overall score” is the summation of the Thai-BIPQ scores for consequences, timeline, personal control, treatment control, identity, illness concerns, understanding, and emotional response. Abbreviations: ASAS-HI, Assessment of Spondyloarthritis International Society–Health Index; ASDAS, Ankylosing Spondylitis Disease Activity Score; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; C, “cognitive illness representation” (summation of the Thai-BIPQ scores for consequences, timeline, personal control, treatment control, and identity); E, “emotional illness representation” (summation of the Thai-BIPQ scores for illness concerns and emotional response); EQ-5D-5L, EuroQoL 5-dimension, 5-level; HADS-A, anxiety subscale of the Hospital Anxiety and Depression Scale; HADS-D, depression subscale of the Hospital Anxiety and Depression Scale; Impairment, percentage of activity impairment according to Work Productivity and Activity Impairment; MTB, Medication Taking Behavior measure for Thai patients; PGA, Patient Global Assessment; PhGA Physician Global Assessment; Thai-BIPQ, Thai version of the Brief Illness Perception Questionnaire Regarding known-group validity, significant differences in Thai-BIPQ scores were identified between the good/non-good health groups and the low/high disease activity groups ( P < 0.01; Table 3 ). Participants with good health or low disease activity reported significantly more positive perceptions for the items “consequences,” “timeline,” and “illness concerns.” Although participants in the good-health group also reported more positive perceptions for the items “personal control” and “emotional response,” these differences were not statistically significant between the disease activity groups. Reliability of the total Thai-BIPQ questionnaire The eight items of the Thai-BIPQ had a Cronbach’s alpha of 0.53, indicating low internal consistency. The exclusion of any of the items “timeline,” “treatment control,” or “understanding” marginally improved the Cronbach’s alpha to 0.59, whereas removing all three items increased the alpha value to 0.76. Test-retest reliability was assessed with 31 participants who reported stable symptoms at baseline and completed the second Thai-BIPQ 4 to 13 days after the baseline assessment. The median (IQR, range) retest score for the total Thai-BIPQ was 23 (12, 6–48). The ICC between the baseline and retest scores for the total Thai-BIPQ score was 0.95 (95% CI 0.90–0.98, P < 0.001). The ICCs for the individual items ranged between 0.80 and 0.95 ( P < 0.001). Associations between BIPQ and functioning and health states Participants with and without impaired functioning and health states (measured by the ASAS-HI) had significantly different scores for total Thai-BIPQ, “cognitive illness representation” (measured by the Thai-BIPQ), and “emotional illness representation” (also measured by the Thai-BIPQ). Exceptions to this pattern were found for driving, community life, handling stress, washing oneself, and sleeping (Table 5 ). Table 5 Relationship between Thai-BIPQ scores and functioning/health status as measured by ASAS-HI ASAS-HI Thai version of the Brief Illness Perception Questionnaire Consequences Timeline Personal control Treatment control Identity Illness concerns Coherence Emotional response C E Overall score 1. Pain: Pain sometimes disrupts my normal activities. No (n = 23) 2 7 4 1 0 1 2 2 16 4 24 Yes (n = 38) 3** 10* 6 1 1** 3** 2 3** 21* 5.5** 28* 2. Maintaining body position: I find it hard to stand for long No (n = 33) 2 8 4 1 0 2 2 2 16 4 25 Yes (n = 28) 4* 9.5 6 1 1* 3** 2.5 3** 21* 7** 32* 3. Moving around: I have problems running. No (n = 25) 2 7 4 2 0 2 2 2 15 3 24 Yes (n = 36) 3* 10* 6** 1 1 3 2 3** 21* 6** 30* 4. Toileting: I have problems using toilet facilities. No (n = 50) 2 8 5 1 1 2 2 2 17 4 26.5 Yes (n = 11) 5 10 6 1 1 4 2 4 24 7** 34** 5. Energy and drive: I am often exhausted. No (n = 37) 2 7 4 1 0 2 2 2 16 4 25 Yes (n = 24) 5* 10* 6** 1 1 4* 2 3** 23.5* 7* 33.5* 6. Motivation: I am less motivated to do anything that requires physical effort. No (n = 41) 2 8 5 1 0 2 2 2 16 4 26 Yes (n = 20) 3** 10** 6 0** 1 3.5* 2 3 21** 7* 31** 7. Sexual function: I have lost interest in sex. No (n = 24) 2 8 4 1.5 1 1.5 2 2 15 4 25 Yes (n = 10) 5** 10 6 0.5 1.5 4* 2 4** 23* 7.5* 33.5* NA (n = 27) 2 8 5 1 1 2 2 2 18 4 26 8. Driving: I have difficulty operating the pedals in my car. No (n = 41) 2 8 5 1 1 2 2 2 17 4 27 Yes (n = 5) 4 10 6 2 2 3 2 4 24** 7 33 NA (n = 15) 2 10 6 1 1 2 2 3 18 6 32 9. Community life: I am finding it hard to make contact with people. No (n = 57) 2 8 5 1 1 2 2 2 18 4 27 Yes (n = 4) 4 5.5 6.5 0 1 7** 0.5 8.5* 23 15.5* 41 10. Moving around: I am not able to walk outdoors on flat ground. No (n = 58) 2 8 5 1 1 2 2 2 17.5 4.5 26.5 Yes (n = 3) 5 10 6 1 2 3 2 4 26** 7 36** 11. Handling stress: I find it hard to concentrate. No (n = 49) 2 8 5 1 1 2 2 2 17 5 27 Yes (n = 12) 2.5 10 6 0 1 2.5 2 2.5 21 6 27 12. Recreation and leisure: I am restricted in traveling because of my mobility. No (n = 38) 2 7.5 4.5 1 0 2 2 2 16 4 24.5 Yes (n = 23) 4* 10* 6 1 1 2 2 3 22* 6 30* 13. Emotional function: I often get frustrated. No (n = 50) 2 8 5 1 1 2 2 2 17 4 26 Yes (n = 11) 4** 10 6 1 1 5** 2 3 21** 10 36** 14. Washing oneself: I find it difficult to wash my hair. No (n = 57) 2 8 5 1 1 2 2 2 18 5 27 Yes (n = 4) 5 9 6 0 0.5 3.5 2.5 5.5 23.5 9 35 15. Economic self-sufficiency: I have experienced financial changes because of my rheumatic disease. No (n = 44) 2 6 5 1 1 2 3 2 16 4.5 26 Yes (n = 17) 4** 10** 6 1 1 3 2 3 21* 7 32** 16. Sleep: I sleep badly at night. No (n = 32) 2 8 4.5 1.5 0 2 2 2 16.5 3.5 25.5 Yes (n = 29) 3** 9 6 1 1 3 2 3** 19 6** 29 17. Handling stress: I cannot overcome my difficulties. No (n = 56) 2 8.5 5 1 1 2 2 2 18 4 26.5 Yes (n = 5) 6 5 6 0 1 9* 1 3 17 10** 36 Values are presented as the median. * P 0.01 to P < 0.05. “Overall score” is the summation of the Thai-BIPQ scores for consequences, timeline, personal control, treatment control, identity, illness concerns, understanding, and emotional response. Abbreviations: ASAS-HI, Assessment of Spondyloarthritis International Society–Health Index; C, “cognitive illness representation” (summation of the Thai-BIPQ scores for consequences, timeline, personal control, treatment control, and identity); E, “emotional illness representation” (summation of the Thai-BIPQ scores for illness concerns and emotional response); n, number; Thai-BIPQ, Thai version of the Brief Illness Perception Questionnaire According to the univariate analysis, ASDAS ≥ 2.1 ( P < 0.0001), total Thai-BIPQ ( P < 0.0001), and cervical rotation ( P = 0.035) were significantly associated with the ASAS-HI (Table 6 ). However, age, sex, disease duration, and marital status were not significantly associated with the ASAS-HI. Multivariate analysis indicated that ASDAS scores ≥ 2.1 (standardized coefficient of 0.47, P < 0.0001) and total Thai-BIPQ scores (standardized coefficient of 0.30, P = 0.006) were significantly correlated with ASAS-HI scores. Cervical rotation lost its association with the ASAS-HI after adjusting for other variables. The multivariate model had an adjusted R 2 of 0.47. Table 6 Factors associated with ASAS-HI: results from linear regression analysis Variable Univariate analysis Multivariate analysis Unstandardized coefficients P Standardized coefficients P Age, y -0.03 0.539 NA Female 1.01 0.380 NA Disease duration, y -0.02 0.778 NA Married 0.11 0.924 NA Cervical rotation, degrees -0.05 0.035 -0.15 0.121 Chest expansion, cm -0.48 0.170 NA Schober test, cm -0.37 0.169 NA ASDAS ≥ 2.1 5.26 < 0.001 0.47 < 0.001 Total Thai-BIPQ 0.22 < 0.001 0.30 0.006 ASAS-HI is a dependent variable. “Total Thai-BIPQ” is the summation of the Thai-BIPQ scores for consequences, timeline, personal control, treatment control, identity, illness concerns, understanding, and emotional response. Abbreviations: ASAS-HI, Assessment of Spondyloarthritis International Society–Health Index; ASDAS, Ankylosing Spondylitis Disease Activity Score; NA, not available; Thai-BIPQ, Thai version of the Brief Illness Perception Questionnaire DISCUSSION This study demonstrated that the Thai-BIPQ is a valid, reliable, and feasible tool for assessing illness perception in Thai patients with AS. The instrument exhibited excellent test-retest reliability, with an ICC of 0.95 for the total BIPQ score and a range of 0.79–0.95 for individual items. Furthermore, the absence of missing data underscores the feasibility of the Thai-BIPQ. Regarding internal consistency, the Thai-BIPQ had a Cronbach’s alpha of 0.53, indicating moderate consistency. Inter-item correlations for the “timeline,” “treatment control,” and “coherence” items were weak (r s -0.28 to 0.22), whereas the 5 remaining items demonstrated stronger correlations (r s -0.10 to 0.64). Most AS patients perceived their disease as long-lasting, as reflected by a median score of 8, which aligns with the chronic nature of the condition and is consistent with previous studies [ 29 ]. Additionally, patients largely viewed their treatment as highly effective, as evidenced by a median score of 1 for “treatment control.” This perception likely correlates with their current disease activity and PASS status, with 64% and 77% of patients reporting inactive to low disease activity states and satisfied PASS, respectively. Assessing a patient’s coherence or understanding of their illness can be challenging because it encompasses three components: comprehensibility, manageability, and meaningfulness [ 30 ]. In our study, most patients had a positive perception of their understanding, indicated by a median reverse score of 2. Cronbach’s alpha is a statistical measure used to assess the reliability of multiple items in measuring the same construct or dimension [ 31 ]. The Thai-BIPQ may not be unidimensional because each item is derived from a distinct subscale of the IPQ-R, capturing different dimensions of illness perception [ 12 ]. This multidimensionality can explain the lower Cronbach’s alpha observed in the present investigation. However, the Cronbach’s alpha increased to an acceptable level after removing the “timeline,” “treatment control,” and “coherence” items. To our knowledge, no previous reports on the Cronbach’s alpha of the BIPQ in AS patients exist. Cronbach’s alpha values of 0.73 and 0.90 have been reported in studies of acute [ 20 ] and chronic [ 19 ] nonspecific low back pain, respectively. However, nonspecific back pain differs significantly from AS in terms of manifestations, disease course, and overall burden [ 32 ]. Rivera et al. reported that the overall pooled Cronbach’s alpha for the IPQ-R was acceptable (0.71–0.87), although it was lower among cardiac disease, diabetes/kidney disease, cancer, and mixed/other samples (Cronbach’s alpha 0.63–0.68). Factors such as age, sex, and race also play a role [ 33 ]. In the current study, the total Thai-BIPQ score was not significantly associated with age or sex. The Thai-BIPQ demonstrated strong construct validity, as evidenced by it fulfilling 87.5% of the hypotheses. “Emotional illness representation” correlated more strongly with the emotional measure (the HADS) than with physical domain measures (disease activity and function); however, “cognitive illness representation” displayed the reverse pattern. Positive patient perceptions for the items “consequences,” “illness concerns,” and “emotional response” were associated with lower disease activity, better overall functioning and health, reduced activity impairment, and lower HADS scores ( P < 0.05). This finding aligns with previous studies [ 15 , 34 ] showing that cognitive illness representations measured by the BIPQ correlate with HRQoL in AS patients [ 34 ]. Van Lunteren et al. highlighted that IPQ-R scores are associated with physical and mental health outcomes using the 36-Item Short Form Health Survey and work productivity loss in axSpA patients [ 15 ]. They also reported that positive perceptions for the “consequences” item are linked with better physical health, and that positive “emotional illness representation” responses correlate with better mental health in axSpA patients [ 15 ]. The “treatment control” item did not correlate with MTB in this study. Conversely, Tolu et al. reported weak positive correlations between medication adherence (assessed by the compliance questionnaire on rheumatology [CQR]) and the “treatment control” and “coherence” items in AS patients [ 29 ]. This discrepancy may stem from the differing content of the MTB and CQR tools. While both are reliable and valid for assessing medication adherence, the CQR incorporates patient expectations of medication efficacy, contextual factors affecting medication adherence, and beliefs about the physician’s ability to manage the disease. None of these aspects are covered by the MTB. Regarding known-group validity, patients in the good-health and low-disease activity groups had significantly lower total Thai-BIPQ scores and lower scores on most Thai-BIPQ items than patients in the non-good-health and high-disease activity groups. However, the “coherence” and “identity” items did not differ between the two groups, potentially because these items are not associated with HRQoL [ 15 ]. Patients with more positive illness perceptions, as measured by the Thai-BIPQ, demonstrated better overall functioning and health states. After adjusting for high disease activity and cervical rotation in multivariate analysis, the total Thai-BIPQ score remained an independent factor associated with the ASAS-HI. The multivariate analysis model accounted for 47% of the variability in the ASAS-HI. Additionally, high disease activity (ASDAS ≥ 2.1) showed a stronger association with the ASAS-HI (standardized coefficient 0.47) than with the total BIPQ score (standardized coefficient 0.30). This study has several limitations. First, its cross-sectional design precluded an assessment of the Thai-BIPQ’s sensitivity to change over time, necessitating a longitudinal study for this purpose. Although van Lunteren et al. [ 16 ] reported no change in IPQ-R scores after 2 years in axSpA patients with improved disease activity, BIPQ scores have been shown to change significantly in vasculitis [ 35 ]. Second, the small sample size prevented the analysis of health subgroups such as good, moderate, and poor [ 6 ]. However, the sample size was sufficient to demonstrate moderate correlations that supported construct validity. Last, as the study participants were from a single tertiary care hospital in Thailand’s capital, they potentially represented more severe cases than patients in primary care settings. The different disease severities and support systems in this tertiary setting may have influenced the study outcomes, limiting generalizability to all Thai patients with AS. Despite these limitations, this study has notable strengths. In particular, it employed multiple parameters and demonstrated correlations between the Thai-BIPQ and various PROs. This comprehensive approach provides a more holistic assessment of patient perceptions and health outcomes. CONCLUSIONS Our study confirmed that the Thai-BIPQ is a valid, reliable, and feasible tool for assessing illness perception in Thai AS patients. This instrument correlates positively with disease activity and the overall functioning and health status of patients. Both positive illness perception and an ASDAS score < 2.1 are independently associated with good functioning and health status, as measured by the ASAS-HI. To achieve optimal health outcomes, treatment should aim for inactivity or low disease activity and foster a positive illness perception. Further research is needed to explore strategies for promoting optimistic illness perceptions in this population. Abbreviations Abbreviation Meaning AS Ankylosing spondylitis ASAS-HI Assessment of Spondyloarthritis International Society–Health Index ASDAS Ankylosing Spondylitis Disease Activity Score ASDAS-CRP Ankylosing Spondylitis Disease Activity Score with C-reactive protein ASDAS-ESR Ankylosing Spondylitis Disease Activity Score with erythrocyte sedimentation rate axSpA Axial spondyloarthritis BASDAI Bath Ankylosing Spondylitis Disease Activity Index BASFI Bath Ankylosing Spondylitis Functional Index BIPQ Brief Illness Perception Questionnaire CQR Compliance questionnaire on rheumatology CRP C-reactive protein ESR Erythrocyte sedimentation rate HADS Hospital Anxiety and Depression Scale HRQoL Health-related quality of life ICC Intraclass correlation coefficient IPQ-R Revised illness perception questionnaire IQR Interquartile range MTB Medication Taking Behavior PASS Patient Acceptable Symptom State PGA Patient Global Assessment PhGA Physician Global Assessment PRO Patient-reported outcome Thai-BIPQ Thai version of the BIPQ Declarations Ethics approval and consent to participate The study protocol was approved by the Siriraj Institutional Review Board (Si-159/2021), and written informed consent was obtained from all participants. All procedures adhered to the principles of the Declaration of Helsinki and its later amendments. Consent for publication Not applicable Availability of data and materials Data of the study are available from the corresponding author upon reasonable request. Competing Interest PC has received a research grant from the non-interventional third-party sponsored/investigator-initiated trial agreement, Novartis (Thailand) Limited (grant number PMA-193). WR and NM have no conflicts of interest. Funding This work is supported by the non-interventional third party sponsored/investigator-initiated trial agreement, Novartis (Thailand) Limited (Grant number PMA-193). The grant had no role in any parts of this work. Authors’ contribution All authors have contributed substantially to conceptualization and methodology. PC and NM have made a substantial contribution to both investigation and data collection. PC has made a substantial contribution to writing the original draft. All authors have made a substantial contribution to reviewing & editing the manuscript. All authors have given final approval for the version to be published. Acknowledgements The authors wish to thank the participants for their cooperation, Prof. Elizabeth Broadbent and Dr. Napaporn Sowattanangoon for permission to use Thai-BIPQ, Assoc, Prof. Tana Nilchaikovit for permission to use the HADS, Prof. Phantipa Sakthong for permission to use the MTB, the EuroQol group and Dr. Juntana Pattanaphesaj for permission to use the Thai version of the EQ-5D-5L, Dr. Chokchai Kittiyanpanya for permission to use the Thai version of BASDAI and BASFI, and the ASAS group for permission to use ASAS-HI. References Strand V, Singh JA (2017) Patient Burden of Axial Spondyloarthritis. J Clin Rheumatol 23 (7):383-91. doi:10.1097/RHU.0000000000000589 Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, et al. 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(2018) Measurement properties of the ASAS Health Index: results of a global study in patients with axial and peripheral spondyloarthritis. Ann Rheum Dis 77 (9):1311-7. doi:10.1136/annrheumdis-2017-212076 Kiltz U, van der Heijde D, Boonen A, Bautista-Molano W, Burgos-Vargas R, Chiowchanwisawakit P, et al. (2016) Measuring impairments of functioning and health in patients with axial spondyloarthritis by using the ASAS Health Index and the Environmental Item Set: translation and cross-cultural adaptation into 15 languages. RMD Open 2 (2):e000311. doi:10.1136/rmdopen-2016-000311 Assessment in SpondyloArthritis international Society. ASAS Health Index [cited 2024 26 June]. Available from: https://www.asas-group.org/instruments/asas-health-index/. Leventhal H, Meyer D, Nerenz D. The common sense representation of illness danger In: Rachman S, editor. Contributions to medical psychology. 2. New York: Pergamon; 1980. p. 7-30. 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(2012) [Perception in chronic illnesses: linguistic validation of the revised Illness Perception Questionnaire and the Brief Illness Perception Questionnaire for a Spanish population]. Atencion primaria / Sociedad Espanola de Medicina de Familia y Comunitaria 44 (5):280-7. doi:10.1016/j.aprim.2010.11.022 van Lunteren M, Scharloo M, Ez-Zaitouni Z, de Koning A, Landewe R, Fongen C, et al. (2018) The Impact of Illness Perceptions and Coping on the Association Between Back Pain and Health Outcomes in Patients Suspected of Having Axial Spondyloarthritis: Data From the SPondyloArthritis Caught Early Cohort. Arthritis Care Res (Hoboken) 70 (12):1829-39. doi:10.1002/acr.23566 van Lunteren M, Landewe R, Fongen C, Ramonda R, van der Heijde D, van Gaalen FA (2020) Do Illness Perceptions and Coping Strategies Change Over Time in Patients Recently Diagnosed With Axial Spondyloarthritis? 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ScientificWorldJournal 2021:3348011. doi:10.1155/2021/3348011 Hallegraeff JM, van der Schans CP, Krijnen WP, de Greef MH (2013) Measurement of acute nonspecific low back pain perception in primary care physical therapy: reliability and validity of the brief illness perception questionnaire. BMC Musculoskelet Disord 14:53. doi:10.1186/1471-2474-14-53 van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27 (4):361-8 Pattanaphesaj J. Health-related quality of life measure (EQ-5D-5L): measurement property testing and its preference-based score in Thai population [Doctoral dissertation]: Mahidol; 2014. Sakthong P, Sonsa-Ardjit N, Sukarnjanaset P, Munpan W, Suksanga P (2016) Development and psychometric testing of the medication taking behavior tool in Thai patients. 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J Clin Epidemiol 60 (1):34-42. doi:10.1016/j.jclinepi.2006.03.012 Machado P, Landewe R, Lie E, Kvien TK, Braun J, Baker D, et al. (2011) Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis 70 (1):47-53. doi:ard.2010.138594 [pii] 10.1136/ard.2010.138594 Tolu S, Rezvani A, Karacan I, Bugdayci D, Kucuk HC, Bucak OF, et al. (2020) Self-Reported Medication Adherence in Patients With Ankylosing Spondylitis: The Role of Illness Perception and Medication Beliefs. Arch Rheumatol 35 (4):495-505. doi:10.46497/ArchRheumatol.2020.7732 Moksnes UK. Sense of Coherence. In: Haugan G, Eriksson M, editors. Health Promotion in Health Care - Vital Theories and Research. Cham (CH)2021. p. 35-46. Bujang MA, Omar ED, Baharum NA (2018) A Review on Sample Size Determination for Cronbach's Alpha Test: A Simple Guide for Researchers. Malays J Med Sci 25 (6):85-99. doi:10.21315/mjms2018.25.6.9 Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP (2021) Low back pain. Lancet 398 (10294):78-92. doi:10.1016/S0140-6736(21)00733-9 Rivera E, Levoy K, Park C, Villalobos A, Martin P, Jung Kim M, et al. (2024) Internal consistency reliability of the Revised Illness Perceptions Questionnaire: A systematic review and reliability generalization meta-analysis. Journal of Health Psychology:13591053231221351. doi:10.1177/13591053231221351 Hyphantis T, Kotsis K, Tsifetaki N, Creed F, Drosos AA, Carvalho AF, et al. (2013) The relationship between depressive symptoms, illness perceptions and quality of life in ankylosing spondylitis in comparison to rheumatoid arthritis. Clin Rheumatol 32 (5):635-44. doi:10.1007/s10067-012-2162-6 Schwartz MN, Rimland CA, Quinn KA, Ferrada M, Gribbons KB, Rosenblum JS, et al. (2020) Utility of the Brief Illness Perception Questionnaire to Monitor Patient Beliefs in Systemic Vasculitis. J Rheumatol. doi:10.3899/jrheum.190828 Additional Declarations Competing interest reported. PC has received a research grant from the non-interventional third-party sponsored/investigator-initiated trial agreement, Novartis (Thailand) Limited (grant number PMA-193). WR and NM have no conflicts of interest. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4840802","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":351171098,"identity":"65f15698-dd5b-4947-b23d-0b65e73e6973","order_by":0,"name":"Praveena Chiowchanwisawakit","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIie3RMUvDQBTA8XcUcsvTOVLRr5ASsGRo+lXuOHCKBXERWjDTudS6ZvMrON184aAucXdwUITMAUHqYGmaqiDktKPD/afjHT94xwG4XP87BF0BMA8Y0c3A34Lk2YZAQ3Ab0sGawF+k3zWlX50/HgK9z80giUe7VGgNkxiG3bSVRLPjo72sKHspjpg5UeLMw5JpmAvAfd1KggLCcEcakvoY1KTDpZ8EGjxdL8YshL6GH0szbEikLj7J8jeCvReSGt4QosyGEGkn0RRPn6dzIyQmQX6l7rhcv4XPBOJDO+kjvdWLiRlc0yKs3tWY31yK/Kl6iw9oZlns6+D9GLP1N1kKbBcul8vl+m4FmfpflDytxDcAAAAASUVORK5CYII=","orcid":"","institution":"Faculty of Medicine Siriraj Hospital, Mahidol University","correspondingAuthor":true,"prefix":"","firstName":"Praveena","middleName":"","lastName":"Chiowchanwisawakit","suffix":""},{"id":351171100,"identity":"810ffdde-25a7-4fff-b0a5-1e17bbaf10c3","order_by":1,"name":"Woraphat Ratta-apha","email":"","orcid":"","institution":"Faculty of Medicine Siriraj Hospital, Mahidol University","correspondingAuthor":false,"prefix":"","firstName":"Woraphat","middleName":"","lastName":"Ratta-apha","suffix":""},{"id":351171102,"identity":"a5c4d7c9-dadb-403b-a211-ab6fd9faac93","order_by":2,"name":"Nutwara Meannui","email":"","orcid":"","institution":"Faculty of Medicine Siriraj Hospital, Mahidol University","correspondingAuthor":false,"prefix":"","firstName":"Nutwara","middleName":"","lastName":"Meannui","suffix":""}],"badges":[],"createdAt":"2024-08-01 09:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4840802/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4840802/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":68489522,"identity":"3eef04b6-f406-4ed8-bdb9-f3ee77e3b200","added_by":"auto","created_at":"2024-11-07 21:16:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1305599,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4840802/v1/efff414f-9291-4b03-ba4c-804ad296d76a.pdf"}],"financialInterests":"Competing interest reported. PC has received a research grant from the non-interventional third-party sponsored/investigator-initiated trial agreement, Novartis (Thailand) Limited (grant number PMA-193). WR and NM have no conflicts of interest.","formattedTitle":"Construct validity and reliability of the Thai version of the Brief Illness Perception Questionnaire and its association with overall functioning and health in patients with ankylosing spondylitis","fulltext":[{"header":"Key-points","content":"\u003cul\u003e\n \u003cli\u003eThe Thai version of the Brief Illness Perception Questionnaire (Thai-BIPQ) is a validated tool for assessing illness perception in patients with ankylosing spondylitis.\u003c/li\u003e\n \u003cli\u003ePositive illness perception, as measured by the Thai-BIPQ, is associated with excellent functioning and health, as well as low or inactive disease activity.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eAxial spondyloarthritis (axSpA), of which ankylosing spondylitis (AS) is a prototype, is a chronic inflammatory disease characterized by clinical manifestations including inflammatory back pain, peripheral arthritis, enthesitis, and extra-musculoskeletal symptoms such as uveitis and inflammatory bowel diseases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The progression of AS often leads to pain, fatigue, deformity, and limited function in the spine and peripheral joints, significantly reducing health-related quality of life (HRQoL) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The primary treatment objective is to maximize HRQoL by controlling disease activity to achieve inactive or low levels and restoring normal function [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Adherence to both nonpharmacological and pharmacological treatments is essential [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In addition to disease activity, HRQoL is influenced by patient adaptation and environmental factors [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The Assessment of Spondyloarthritis International Society\u0026ndash;Health Index (ASAS-HI) tool was developed to evaluate overall functioning and health, which included body functions, activities, and participation, in spondyloarthritis patients as per the International Classification of Functioning, Disability and Health [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The ASAS-HI is available in 30 languages, including Thai, and has been validated as reliable, interpretable, and responsive for assessing overall functioning and health [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn line with the common-sense self-regulatory model [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], illness beliefs significantly influence physical and psychological adaptation to illness. Understanding these beliefs is valuable for predicting mental and physical outcomes and treatment adherence in patients with chronic diseases [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Initially, the revised illness perception questionnaire (IPQ-R) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], adapted from Leventhal\u0026rsquo;s self-regulatory model [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], was used to assess illness perception and adaptation. However, with 84 questions, the IPQ-R may be impractical for routine clinical use [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. To address this issue, the Brief Illness Perception Questionnaire (BIPQ) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], a simplified nine-item scale derived from the IPQ-R, can be used instead. Validated in patients with chronic conditions such as asthma, hypertension, and diabetes [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], the BIPQ has demonstrated good psychometric properties, including validity and reliability, in more than 36 countries, including Thailand [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the relevance of illness perception in chronic conditions, research on its value in axSpA and AS is limited [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The IPQ-R has been linked to HRQoL and work productivity loss in axSpA patients [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, the BIPQ has been associated with disease activity [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and medication adherence [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] in AS patients. However, the BIPQ has yet to be validated in axSpA and AS populations. Existing validation studies for the BIPQ have focused on nonspecific back pain [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], which presents different clinical manifestations and burdens than AS [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Therefore, this study aimed to investigate the construct validity and reliability of a Thai-language version of the BIPQ (Thai-BIPQ) in AS patients. Additionally, the study examined the relationships between Thai-BIPQ scores and the ASAS-HI. This research fills a gap in understanding the role of illness perception in AS.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eThis cross-sectional study consecutively enrolled Thai patients over 18 years of age who were diagnosed with AS by a rheumatologist according to the modified New York criteria [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Participants were recruited from the outpatient clinics of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, between April 21, 2021, and October 31, 2022. Siriraj Hospital is a 2300-bed national tertiary care center. All eligible patients were invited to participate, with refusal to complete the questionnaire being the sole exclusion criterion.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEthics statement\u003c/h2\u003e \u003cp\u003e The study protocol was approved by the Siriraj Institutional Review Board (Si-159/2021), and written informed consent was obtained from all participants. All procedures adhered to the principles of the Declaration of Helsinki and its later amendments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eThai Brief Illness Perception Questionnaire\u003c/h2\u003e \u003cp\u003eThe original developers of the BIPQ permitted us to use the Thai version [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The Thai-BIPQ consists of 8 items, each rated on a 10-point scale (0 = \u0026ldquo;no/best\u0026rdquo; to 10 = \u0026ldquo;highest/worst\u0026rdquo;). Items 3, 4, and 7 are reverse scored. The 8 items are shown at Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The \u0026ldquo;cognitive illness representation\u0026rdquo; is calculated by summing the scores for items 1 to 5 (range 0\u0026ndash;50), while the \u0026ldquo;emotional illness representation\u0026rdquo; is obtained by summing the scores for two of the items (items 6 and 8; range 0\u0026ndash;20). The total BIPQ score, ranging from 0 to 80, represents the perceived severity of the illness by summing the scores of all 8 items. A higher total BIPQ score indicates a more threatening view of the illness. There is also an additional ninth item. It is an open-ended question that asks patients to list the three most important causal factors in their illness [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThai Brief Illness Perception Questionnaire and variables for convergent validity hypothesis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eValidity hypothesis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Consequences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow much does your illness affect your life?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eASDAS, PGA, pain, PhGA, BASFI, ASAS-HI, activity impairment, EQ-5D index*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Timeline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow long do you think your illness will continue?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot available\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Personal control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow much control do you feel you have over your illness?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot available\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Treatment control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow much do you think your treatment can help your illness?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMTB*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Identity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow much do you experience symptoms from your illness?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot available\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Illness concerns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow concerned are you about your illness?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHADS (anxiety subscale), PGA, pain, ASDAS, and ASAS-HI, EQ-5D*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Coherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow well do you feel you understand your illness?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot available\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Emotional response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow much does your illness affect you emotionally (e.g., does it make you angry, scared, or depressed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHADS-A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Thai-BIPQ score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eASDAS, PGA, PhGA, BASFI, ASAS-HI, activity impairment, HADS-A, EQ-5D*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eRegarding validity hypothesis, * variables were negatively and the others were positively associated with Thai-BIPQ.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eAbbreviations: \u003cem\u003eASAS-HI\u003c/em\u003e, The Assessment of Spondyloarthritis International Society Health Index; \u003cem\u003eASDAS\u003c/em\u003e, Ankylosing Spondylitis Disease Activity Score; \u003cem\u003eBASFI\u003c/em\u003e, Bath Ankylosing Spondylitis Functional Index; \u003cem\u003eEQ5D\u003c/em\u003e, the EuroQoL-5 dimensions, 5 level index; \u003cem\u003eHAD-A\u003c/em\u003e, anxiety according to Hospital Anxiety and Depression Scale; \u003cem\u003eactivity impairment\u003c/em\u003e, percentage of activity impairment according to Work Productivity and Activity Impairment; \u003cem\u003eMTB\u003c/em\u003e, the medication taking behavior measure for Thai patients; \u003cem\u003ePGA\u003c/em\u003e, Patient Global Assessment; \u003cem\u003ePhGA\u003c/em\u003e Physician Global Assessment; \u003cem\u003eThai-BIPQ\u003c/em\u003e, Thai version of the Brief Illness Perception Questionnaire\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003ePatients underwent face-to-face interviews and medical record reviews to obtain baseline characteristics. These included age, sex, education level, and marital status. Current and past medications were documented, including nonsteroidal anti-inflammatory drugs as well as conventional and biologic disease-modifying antirheumatic drugs. Additionally, lifestyle factors such as smoking status, alcohol consumption, exercise habits, and cannabis use were recorded.\u003c/p\u003e \u003cp\u003ePatient-reported outcome (PRO) data were collected using Thai versions of validated tools. These included the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], Bath Ankylosing Spondylitis Functional Index (BASFI) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], EQ-5D-5L [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and ASAS-HI [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Additional measures encompassed Patient Global Assessment (PGA), pain assessment, and the Work Productivity and Activity Impairment questionnaire [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The Hospital Anxiety and Depression Scale (HADS) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], Medication Taking Behavior Measure for Thai Patients (MTB) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], Rheumatic Disease Comorbidity Index [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and Patient Acceptable Symptom State (PASS) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e27\u003c/span\u003e] were also utilized. EQ-5D-5L scores were calculated, with 0 and 1 representing \u0026ldquo;dead\u0026rdquo; and \u0026ldquo;perfect health,\u0026rdquo; respectively [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Total MTB scores ranged from 4 to 24 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Participants completed the questionnaires independently or with assistance from a trained research assistant. Serum C-reactive protein levels or erythrocyte sedimentation rates were collected to calculate the ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP) or the ankylosing spondylitis disease activity score with erythrocyte sedimentation rate (ASDAS-ESR). Both measures are referred to simply as \u0026ldquo;ASDAS\u0026rdquo; [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePhysical examination\u003c/h2\u003e \u003cp\u003eSpinal mobility, including cervical rotation, chest expansion, and the Schober test, was measured according to ASAS recommendations [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Assessments were performed by either an investigator (P.C.) or a trained research assistant (N.M.), both of whom were blinded to the PRO data. The interrater reliability of the mobility measurements between PC and NM was excellent, with an intraclass correlation coefficient (ICC) of 0.98 (95% CI 0.98\u0026ndash;0.98). The Physician Global Assessment (PhGA; 0 [worst]\u0026ndash;10 [best]) was rated by a treating physician who was also blinded to the PRO data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe sample size was calculated based on the primary objective of detecting a moderate correlation between the total BIPQ score and the ASAS-HI score. Without previous reports on this correlation, we assumed a correlation coefficient of 0.5. This resulted in a required sample size of 52 with 90% power to detect a significant correlation at a two-sided 0.01% significance level.\u003c/p\u003e \u003cp\u003eContinuous variables were compared using Student\u0026rsquo;s t test or the Mann\u0026ndash;Whitney U test, depending on distribution, for comparisons between two groups. Categorical variables were compared using Pearson\u0026rsquo;s chi-squared test or Fisher\u0026rsquo;s exact test, as appropriate. A \u003cem\u003eP\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated statistical significance.\u003c/p\u003e \u003cp\u003eInternal consistency was assessed using Cronbach\u0026rsquo;s alpha coefficient, with a value\u0026thinsp;\u0026gt;\u0026thinsp;0.7 indicating adequate consistency [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Test-retest reliability was assessed in 31 stable patients using ICC in a two-way mixed model for absolute agreement. A value\u0026thinsp;\u0026gt;\u0026thinsp;0.7 indicated acceptable concordance for self-assessment over a 4\u0026ndash;14 day interval after the baseline [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe used two methods to assess the construct validity of the total Thai-BIPQ score: convergent validity and known-group validity.\u003c/p\u003e \u003cp\u003eTo assess convergent validity, we evaluated correlations using Spearman's rank correlation coefficient (r\u003csub\u003es\u003c/sub\u003e), hypothesizing 20 moderate positive correlations and 4 moderate negative correlations (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The correlation strengths were interpreted based on established guidelines [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Coefficients below 0.1 were considered not correlated, while those between 0.10 and 0.39 were deemed weakly correlated. Moderate correlations were defined as coefficients ranging from 0.40 to 0.69. Strong correlations were identified by coefficients between 0.70 and 0.89, and very strong correlations were indicated by coefficients from 0.90 to 1.00. Convergent validity was considered good if more than 75% of the hypotheses were confirmed [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo examine known-group validity, we compared the total Thai-BIPQ scores between patient groups based on different health statuses. We used the ASAS-HI to differentiate between good health (score\u0026thinsp;\u0026le;\u0026thinsp;5) and non-good health (score\u0026thinsp;\u0026gt;\u0026thinsp;5) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, we utilized the ASDAS to distinguish between low disease activity (ASDAS\u0026thinsp;\u0026lt;\u0026thinsp;2.1) and high disease activity (ASDAS\u0026thinsp;\u0026ge;\u0026thinsp;2.1) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study employed linear regression analysis to evaluate the relationship between the ASAS-HI score and the total Thai-BIPQ score. It also examined the relationship between the ASAS-HI score and other pertinent factors: age, sex, disease duration, marital status, and an ASDAS score\u0026thinsp;\u0026ge;\u0026thinsp;2.1. Variables with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in univariate analysis, along with the total Thai-BIPQ score, were further examined using multivariate linear regression via the enter method. Multicollinearity among independent variables was assessed using the variance inflation factor in the multivariate regression model. The adjusted \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e was utilized to gauge the proportion of variance in the ASAS-HI accounted for by the independent variables, thereby evaluating the model\u0026rsquo;s validity. All the statistical analyses were conducted using PASW Statistics, version 18 (SPSS Inc., Chicago, IL, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eSixty-one patients were recruited, comprising 35 (57.4%) in the good-health group and 26 (42.6%) in the non-good-health group. All participants had attained at least a primary school education, with 59 (96.7%) identifying as Buddhist and 35 (57.4%) being married. Among the participants, 11 (18.0%) reported out-of-pocket health expenditures, and 2 (3.3%) reported cannabis use. There were no statistically significant differences in these factors between the good-health and non-good-health groups.\u003c/p\u003e \u003cp\u003eThe good-health group exhibited lower utilization of nonsteroidal anti-inflammatory drugs, enhanced spinal flexibility (cervical rotation and lumbar flexion), a higher proportion of patients achieving PASS, lower disease activity, better function, superior HRQoL, and a lower percentage of overall work and activity impairment than did the non-good-health group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Although the proportions of patients receiving treatment with conventional or biologic disease-modifying antirheumatic drugs were lower in the good-health group, these differences did not reach statistical significance.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and clinical characteristics of study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;61)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGood health*\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-good health*\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean (SD), y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.9 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.8 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.0 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.956\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (63.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (68.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (57.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.382\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of AS, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school education, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.315\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncurred out-of-pocket health expenditures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (72.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (74.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive tobacco use, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive alcohol consumption, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEngages in regular exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (72.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (77.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.374\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent NSAID users, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (45.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecDMARD user, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (83.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (77.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ebDMARD user, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRDCI score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.596\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCervical rotation, degrees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChest expansion, cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.8 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchober test, cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysician Global Assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Global Assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.5 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBASDAI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8 (2.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASDAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5 (0.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.4 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBASFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEQ-5D-5L, mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.88 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.96 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.79 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePASS, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (88.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (61.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall work impairment, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (52.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivity impairment, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThai-BIPQ, mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.1 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.9 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.3 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eValues are presented as median (interquartile range), unless otherwise specified.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* \u0026ldquo;Good health\u0026rdquo; and \u0026ldquo;non-good health\u0026rdquo; groups refer to patients with an ASAS-HI score of \u0026le;\u0026thinsp;5 and \u0026gt;\u0026thinsp;5, respectively.\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e AS, ankylosing spondylitis; ASAS-HI, Assessment of Spondyloarthritis International Society\u0026ndash;Health Index; ASDAS, Ankylosing Spondylitis Disease Activity Score; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; bDMARD, biologic disease modifying antirheumatic drug; cDMARD, conventional disease modifying antirheumatic drug; EQ-5D-5L, EuroQoL 5 dimension, 5 level; n, number; NSAIDs, non-steroidal anti-inflammatory drugs; PASS, Patient Acceptable Symptom State; RDCI, Rheumatic Disease Comorbidity Index; SD, standard deviation; Thai-BIPQ, Thai version of the Brief Illness Perception Questionnaire\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eThai-BIPQ questionnaire results\u003c/h2\u003e \u003cp\u003eThe median total Thai-BIPQ score was 27 (interquartile range [IQR] 12.5, range 5\u0026ndash;51; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Among the individual items, \u0026ldquo;timeline\u0026rdquo; had the highest median score (8), followed by \u0026ldquo;personal control\u0026rdquo;, with a median of 5; the 6 remaining items had medians\u0026thinsp;\u0026le;\u0026thinsp;2. There were no missing data for items 1 through 8. However, item 9 was completed by only 15 participants (24.6%), with 3 (20.0%) attributing their condition to hereditary factors and all 15 (100.0%) citing stress and lifestyle factors.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThai-BIPQ scores by ASAS-HI and ASDAS status in patients with ankylosing spondylitis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThai-BIPQ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;61\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eASAS-HI\u0026thinsp;\u0026le;\u0026thinsp;5\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;35\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eASAS-HI\u0026thinsp;\u0026gt;\u0026thinsp;5\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;26\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eASDAS\u0026thinsp;\u0026lt;\u0026thinsp;2.1\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;39\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eASDAS\u0026thinsp;\u0026ge;\u0026thinsp;2.1\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsequences#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (4, 0\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (4)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (4)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTimeline#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (5, 0\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (2)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (2)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal control#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4, 1\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (2.3)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment control#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2, 0\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIdentity#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2, 0\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIllness concerns#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (3.5, 0\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (3)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (5.3)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderstanding#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (3, 0\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional response#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (3.5, 0\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (3.5)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (5.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive illness representation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (8.5, 2\u0026ndash;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.5 (6.8)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.5 (5.8)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional illness representation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (5, 0\u0026ndash;20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (7)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (8.8)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (12.5, 5\u0026ndash;51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (13.5)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31.5 (14.3)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eValues are presented as median (interquartile range, range). # The scores for each item of the Thai version of the Brief Illness Perception Questionnaire ranged from 0 (\u0026ldquo;no/best\u0026rdquo;) to 10 (\u0026ldquo;highest/worst\u0026rdquo;), with items 3, 4, and 7 reverse scored. \u0026ldquo;Cognitive illness representation\u0026rdquo; is the summation of the Thai-BIPQ scores for consequences, timeline, personal control, treatment control, and identity. \u0026ldquo;Emotional illness representation\u0026rdquo; is the summation of the Thai-BIPQ scores for illness concerns and emotional response. \u0026ldquo;Total score\u0026rdquo; is the summation of the Thai-BIPQ scores for consequences, timeline, personal control, treatment control, identity, illness concerns, understanding, and emotional response. The item and total scores of the Thai-BIPQ were compared between the ASAS-HI\u0026thinsp;\u0026le;\u0026thinsp;5 vs. ASAS-HI\u0026thinsp;\u0026gt;\u0026thinsp;5 patient groups, and the ASDAS\u0026thinsp;\u0026lt;\u0026thinsp;2.1 vs. ASDAS\u0026thinsp;\u0026ge;\u0026thinsp;2.1 patient groups. * \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01; ** \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.01 to \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e ASAS-HI, Assessment of Spondyloarthritis International Society\u0026ndash;Health Index; ASDAS, Ankylosing Spondylitis Disease Activity Score; Thai-BIPQ, Thai version of the Brief Illness Perception Questionnaire\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eConstruct validity of the Thai-BIPQ questionnaire\u003c/h2\u003e \u003cp\u003eThe Thai-BIPQ questionnaire demonstrated favorable convergent validity, confirming 21 out of 24 hypotheses (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Three hypotheses did not meet the prespecified criteria: two (\u0026ldquo;consequences\u0026rdquo;\u0026ndash;BASFI, and \u0026ldquo;illness concerns\u0026rdquo;\u0026ndash;ASAS-HI) showed weak associations, while one (\u0026ldquo;treatment control\u0026rdquo;\u0026ndash;MTB) lacked any correlation. A moderate correlation was observed between the total Thai-BIPQ score and most PRO and PhGA measures (r\u003csub\u003es\u003c/sub\u003e 0.43\u0026ndash;0.58; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Various associations were observed between the individual Thai-BIPQ items and the PRO/PhGA measures. The items \u0026ldquo;consequences\u0026rdquo; and \u0026ldquo;illness concerns\u0026rdquo; showed similar correlation patterns with the PROs and PhGA as the total Thai-BIPQ score did, albeit with some weaker correlations. Conversely, the items \u0026ldquo;treatment control\u0026rdquo; and \u0026ldquo;understanding\u0026rdquo; did not correlate with any PRO or PhGA measure.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpearman correlations between Thai-BIPQ items and various health assessments\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHealth assessment tool\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"11\" nameend=\"c12\" namest=\"c2\"\u003e \u003cp\u003eThai version of the Brief Illness Perception Questionnaire\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsequences\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTimeline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePersonal control\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTreatment control\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIdentity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIllness concerns\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCoherence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEmotional response\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTotal score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASDAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.57\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.35\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.31\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.47\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.29\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.56\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.40\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.56\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBASDAI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.49\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.28\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.55\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.38\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.47\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.51\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.58\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.49\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.43\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.30\u003csup\u003e*!\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.44\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.40\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.45\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.49\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.42\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.29\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.44\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.38\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.44\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.46\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.29\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.46\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.36\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.41\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.46\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.49\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBASFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.36\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.33\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.25\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.29\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.37\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.43\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.37\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.43\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEQ-5D-5L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.44\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.28\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.28\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.28\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.43\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.37\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.47\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.44\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.47\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImpairment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.48\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.28\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.34\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.39\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.42\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.52\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.46\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.51\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHADS-A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.39\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.57\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.44\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.26\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.55\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.44\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHADS-D\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.30\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.45\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.39\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.32\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.45\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.44\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMTB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASAS-HI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.51\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.42\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.29\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.26\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.39\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.39\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.57\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.43\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.49\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003e* Correlation was significant at the 0.05 level (two-tailed). ** Correlation was significant at the 0.01 level (two-tailed). \u0026ldquo;Overall score\u0026rdquo; is the summation of the Thai-BIPQ scores for consequences, timeline, personal control, treatment control, identity, illness concerns, understanding, and emotional response.\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e ASAS-HI, Assessment of Spondyloarthritis International Society\u0026ndash;Health Index; ASDAS, Ankylosing Spondylitis Disease Activity Score; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; C, \u0026ldquo;cognitive illness representation\u0026rdquo; (summation of the Thai-BIPQ scores for consequences, timeline, personal control, treatment control, and identity); E, \u0026ldquo;emotional illness representation\u0026rdquo; (summation of the Thai-BIPQ scores for illness concerns and emotional response); EQ-5D-5L, EuroQoL 5-dimension, 5-level; HADS-A, anxiety subscale of the Hospital Anxiety and Depression Scale; HADS-D, depression subscale of the Hospital Anxiety and Depression Scale; Impairment, percentage of activity impairment according to Work Productivity and Activity Impairment; MTB, Medication Taking Behavior measure for Thai patients; PGA, Patient Global Assessment; PhGA Physician Global Assessment; Thai-BIPQ, Thai version of the Brief Illness Perception Questionnaire\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding known-group validity, significant differences in Thai-BIPQ scores were identified between the good/non-good health groups and the low/high disease activity groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Participants with good health or low disease activity reported significantly more positive perceptions for the items \u0026ldquo;consequences,\u0026rdquo; \u0026ldquo;timeline,\u0026rdquo; and \u0026ldquo;illness concerns.\u0026rdquo; Although participants in the good-health group also reported more positive perceptions for the items \u0026ldquo;personal control\u0026rdquo; and \u0026ldquo;emotional response,\u0026rdquo; these differences were not statistically significant between the disease activity groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eReliability of the total Thai-BIPQ questionnaire\u003c/h2\u003e \u003cp\u003eThe eight items of the Thai-BIPQ had a Cronbach\u0026rsquo;s alpha of 0.53, indicating low internal consistency. The exclusion of any of the items \u0026ldquo;timeline,\u0026rdquo; \u0026ldquo;treatment control,\u0026rdquo; or \u0026ldquo;understanding\u0026rdquo; marginally improved the Cronbach\u0026rsquo;s alpha to 0.59, whereas removing all three items increased the alpha value to 0.76. Test-retest reliability was assessed with 31 participants who reported stable symptoms at baseline and completed the second Thai-BIPQ 4 to 13 days after the baseline assessment. The median (IQR, range) retest score for the total Thai-BIPQ was 23 (12, 6\u0026ndash;48). The ICC between the baseline and retest scores for the total Thai-BIPQ score was 0.95 (95% CI 0.90\u0026ndash;0.98, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The ICCs for the individual items ranged between 0.80 and 0.95 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eAssociations between BIPQ and functioning and health states\u003c/h2\u003e \u003cp\u003eParticipants with and without impaired functioning and health states (measured by the ASAS-HI) had significantly different scores for total Thai-BIPQ, \u0026ldquo;cognitive illness representation\u0026rdquo; (measured by the Thai-BIPQ), and \u0026ldquo;emotional illness representation\u0026rdquo; (also measured by the Thai-BIPQ). Exceptions to this pattern were found for driving, community life, handling stress, washing oneself, and sleeping (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship between Thai-BIPQ scores and functioning/health status as measured by ASAS-HI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eASAS-HI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"11\" nameend=\"c12\" namest=\"c2\"\u003e \u003cp\u003eThai version of the Brief Illness Perception Questionnaire\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsequences\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTimeline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePersonal control\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTreatment control\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIdentity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIllness concerns\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCoherence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEmotional response\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOverall score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e1. Pain: Pain sometimes disrupts my normal activities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5.5**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e28*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e2. Maintaining body position: I find it hard to stand for long\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e32*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e3. Moving around: I have problems running.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e30*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e4. Toileting: I have problems using toilet facilities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e34**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e5. Energy and drive: I am often exhausted.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e23.5*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e33.5*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e6. Motivation: I am less motivated to do anything that requires physical effort.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.5*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e31**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e7. Sexual function: I have lost interest in sex.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e23*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7.5*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e33.5*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNA (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e8. Driving: I have difficulty operating the pedals in my car.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e24**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNA (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e9. Community life: I am finding it hard to make contact with people.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.5*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e15.5*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e10. Moving around: I am not able to walk outdoors on flat ground.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e26**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e36**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e11. Handling stress: I find it hard to concentrate.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e12. Recreation and leisure: I am restricted in traveling because of my mobility.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e24.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e22*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e30*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e13. Emotional function: I often get frustrated.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e36**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e14. Washing oneself: I find it difficult to wash my hair.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e23.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e15. Economic self-sufficiency: I have experienced financial changes because of my rheumatic disease.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e32**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e16. Sleep: I sleep badly at night.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e25.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e17. Handling stress: I cannot overcome my difficulties.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e10**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003eValues are presented as the median. * \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01; ** \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.01 to \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. \u0026ldquo;Overall score\u0026rdquo; is the summation of the Thai-BIPQ scores for consequences, timeline, personal control, treatment control, identity, illness concerns, understanding, and emotional response.\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e ASAS-HI, Assessment of Spondyloarthritis International Society\u0026ndash;Health Index; C, \u0026ldquo;cognitive illness representation\u0026rdquo; (summation of the Thai-BIPQ scores for consequences, timeline, personal control, treatment control, and identity); E, \u0026ldquo;emotional illness representation\u0026rdquo; (summation of the Thai-BIPQ scores for illness concerns and emotional response); n, number; Thai-BIPQ, Thai version of the Brief Illness Perception Questionnaire\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the univariate analysis, ASDAS\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;2.1 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), total Thai-BIPQ (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and cervical rotation (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035) were significantly associated with the ASAS-HI (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). However, age, sex, disease duration, and marital status were not significantly associated with the ASAS-HI. Multivariate analysis indicated that ASDAS scores\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;2.1 (standardized coefficient of 0.47, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and total Thai-BIPQ scores (standardized coefficient of 0.30, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006) were significantly correlated with ASAS-HI scores. Cervical rotation lost its association with the ASAS-HI after adjusting for other variables. The multivariate model had an adjusted \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e of 0.47.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with ASAS-HI: results from linear regression analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnstandardized coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandardized coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisease duration, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCervical rotation, degrees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChest expansion, cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchober test, cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASDAS\u0026thinsp;\u0026ge;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Thai-BIPQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eASAS-HI is a dependent variable. \u0026ldquo;Total Thai-BIPQ\u0026rdquo; is the summation of the Thai-BIPQ scores for consequences, timeline, personal control, treatment control, identity, illness concerns, understanding, and emotional response.\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e ASAS-HI, Assessment of Spondyloarthritis International Society\u0026ndash;Health Index; ASDAS, Ankylosing Spondylitis Disease Activity Score; NA, not available; Thai-BIPQ, Thai version of the Brief Illness Perception Questionnaire\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study demonstrated that the Thai-BIPQ is a valid, reliable, and feasible tool for assessing illness perception in Thai patients with AS. The instrument exhibited excellent test-retest reliability, with an ICC of 0.95 for the total BIPQ score and a range of 0.79\u0026ndash;0.95 for individual items. Furthermore, the absence of missing data underscores the feasibility of the Thai-BIPQ.\u003c/p\u003e \u003cp\u003eRegarding internal consistency, the Thai-BIPQ had a Cronbach\u0026rsquo;s alpha of 0.53, indicating moderate consistency. Inter-item correlations for the \u0026ldquo;timeline,\u0026rdquo; \u0026ldquo;treatment control,\u0026rdquo; and \u0026ldquo;coherence\u0026rdquo; items were weak (r\u003csub\u003es\u003c/sub\u003e -0.28 to 0.22), whereas the 5 remaining items demonstrated stronger correlations (r\u003csub\u003es\u003c/sub\u003e -0.10 to 0.64). Most AS patients perceived their disease as long-lasting, as reflected by a median score of 8, which aligns with the chronic nature of the condition and is consistent with previous studies [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Additionally, patients largely viewed their treatment as highly effective, as evidenced by a median score of 1 for \u0026ldquo;treatment control.\u0026rdquo; This perception likely correlates with their current disease activity and PASS status, with 64% and 77% of patients reporting inactive to low disease activity states and satisfied PASS, respectively.\u003c/p\u003e \u003cp\u003eAssessing a patient\u0026rsquo;s coherence or understanding of their illness can be challenging because it encompasses three components: comprehensibility, manageability, and meaningfulness [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In our study, most patients had a positive perception of their understanding, indicated by a median reverse score of 2. Cronbach\u0026rsquo;s alpha is a statistical measure used to assess the reliability of multiple items in measuring the same construct or dimension [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The Thai-BIPQ may not be unidimensional because each item is derived from a distinct subscale of the IPQ-R, capturing different dimensions of illness perception [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This multidimensionality can explain the lower Cronbach\u0026rsquo;s alpha observed in the present investigation. However, the Cronbach\u0026rsquo;s alpha increased to an acceptable level after removing the \u0026ldquo;timeline,\u0026rdquo; \u0026ldquo;treatment control,\u0026rdquo; and \u0026ldquo;coherence\u0026rdquo; items.\u003c/p\u003e \u003cp\u003eTo our knowledge, no previous reports on the Cronbach\u0026rsquo;s alpha of the BIPQ in AS patients exist. Cronbach\u0026rsquo;s alpha values of 0.73 and 0.90 have been reported in studies of acute [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and chronic [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] nonspecific low back pain, respectively. However, nonspecific back pain differs significantly from AS in terms of manifestations, disease course, and overall burden [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Rivera et al. reported that the overall pooled Cronbach\u0026rsquo;s alpha for the IPQ-R was acceptable (0.71\u0026ndash;0.87), although it was lower among cardiac disease, diabetes/kidney disease, cancer, and mixed/other samples (Cronbach\u0026rsquo;s alpha 0.63\u0026ndash;0.68). Factors such as age, sex, and race also play a role [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In the current study, the total Thai-BIPQ score was not significantly associated with age or sex.\u003c/p\u003e \u003cp\u003eThe Thai-BIPQ demonstrated strong construct validity, as evidenced by it fulfilling 87.5% of the hypotheses. \u0026ldquo;Emotional illness representation\u0026rdquo; correlated more strongly with the emotional measure (the HADS) than with physical domain measures (disease activity and function); however, \u0026ldquo;cognitive illness representation\u0026rdquo; displayed the reverse pattern. Positive patient perceptions for the items \u0026ldquo;consequences,\u0026rdquo; \u0026ldquo;illness concerns,\u0026rdquo; and \u0026ldquo;emotional response\u0026rdquo; were associated with lower disease activity, better overall functioning and health, reduced activity impairment, and lower HADS scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This finding aligns with previous studies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e34\u003c/span\u003e] showing that cognitive illness representations measured by the BIPQ correlate with HRQoL in AS patients [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Van Lunteren et al. highlighted that IPQ-R scores are associated with physical and mental health outcomes using the 36-Item Short Form Health Survey and work productivity loss in axSpA patients [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. They also reported that positive perceptions for the \u0026ldquo;consequences\u0026rdquo; item are linked with better physical health, and that positive \u0026ldquo;emotional illness representation\u0026rdquo; responses correlate with better mental health in axSpA patients [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe \u0026ldquo;treatment control\u0026rdquo; item did not correlate with MTB in this study. Conversely, Tolu et al. reported weak positive correlations between medication adherence (assessed by the compliance questionnaire on rheumatology [CQR]) and the \u0026ldquo;treatment control\u0026rdquo; and \u0026ldquo;coherence\u0026rdquo; items in AS patients [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This discrepancy may stem from the differing content of the MTB and CQR tools. While both are reliable and valid for assessing medication adherence, the CQR incorporates patient expectations of medication efficacy, contextual factors affecting medication adherence, and beliefs about the physician\u0026rsquo;s ability to manage the disease. None of these aspects are covered by the MTB.\u003c/p\u003e \u003cp\u003eRegarding known-group validity, patients in the good-health and low-disease activity groups had significantly lower total Thai-BIPQ scores and lower scores on most Thai-BIPQ items than patients in the non-good-health and high-disease activity groups. However, the \u0026ldquo;coherence\u0026rdquo; and \u0026ldquo;identity\u0026rdquo; items did not differ between the two groups, potentially because these items are not associated with HRQoL [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients with more positive illness perceptions, as measured by the Thai-BIPQ, demonstrated better overall functioning and health states. After adjusting for high disease activity and cervical rotation in multivariate analysis, the total Thai-BIPQ score remained an independent factor associated with the ASAS-HI. The multivariate analysis model accounted for 47% of the variability in the ASAS-HI. Additionally, high disease activity (ASDAS\u0026thinsp;\u0026ge;\u0026thinsp;2.1) showed a stronger association with the ASAS-HI (standardized coefficient 0.47) than with the total BIPQ score (standardized coefficient 0.30).\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, its cross-sectional design precluded an assessment of the Thai-BIPQ\u0026rsquo;s sensitivity to change over time, necessitating a longitudinal study for this purpose. Although van Lunteren et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] reported no change in IPQ-R scores after 2 years in axSpA patients with improved disease activity, BIPQ scores have been shown to change significantly in vasculitis [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Second, the small sample size prevented the analysis of health subgroups such as good, moderate, and poor [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, the sample size was sufficient to demonstrate moderate correlations that supported construct validity. Last, as the study participants were from a single tertiary care hospital in Thailand\u0026rsquo;s capital, they potentially represented more severe cases than patients in primary care settings. The different disease severities and support systems in this tertiary setting may have influenced the study outcomes, limiting generalizability to all Thai patients with AS.\u003c/p\u003e \u003cp\u003eDespite these limitations, this study has notable strengths. In particular, it employed multiple parameters and demonstrated correlations between the Thai-BIPQ and various PROs. This comprehensive approach provides a more holistic assessment of patient perceptions and health outcomes.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eOur study confirmed that the Thai-BIPQ is a valid, reliable, and feasible tool for assessing illness perception in Thai AS patients. This instrument correlates positively with disease activity and the overall functioning and health status of patients. Both positive illness perception and an ASDAS score\u0026thinsp;\u0026lt;\u0026thinsp;2.1 are independently associated with good functioning and health status, as measured by the ASAS-HI. To achieve optimal health outcomes, treatment should aim for inactivity or low disease activity and foster a positive illness perception. Further research is needed to explore strategies for promoting optimistic illness perceptions in this population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"593\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeaning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eAnkylosing spondylitis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eASAS-HI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eAssessment of Spondyloarthritis International Society\u0026ndash;Health Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eASDAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eAnkylosing Spondylitis Disease Activity Score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eASDAS-CRP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eAnkylosing Spondylitis Disease Activity Score with C-reactive protein\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eASDAS-ESR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eAnkylosing Spondylitis Disease Activity Score with erythrocyte sedimentation rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eaxSpA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eAxial spondyloarthritis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eBASDAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eBath Ankylosing Spondylitis Disease Activity Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eBASFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eBath Ankylosing Spondylitis Functional Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eBIPQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eBrief Illness Perception Questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eCQR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eCompliance questionnaire on rheumatology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eCRP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eC-reactive protein\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eESR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eErythrocyte sedimentation rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eHADS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eHospital Anxiety and Depression Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eHRQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eHealth-related quality of life\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eICC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eIntraclass correlation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eIPQ-R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eRevised illness perception questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eInterquartile range\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eMTB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eMedication Taking Behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003ePASS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003ePatient Acceptable Symptom State\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003ePGA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003ePatient Global Assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003ePhGA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003ePhysician Global Assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003ePRO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003ePatient-reported outcome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.404721753794266%\"\u003e\n \u003cp\u003eThai-BIPQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"79.59527824620574%\"\u003e\n \u003cp\u003eThai version of the BIPQ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Siriraj Institutional Review Board (Si-159/2021), and written informed consent was obtained from all participants. All procedures adhered to the principles of the Declaration of Helsinki and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData of the study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePC has received a research grant from the non-interventional third-party sponsored/investigator-initiated trial agreement, Novartis (Thailand) Limited (grant number PMA-193). WR and NM have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work is supported by the non-interventional third party sponsored/investigator-initiated trial agreement, Novartis (Thailand) Limited (Grant number PMA-193). The grant had no role in any parts of this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have contributed substantially to conceptualization and methodology. PC and NM have made a substantial contribution to both investigation and data collection. PC has made a substantial contribution to writing the original draft. All authors have made a substantial contribution to reviewing \u0026amp; editing the manuscript. All authors have given final approval for the version to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003cbr\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank the participants for their cooperation, Prof. Elizabeth Broadbent and Dr. Napaporn Sowattanangoon for permission to use Thai-BIPQ, Assoc, Prof. Tana Nilchaikovit for permission to use the HADS, Prof. Phantipa Sakthong for permission to use the MTB, the EuroQol group and Dr. Juntana Pattanaphesaj for permission to use the Thai version of the EQ-5D-5L, Dr. Chokchai Kittiyanpanya for permission to use the Thai version of BASDAI and BASFI, and the ASAS group for permission to use ASAS-HI.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStrand V, Singh JA (2017) Patient Burden of Axial Spondyloarthritis. J Clin Rheumatol 23 (7):383-91. doi:10.1097/RHU.0000000000000589\u003c/li\u003e\n\u003cli\u003eRamiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, et al. (2022) ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. doi:10.1136/ard-2022-223296\u003c/li\u003e\n\u003cli\u003eSmolen JS, Gladman D, McNeil HP, Mease PJ, Sieper J, Hojnik M, et al. (2019) Predicting adherence to therapy in rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis: a large cross-sectional study. RMD Open 5 (1):e000585. doi:10.1136/rmdopen-2017-000585\u003c/li\u003e\n\u003cli\u003eAlonso S, Morante I, Alperi M, Queiro R (2022) The ASAS Health Index: A New Era for Health Impact Assessment in Spondyloarthritis. J Rheumatol 49 (1):8-15. doi:10.3899/jrheum.200586\u003c/li\u003e\n\u003cli\u003eKiltz U, van der Heijde D, Boonen A, Braun J (2014) The ASAS Health Index (ASAS HI) - a new tool to assess the health status of patients with spondyloarthritis. Clin Exp Rheumatol 32 (5 Suppl 85):S-105-8\u003c/li\u003e\n\u003cli\u003eKiltz U, van der Heijde D, Boonen A, Akkoc N, Bautista-Molano W, Burgos-Vargas R, et al. (2018) Measurement properties of the ASAS Health Index: results of a global study in patients with axial and peripheral spondyloarthritis. Ann Rheum Dis 77 (9):1311-7. doi:10.1136/annrheumdis-2017-212076\u003c/li\u003e\n\u003cli\u003eKiltz U, van der Heijde D, Boonen A, Bautista-Molano W, Burgos-Vargas R, Chiowchanwisawakit P, et al. (2016) Measuring impairments of functioning and health in patients with axial spondyloarthritis by using the ASAS Health Index and the Environmental Item Set: translation and cross-cultural adaptation into 15 languages. RMD Open 2 (2):e000311. doi:10.1136/rmdopen-2016-000311\u003c/li\u003e\n\u003cli\u003eAssessment in SpondyloArthritis international Society. ASAS Health Index [cited 2024 26 June]. Available from: https://www.asas-group.org/instruments/asas-health-index/.\u003c/li\u003e\n\u003cli\u003eLeventhal H, Meyer D, Nerenz D. The common sense representation of illness danger In: Rachman S, editor. Contributions to medical psychology. 2. New York: Pergamon; 1980. p. 7-30.\u003c/li\u003e\n\u003cli\u003eStanton AL, Revenson TA, Tennen H (2007) Health psychology: psychological adjustment to chronic disease. Annu Rev Psychol 58:565-92. doi:10.1146/annurev.psych.58.110405.085615\u003c/li\u003e\n\u003cli\u003eMoss-Morris R, Weinman J, Petrie K, Horne R, Cameron L, Buick D (2002) The Revised Illness Perception Questionnaire (IPQ-R). Psychology \u0026amp; Health 17 (1):1-16. doi:10.1080/08870440290001494\u003c/li\u003e\n\u003cli\u003eBroadbent E, Petrie KJ, Main J, Weinman J (2006) The brief illness perception questionnaire. J Psychosom Res 60 (6):631-7. doi:10.1016/j.jpsychores.2005.10.020\u003c/li\u003e\n\u003cli\u003eBroadbent E, Wilkes C, Koschwanez H, Weinman J, Norton S, Petrie KJ (2015) A systematic review and meta-analysis of the Brief Illness Perception Questionnaire. Psychol Health 30 (11):1361-85. doi:10.1080/08870446.2015.1070851\u003c/li\u003e\n\u003cli\u003ePacheco-Huergo V, Viladrich C, Pujol-Ribera E, Cabezas-Pena C, Nunez M, Roura-Olmeda P, et al. (2012) [Perception in chronic illnesses: linguistic validation of the revised Illness Perception Questionnaire and the Brief Illness Perception Questionnaire for a Spanish population]. Atencion primaria / Sociedad Espanola de Medicina de Familia y Comunitaria 44 (5):280-7. doi:10.1016/j.aprim.2010.11.022\u003c/li\u003e\n\u003cli\u003evan Lunteren M, Scharloo M, Ez-Zaitouni Z, de Koning A, Landewe R, Fongen C, et al. (2018) The Impact of Illness Perceptions and Coping on the Association Between Back Pain and Health Outcomes in Patients Suspected of Having Axial Spondyloarthritis: Data From the SPondyloArthritis Caught Early Cohort. Arthritis Care Res (Hoboken) 70 (12):1829-39. doi:10.1002/acr.23566\u003c/li\u003e\n\u003cli\u003evan Lunteren M, Landewe R, Fongen C, Ramonda R, van der Heijde D, van Gaalen FA (2020) Do Illness Perceptions and Coping Strategies Change Over Time in Patients Recently Diagnosed With Axial Spondyloarthritis? J Rheumatol 47 (12):1752-9. doi:10.3899/jrheum.191353\u003c/li\u003e\n\u003cli\u003eKieskamp SC, Paap D, Carbo MJG, Wink F, Bos R, Bootsma H, et al. (2021) Central sensitization, illness perception and obesity should be considered when interpreting disease activity in axial spondyloarthritis. Rheumatology (Oxford) 60 (10):4476-85. doi:10.1093/rheumatology/keab019\u003c/li\u003e\n\u003cli\u003eZeineb Z, Jemmali S, Rekik S, Boussaid S, Rahmouni S, Zouaoui K, et al. (2022) POS1568-PARE THE BRIEF-ILLNESS PERCEPTION QUESTIONNAIRE: A METHOD FOR ASSESSING THE COGNITIVE REPRESENTATION OF RHEUMATIC DISEASE. Annals of the Rheumatic Diseases 81 (Suppl 1):1130-. doi:10.1136/annrheumdis-2022-eular.4725\u003c/li\u003e\n\u003cli\u003eKarimi-Ghasemabad S, Akhbari B, Saeedi A, Talebian Moghaddam S, Nakhostin Ansari N (2021) The Persian Brief Illness Perception Questionnaire: Validation in Patients with Chronic Nonspecific Low Back Pain. ScientificWorldJournal 2021:3348011. doi:10.1155/2021/3348011\u003c/li\u003e\n\u003cli\u003eHallegraeff JM, van der Schans CP, Krijnen WP, de Greef MH (2013) Measurement of acute nonspecific low back pain perception in primary care physical therapy: reliability and validity of the brief illness perception questionnaire. BMC Musculoskelet Disord 14:53. doi:10.1186/1471-2474-14-53\u003c/li\u003e\n\u003cli\u003evan der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27 (4):361-8\u003c/li\u003e\n\u003cli\u003ePattanaphesaj J. Health-related quality of life measure (EQ-5D-5L): measurement property testing and its preference-based score in Thai population [Doctoral dissertation]: Mahidol; 2014.\u003c/li\u003e\n\u003cli\u003eSakthong P, Sonsa-Ardjit N, Sukarnjanaset P, Munpan W, Suksanga P (2016) Development and psychometric testing of the medication taking behavior tool in Thai patients. Int J Clin Pharm 38 (2):438-45. doi:10.1007/s11096-016-0275-8\u003c/li\u003e\n\u003cli\u003evan der Heijde D, Lie E, Kvien TK, Sieper J, Van den Bosch F, Listing J, et al. (2009) The ASDAS is a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis 68:1811-8\u003c/li\u003e\n\u003cli\u003eSieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, et al. (2009) The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 68 Suppl 2:ii1-44. doi:68/Suppl_2/ii1 [pii] 10.1136/ard.2008.104018\u003c/li\u003e\n\u003cli\u003eSchober P, Boer C, Schwarte LA (2018) Correlation Coefficients: Appropriate Use and Interpretation. Anesth Analg 126 (5):1763-8. doi:10.1213/ANE.0000000000002864\u003c/li\u003e\n\u003cli\u003eTerwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60 (1):34-42. doi:10.1016/j.jclinepi.2006.03.012\u003c/li\u003e\n\u003cli\u003eMachado P, Landewe R, Lie E, Kvien TK, Braun J, Baker D, et al. (2011) Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis 70 (1):47-53. doi:ard.2010.138594 [pii] 10.1136/ard.2010.138594\u003c/li\u003e\n\u003cli\u003eTolu S, Rezvani A, Karacan I, Bugdayci D, Kucuk HC, Bucak OF, et al. (2020) Self-Reported Medication Adherence in Patients With Ankylosing Spondylitis: The Role of Illness Perception and Medication Beliefs. Arch Rheumatol 35 (4):495-505. doi:10.46497/ArchRheumatol.2020.7732\u003c/li\u003e\n\u003cli\u003eMoksnes UK. Sense of Coherence. In: Haugan G, Eriksson M, editors. Health Promotion in Health Care - Vital Theories and Research. Cham (CH)2021. p. 35-46.\u003c/li\u003e\n\u003cli\u003eBujang MA, Omar ED, Baharum NA (2018) A Review on Sample Size Determination for Cronbach\u0026apos;s Alpha Test: A Simple Guide for Researchers. Malays J Med Sci 25 (6):85-99. doi:10.21315/mjms2018.25.6.9\u003c/li\u003e\n\u003cli\u003eKnezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP (2021) Low back pain. Lancet 398 (10294):78-92. doi:10.1016/S0140-6736(21)00733-9\u003c/li\u003e\n\u003cli\u003eRivera E, Levoy K, Park C, Villalobos A, Martin P, Jung Kim M, et al. (2024) Internal consistency reliability of the Revised Illness Perceptions Questionnaire: A systematic review and reliability generalization meta-analysis. Journal of Health Psychology:13591053231221351. doi:10.1177/13591053231221351\u003c/li\u003e\n\u003cli\u003eHyphantis T, Kotsis K, Tsifetaki N, Creed F, Drosos AA, Carvalho AF, et al. (2013) The relationship between depressive symptoms, illness perceptions and quality of life in ankylosing spondylitis in comparison to rheumatoid arthritis. Clin Rheumatol 32 (5):635-44. doi:10.1007/s10067-012-2162-6\u003c/li\u003e\n\u003cli\u003eSchwartz MN, Rimland CA, Quinn KA, Ferrada M, Gribbons KB, Rosenblum JS, et al. (2020) Utility of the Brief Illness Perception Questionnaire to Monitor Patient Beliefs in Systemic Vasculitis. J Rheumatol. doi:10.3899/jrheum.190828\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ankylosing spondylitis, ASAS-HI, General health, Illness belief, Illness perception, BIPQ","lastPublishedDoi":"10.21203/rs.3.rs-4840802/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4840802/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis cross-sectional study investigated the construct validity and reliability of a Thai-language version of the Brief Illness Perception Questionnaire (Thai-BIPQ) and its association with health in ankylosing spondylitis (AS) patients, as measured by the ASAS\u0026ndash;Health Index (ASAS-HI)\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAS patients receiving treatment at Siriraj Hospital were recruited. Reliability was assessed using Cronbach\u0026rsquo;s alpha coefficient and the intraclass correlation coefficient (ICC). Construct validity was determined by Spearman correlation with the Ankylosing Spondylitis Disease Activity Score (ASDAS), ASAS-HI, and Hospital Anxiety and Depression Scale (HADS). Linear regression was used to analyze the associations between the ASAS-HI (dependent variable) and the Thai-BIPQ (independent variable).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe recruited 61 patients, 63.9% male, with a mean age of 47.9 years and a mean disease duration of 16 years. The median Thai-BIPQ score was 2. Cronbach\u0026rsquo;s alpha was 0.53 but increased to 0.73 after deleting the items \u0026ldquo;timeline,\u0026rdquo; \u0026ldquo;treatment control,\u0026rdquo; and \u0026ldquo;coherence.\u0026rdquo; The ICC was 0.95 with no missing data. The Thai-BIPQ showed moderate correlations with the ASDAS, ASAS-HI, and HADS (Spearman\u0026rsquo;s rho 0.44\u0026ndash;0.56). According to multivariate regression, Thai-BIPQ (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006) and ASDAS\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;2.1 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were positively associated with the ASAS-HI.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe Thai-BIPQ is a valid, reliable, and feasible tool for evaluating illness perception in AS patients. Low disease activity and positive illness perception are associated with better functionality and health. Further research is necessary to explore strategies for modifying illness perceptions in AS patients.\u003c/p\u003e","manuscriptTitle":"Construct validity and reliability of the Thai version of the Brief Illness Perception Questionnaire and its association with overall functioning and health in patients with ankylosing spondylitis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-09 15:36:44","doi":"10.21203/rs.3.rs-4840802/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3b85f9ec-eee5-473c-bdd4-7d36162d43e2","owner":[],"postedDate":"September 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-07T21:08:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-09 15:36:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4840802","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4840802","identity":"rs-4840802","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}