Open Access Research article

Swedish version of the multi dimensional health assessment questionnaire – translation and psychometric evaluation

Kristina Areskoug Josefsson12*, Charlotte Ekdahl1, Ulf Jakobsson3 and Gunvor Gard1

Author Affiliations

1 Department of Health Sciences, Division of Physiotherapy, Lund University, Box 157, 221 00, Lund, Sweden

2 Värnamo Hospital, Samrehab, Värnamo Sjukhus, 331 85, Värnamo, Sweden

3 Center for Primary Health Care Research, Lund University, CRC, 20205, Malmö, Sweden

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BMC Musculoskeletal Disorders 2013, 14:178  doi:10.1186/1471-2474-14-178

Published: 4 June 2013



Health assessment measurements for patients with Rheumatoid arthritis (RA) have to be meaningful, valid and relevant. A commonly used questionnaire for patients with RA is the Stanford Health Assessment Questionnaire Disability Index (HAQ), which has been available in Swedish since 1988. The HAQ has been revised and improved several times and the latest version is the Multi Dimensional Health Assessment Questionnaire (MDHAQ). The aim of this study was to translate the MDHAQ to Swedish conditions and to test the validity and reliability of this version for persons with RA.


Translation and adaption of the MDHAQ were performed according to guidelines by Guillemin et al. The translated version was tested for face validity and test-retest in a group of 30 patients with RA. Content validity, criterion validity and internal consistency were tested in a larger study group of 83 patients with RA. Reliability was tested with test-retest and Cronbach´s alpha for internal consistency. Two aspects of validity were explored: content and criterion validity. Content validity was tested with a content validity index.

Criterion validity was tested with concurrent validity by exploring the correlation between the MDHAQ-S and the AIMS2-SF. Floor and ceiling effects were explored.


Test-retest with intra-class correlation coefficient (ICC) gave a coefficient of 0.85 for physical function and 0.79 for psychological properties. Reliability test with Cronbach´s alpha gave an alpha of 0.65 for the psychological dimension and an alpha of 0.88 for the physical dimension of the MDHAQ-S.

The average sum of the content validity index for each item was of the MDHAQ-S was 0.94. The MDHAQ-S had mainly a moderate correlation with the AIMS2-SF, except for the social dimension of the AIMS2-SF, which had a very low correlation with the MDHAQ-S.


The MDHAQ-S was considered to be reliable and valid, but further research is needed concerning sensitivity to change.

Health assessment; Rheumatoid arthritis; Rehabilitation