Open Access Open Badges Research article

A 5 item version of the Compliance Questionnaire for Rheumatology (CQR5) successfully identifies low adherence to DMARDs

Lyndsay D Hughes12*, John Done2 and Adam Young3

Author Affiliations

1 Health Psychology Section, Institute of Psychiatry, King’s College London, 5th Floor Bermondsey Wing, Guy’s Hospital, London SE1 9RT, England

2 Centre for Lifespan and Chronic Illness Research (CLiCIR), University of Hertfordshire, Health Research Building, College Lane, Hatfield AL10 9AB, England

3 Department of Rheumatology, St Alban’s City Hospital, Waverley Road, St Albans, Hertfordshire AL3 5PN, England

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BMC Musculoskeletal Disorders 2013, 14:286  doi:10.1186/1471-2474-14-286

Published: 8 October 2013



Taking DMARDs as prescribed is an essential part of self-management for patients with Rheumatoid Arthritis. To date, the Compliance Questionnaire for Rheumatology (CQR) is the only self-report adherence measure created specifically for and validated in rheumatic diseases. However, the factor structure of the CQR has not been reported and it can be considered lengthy at 19 items. The aim of this study was to test the factor structure of the CQR and reduce the number of items whilst retaining robust explanation of non-adherence to DMARDs. Such a reduction would increase the clinical utility of the scale, to identify patients with sub-optimal adherence to DMARDs in the clinic as well as for research purposes.


An exploratory factor analysis was performed to reduce the number of items in the CQR and then a confirmatory factor analysis was run to establish the fit of a 5 item version (CQR5) to the data. A discriminant function analysis was performed to determine the optimal combination of questions to identify suboptimal adherence.


The factor analyses identified a unidimensional 5 item model that explains 50.3% of the variance in adherence and has good internal consistency and fit to the data. Discriminant function analysis shows that the CQR5 can affectively detect 69% of low adherers to DMARDs using Fisher’s weighted regression equation.


A shortened version of the CQR increases the clinical utility by reducing the patient burden whilst maintaining a good level of reliability and validity for a short, self-administered, self-report questionnaire.

Rheumatoid arthritis; DMARDs; Medication adherence; Compliance; Questionnaire; Factor analysis