127Dougados Functional Index
It contains 20 questions on activities of daily living, addressing aspects of dressing,
bathing, standing, climbing stairs, bending, changing position, doing housework,
coughing, and breathing deeply [ 35 ]. The value of the 3-point Likert scale is added
to give a total sum score between 0 and 40; higher values refl ecting higher func-
tional impairment. The Dougados Functional Index (DFI) has been used in studies
of disease outcome and in clinical trials.
Health Assessment Questionnaire for the Spondyloarthropathies
See later section: Assessment in Patients with SpA (axSpA and PsA) with Generic Tools
Functioning and Quality of Life (ASQoL, ASAS HI)
The most prevalent symptoms in patients with AS are pain, stiffness, fatigue, and
sleep problems [ 11 ]. On the other hand, other aspects, such as having energy for
social activities or work participation, also have been mentioned as very important
for patients with SpA [ 8 , 36 ]. Instruments currently available for the assessment of
patients with SpA focus predominantly on physical function, taking into account
that the overall picture of impairments, limitations, and restrictions in activities or
social participation of patients with established AS are not adequately assessed in
general SpA questionnaires and none of the questionnaires measures the entire
range of functional disability [ 37 ].
Ankylosing Spondylitis Quality of Life Questionnaire
The most frequently used HRQoL instrument in SpA trials so far is the ASQoL [ 38 ,
39 ]. The 18 items that are being addressed here include aspects such as pain, fatigue,
dressing, emotional functions, and social community. The items can be summed up to
give a total score ranging from 0 to 18—with a lower score refl ecting a higher HRQoL.
ASAS Health Index
The ASAS Health Index ( ASAS HI) overcomes these limitations by using the
International Classifi cation of Functioning, Disability and Health (ICF) as a con-
ceptualized basis (see Appendix 2 ) [ 40 ]. The ASAS HI is an instrument for patients
with established AS but also nr-axSpA that assesses functioning and health as oper-
ationalized by the ICF core set for AS [ 41 ]. It is a linear composite measure and
contains 17 items (dichotomous response option: “I agree” and “I do not agree”)
that cover most of the ICF core set (see Appendix 2 ). The items are addressed
5 PROMs for Spondyloarthritis