Improving Scoring Precision and Internal Construct Validity of the Bath Ankylosing Spondylitis Disease Activity Index Using Rasch Measurement Theory

OBJECTIVE: To test the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) according to Rasch Measurement Theory and investigate whether measurement precision can be improved.

METHODS: Secondary analysis of a BASDAI database. The data had been collected from individuals starting an Ankylosing Spondylitis Exercise Course at the Royal National Hospital for Rheumatic Diseases in Bath, UK.

RESULTS: Data were available for 250 participants (23.6% female) aged between 18 and 85 years (mean 52.8, SD 14.6). Initial fit of the data to the Rasch model appeared good and item thresholds were consistent, but local item dependence (LID) was identified. After addressing the LID, a unidimensional measure was achieved. The Person Separation Index (reliability) was 0.83 and the location of the items was well matched to that of the respondents. A transformation table was generated to convert total raw BASDAI scores into linearized Rasch transformed scores that form an interval scale. The Smallest Detectable Difference improved from 2 to 1.2. This finding suggests that a change score of > 1.2 points on the modified BASDAI is required to achieve meaningful change.

CONCLUSION: Applying the Rasch transformed scores simplifies completion and scoring of the measure and confirms internal construct validity. It also ensures linear measurement and justifies the use of parametric statistical analyses when analyzing datasets. The transformation table can be used with existing BASDAI datasets to allow direct comparisons of disease activity scores with those generated from future studies.