The revised Bristol Rheumatoid Arthritis Fatigue measures and the Rheumatoid Arthritis Impact of Disease scale: Validation in six countries

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Objective. To evaluate the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAFMDQ), the revised Bristol Rheumatoid Arthritis Numerical Rating Scales (BRAF-NRS V2) and the Rheumatoid Arthritis Impact of Disease (RAID) scale in six countries. Methods. We surveyed RA patients in France, Germany, The Netherlands, Spain, Sweden and the UK, including the HAQ, 36-item Short Form Health Survey (SF-36) and potential revisions of the BRAF-NRS coping and Spanish RAID coping items. Factor structure and internal consistency were examined by factor analysis and Cronbach's α and construct validity by Spearman's correlation. Results. A total of 1276 patients participated (76% female, 25% with a disease duration < 5 years, median HAQ 1.0). The original BRAF-MDQ four-factor structure and RAID single-factor structure were confirmed in every country with ≥66% of variation in items explained by each factor and all item factor loadings of 0.71-0.98. Internal consistency for the BRAF-MDQ total and subscales was a Cronbach's α of 0.75-0.96 and for RAID, 0.93-0.96. Fatigue construct validity was shown for the BRAF-MDQ and BRAF-NRS severity and effect scales, correlated internally with SF-36 vitality and with RAID fatigue (r = 0.63-0.93). Broader construct validity for the BRAFs and RAID was shown by correlation with each other, HAQ and SF-36 domains (r = 0.46-0.82), with similar patterns in individual countries. The revised BRAF-NRS V2 Coping item had stronger validity than the original in all analyses. The revised Spanish RAID coping item performed as well as the original. Conclusion. Across six European countries, the BRAF-MDQ identifies the same four aspects of fatigue, and along with the RAID, shows strong factor structure and internal consistency and moderate-good construct validity. The revised BRAF-NRS V2 shows improved construct validity and replaces the original.


  • Sarah Hewlett
  • John Kirwan
  • Christina Bode
  • Fiona Cramp
  • Loreto Carmona
  • Emma Dures
  • Matthias Englbrecht
  • Jaap Fransen
  • Rosemary Greenwood
  • Sofia Hagel
  • Maart van de Laar
  • Anna Molto
  • Joanna Nicklin
  • Ingemar F. Petersson
  • Marta Redondo
  • Georg Schett
  • Laure Gossec
External organisations
  • University of the West of England
  • University of Bristol
  • University Hospital Erlangen
  • Radboud University Nijmegen
  • Bristol Royal Infirmary
  • Paris Descartes University
  • Camilo José Cela University
  • Sorbonne Paris Cité Université
  • University of Twente
  • Instituto de Salud Musculoesquelética (InMusc)
  • Friedrich-Alexander University Erlangen-Nürnberg
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Rheumatology and Autoimmunity


  • Cultural, Fatigue, Impact, PROMs, Rheumatoid arthritis, Validation
Original languageEnglish
Pages (from-to)300-308
Number of pages9
JournalRheumatology (United Kingdom)
Issue number2
Publication statusPublished - 2018 Feb
Publication categoryResearch