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

Hewlett, Sarah; Kirwan, John; Bode, Christina; Cramp, Fiona; Carmona, Loreto; Dures, Emma; Englbrecht, Matthias; Fransen, Jaap; Greenwood, Rosemary; Hagel, Sofia; van de Laar, Maart; Molto, Anna; Nicklin, Joanna; Petersson, Ingemar F.; Redondo, Marta; Schett, Georg; Gossec, Laure


John Kirwan

Christina Bode

Fiona Cramp
Professor in Long Term Conditions

Loreto Carmona

Emma Dures
Professor in Rheumatology and Self-management

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


© The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. 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.


Hewlett, S., Kirwan, J., Bode, C., Cramp, F., Carmona, L., Dures, E., …Gossec, L. (2018). The revised Bristol Rheumatoid Arthritis Fatigue measures and the Rheumatoid Arthritis Impact of Disease scale: Validation in six countries. Rheumatology, 57(2), 300-308.

Journal Article Type Article
Acceptance Date Jul 2, 2017
Online Publication Date Oct 26, 2017
Publication Date Feb 1, 2018
Publicly Available Date Nov 1, 2017
Journal Rheumatology (United Kingdom)
Print ISSN 1462-0324
Electronic ISSN 1462-0332
Publisher Oxford University Press (OUP)
Peer Reviewed Peer Reviewed
Volume 57
Issue 2
Pages 300-308
Keywords PROMs, validation, cultural, fatigue, impact, rheumatoid arthritis
Public URL
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