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Department of Family Medicine

Arthritis Self-Efficacy Scale

Authors:

Lorig K, Chastain RL, Ung E, Shoor S, Holman HR. (1989)

Background and Development:

The ASES was developed in consultation with patients and physicians and through a study of four groups of patients.  A rheumatologist suggested 23 items and patient focus groups suggested 20 more.  Using further patient testing and confirmatory factor analysis the initial set of 43 items was pared down to the 20 in the current scale.  The ASES has three subscales: Pain (PSE - 5 items), Function (FSE - 9 items), and Other Symptoms (OSE - 6 items).  Each item is scored on a scale of 10-100 where higher scores correspond to greater self-efficacy. The score for each subscale is the mean of the scores of each item.  Internal reliability (Cronbach coefficient alpha) for the three subscales is 0.76, 0.89, and 0.87, respectively.  Test-retest reliability for the three subscales ranged from 0.85 to 0.90.

Assessment in Elderly Populations:

The mean age of the patient population during development of this scale was 63.7 years. In a program involving patients with rheumatoid arthritis Smarr et al. (1997) measured changes in ASES and other selected measures of dpression, pain, health status, and disease activity following and intervention.  They found significant relationships between ASES score and these other measures.  In a program to examine how self efficacy relates to pain tolerance, osteoarthritis patients (average age 62.5 years) completed the ASES and then participated in a experimental session to measure their thermal pain threshold (Keefe et al. 1997).  Individuals who scored higher on the ASES also had higer pain thresholds.

Assessment in Minority Populations:

An 11-item Spanish translation of the ASES contaiing only the PSE and OSE subscales has been tested and validated in Hispanic-Americans (Gonzalez et al. 1995).  Barlow et al. (1997) examined the comprehensibility, reliability, and validity of the ASES among British people with arthritis.  They concluded that the ASES is a reliable and valid measure for use in a community-based sample.

Subsequent Studies:

Brekke et al. (1999) observed that patients with rheumatoid arthritis who lived in a less affluent area within Oslo, Norway were more seriously ill and scored significantly lower on the ASES than similar patients from a more affluent area of the city.  Bailey et al. (1999) used the ASES and other measures in a comparative evaluation of a fibromyalgia rehabilitation program.  Hartman et al. (2000) used the ASES to assess the effects of a Tai Chi exercise program on function and quality of life in patients with osteoarthritis.   Likewise, Gowans et al. (2001) used the ASES to assess the effects of exercise on mood and physical function in individuals with fibromyalgia.  The ASES has been translated into other languages.  Gonzales et al. (1995) created a 13-item Spanish version of the ASES consisting of 11 items from the ASES and two additional items of their own construction.   Mueller et al. (2003) translated this version into German.  A Swedish version that also displays the same 3-part structure with satisfactory internal consistency and test-retest reliability is also available (Lomi 1992, Lomi and Nordholm 1992).  The Swedish version has been used to assess physiotherapy approaches among patients with non-specific musculoskeletal disorders (Malmgren-Olsson and Branholm (2002). 

Contact Information:

The original 20-item ASES is available as a table in Lorig et al. (1989).  The 8-item abbreviated scale, along with the German translation is available in Mueller et al. (2003).  The Spanish translation is available as an appendix in Gonzalez et al. (1995).

References:

Bailey, A; Starr, L; Alderson, M; Moreland, J (1999) A comparative evaluation of a fibromyalgia rehabilitation program. Arthritis Care & Research. Vol 12(5) 336-340.

Barlow JH; Williams B; Wright, CC (1997) The reliability and validity of the Arthritis Self-Efficacy Scale in a UK context. Psychology, Health & Medicine. Vol 2(1) 3-17.

Brekke, M; Hjortdahl, P; Thelle, DS; Kvien, TK. (1999) Disease activity and severity in patients with rheumatoid arthritis: Relations to socioeconomic inequality. Social Science & Medicine. Vol 48(12) 1743-1750.

Gonzalez VM, Stewart A, Ritter PL, Lorig K. (1995) Translation and validation of arthritis outcome measures into Spanish. Arthritis Rheum 38:1429–46.

Gowans, S. E; deHueck, A; Voss, S; Silaj, A; Abbey, S. E; Reynolds, W. J. (2001) Effect of a Randomized, Controlled Trial of Exercise on Mood and Physical Function in Individuals With Fibromyalgia. Arthritis & Rheumatism: Arthritis Care & Research. Vol 45(6) 519-529.

Hartman, CA; Manos, TM; Winter, C; Hartman, DM; Li, B; Smith, JC. (2000) Effects of T'ai Chi training on function and quality of life indicators in older adults with osteoarthritis. Journal of the American Geriatrics Society. Vol 48(12) 1553-1559.

Keefe, FJ, Lefebvre JC; Maixner W, Salley AN Jr, Caldwell DS (1997) Self-efficacy for arthritis pain: Relationship to perception of thermal laboratory pain stimuli. Arthritis Care & Research. Vol 10(3) 177-184.

Lomi, C (1992) Evaluation of a Swedish version of the Arthritis Self-efficacy Scale. Scandinavian Journal of Caring Sciences. Vol 6(3) 131-138.

Lomi C, Nordholm LA.(1992) Validation of a Swedish version of the arthritis self-efficacy scale. Scand J Rheumatol 21:231–7.

Lorig K, Chastain RL, Ung E, Shoor S, Holman HR (1989) Development and evaluation of a scale to measure perceived self efficacy in people with arthritis. Arthritis Rheum 32:37- 44.

Malmgren-Olsson, E-B, Branholm, I-B (1992) A comparison between three physiotherapy approaches with regard to health-related factors in patients with non-specific musculoskeletal disorders. Disability and Rehabilitation: An International Multidisciplinary Journal. Vol 24(6) 308-317.

Mueller A, Hartmann M, Mueller K, Eich W (2003) Validation of the arthritis self-efficacy short-form scale in German fibromyalgia patients. European Journal of Pain. Vol 7(2) 163-171.

 
 
 

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