Shortening patient-reported outcome measures through optimal test assembly: Application to the Social Appearance Anxiety Scale in the Scleroderma Patient-centered Intervention Network Cohort

Daphna Harel, Sarah D. Mills, Linda Kwakkenbos, Marie Eve Carrier, Karen Nielsen, Alexandra Portales, Susan J. Bartlett, Vanessa L. Malcarne, Brett D. Thombs

Research output: Contribution to journalArticle


Objectives The Social Appearance Anxiety Scale (SAAS) is a 16-item measure that assesses social anxiety in situations where appearance is evaluated. The objective was to use optimal test assembly (OTA) methods to develop and validate a short-form SAAS based on objective and reproducible criteria. Design This study was a cross-sectional analysis of baseline data from adults enrolled in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort. Setting Adults in the SPIN Cohort in the present study were enrolled at 28 centres in Canada, the USA and the UK. Participants The SAAS was administered to 926 adults with scleroderma. Primary and secondary measures The SAAS, Brief Fear of Negative Evaluation II (BFNE II), Brief Satisfaction with Appearance Scale (Brief-SWAP), Patient Health Questionnaire-8 (PHQ8) and Social Interaction Anxiety Scale-6 (SIAS-6) were collected, as well as demographic characteristics. Results OTA methods identified a maximally informative shortened version for each possible form length between 1 and 15 items. The final shortened version was selected based on prespecified criteria for reliability, concurrent validity and statistically equivalent convergent validity with the BFNE II scale. A five-item short version was selected (SAAS-5). The SAAS-5 had a Cronbach's α of 0.95 and had high concurrent validity with the full-length form (r=0.97). The correlation of the SAAS-5 with the BFNE II was 0.66, which was statistically equivalent to that of the full-length form. Furthermore, the correlation of the SAAS-5 with the two subscales of the Brief-SWAP, and the SIAS-6, were statistically equivalent to that of the full-length form. Conclusions OTA was an efficient method for shortening the full-length SAAS to create the SAAS-5.

Original languageEnglish (US)
Article numbere024010
JournalBMJ open
Issue number2
StatePublished - Feb 1 2019



  • generalized partial credit model
  • optimal test assembly
  • patient reported outcome measure
  • short form
  • systemic sclerosis

ASJC Scopus subject areas

  • Medicine(all)

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