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Exploring the ceiling effect of the revised Childhood Health Assessment Questionnaire in a European patient sample


The original version of the Childhood Health Assessment Questionnaire (CHAQ30orig) suffers from a ceiling effect and hence has reduced clinical validity [1]. The effect of adding eight more demanding items and a new continuous response option (CATII) was tested.


Twenty-four children with JIA [2] were recruited from eight centres across Europe. Demographic, clinical, and CHAQ data were obtained. Five different score calculations were applied: the original method (CHAQ30orig), and the mean item scores for the 30 and 38-question versions with two categorical response options (Chaq30item CAT I and II and Chaq38item CAT I and II).

Descriptive statistics were calculated and CHAQ-data were tested for normality. A ceiling effect was defined by 15% or more patients scoring the best possible score.


(preliminary, based on 30% of total data).

A ceiling effect was observed in CHAQ30orig and CHAQ30item (20.8% for both). The median scores, KS-statistics, p-values, and interquartile range (IQR) are presented in table 1.

Table 1 Median, ceiling effect, KS results, and interquartile range of five CHAQ scoring methods.


The CHAQ38 with CATII scoring showed best overall distribution characteristics: no ceiling effect, more normally distribution, and the second largest IQR. (In September 2008 final results are presented).


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Groen, W., Net, J.V.d., Nørgaard, M. et al. Exploring the ceiling effect of the revised Childhood Health Assessment Questionnaire in a European patient sample. Pediatr Rheumatol 6 (Suppl 1), P102 (2008).

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