# Validation of the Coping with Health Injuries and Problems questionnaire in a longitudinal cohort with recent-onset RA

## TL;DR

This study validates a questionnaire to assess coping strategies in patients with recent-onset rheumatoid arthritis, finding it reliable and suggesting a potential refinement to better capture treatment adherence.

## Contribution

The study validates the CHIP questionnaire for RA patients and proposes a revised subscale structure to better reflect treatment adherence.

## Key findings

- The CHIP questionnaire showed good psychometric properties in both early and established RA patients.
- Three items related to treatment adherence consistently formed a separate subscale in factor analyses.
- Internal consistency was comparable between early and established RA patients.

## Abstract

To validate the Coping with Health Injuries and Problems (CHIP) questionnaire in a prospective cohort of early RA patients.

Between 2006 and 2022, newly diagnosed RA patients self-administered CHIP at baseline and at follow-up visits. The original CHIP comprises four subscales (Distraction, Palliative, Instrumental, Emotional preoccupation), each containing eight items (scores 8 to 40). At inclusion and again after more than 2 years of follow-up, internal consistency was assessed with Cronbach’s alpha, factor structure with exploratory and confirmatory factor analyses (EFA, CFA), and sensitivity to change with mixed linear models with repeated measures.

In 381 early RA patients, the means (SD) were 23.75 (6.52) for Distraction, 23.55 (6.11) for Palliative, 31.38 (5.41) for Instrumental and 25.11 (7.89) for Emotional preoccupation, values comparable to the literature only available in back pain patients. In 253 of the 381 patients followed up into established RA, all subscales except Distraction had decreased significantly between inclusion and follow-up. Internal consistency was similar in established and early RA (Cronbach’s alphas: 0.77 to 0.89 vs 0.75 to 0.86, respectively). EFA in early and established RA suggested that three items linked to treatment adherence consistently segregated from other Instrumental items as a subscale, although this did not improve internal consistency and CFA significantly.

The original CHIP possesses good psychometric properties to describe individual coping styles in both early and established RA. Coping in RA might be better characterized using five rather than four subscales, with the additional subscale addressing treatment adherence.