Assessing internal construct validity of DAPSA and DAPSA28 in psoriatic arthritis: a European observational study using confirmatory factor analysis and additional psychometric testing

Objectives The Disease Activity index for Psoriatic Arthritis (DAPSA) was developed to assess disease activity in patients with psoriatic arthritis (PsA). A modified version, DAPSA28, uses 28 joints instead of 66/68. This study evaluated key psychometric properties of DAPSA and DAPSA28. Methods Data from 1865 patients with PsA in the European Spondyloarthritis (EuroSpA) Research Collaboration Network, having DAPSA and DAPSA28 scores at baseline and follow-up, were analysed. Tests included assessment of internal construct validity by scree plots, confirmatory factor analysis (CFA) and structural equation modelling (SEM), supplemented by tests of differential item functioning (DIF) and evaluation of internal consistency reliability by Cronbach’s α (CA). A subset of 625 patients was used for most analyses, except descriptive statistics, correlation matrix and CA. Results One-dimensional CFA models for DAPSA and DAPSA28 showed acceptable model fit at baseline (root mean square error of approximation, RMSEA: 0.020, 0.034). However, model fit at 6months follow-up was poor (RMSEA: 0.057, 0.063). SEM combining baseline and follow-up data could not identify an acceptable model fit. DIF was found for sex and country. CA indicated acceptable internal consistency (DAPSA: 0.65; DAPSA28: 0.63). Heterogeneity across countries was observed. Conclusions Overall, the model fit was acceptable across model fit statistics, supporting internal construct validity, but some evidence of misfit at country level was disclosed. Our findings support acceptable internal consistency reliability, but DIF was found for sex and country. Based on mixed results of model fit and DIF, further investigation of these and other PsA disease activity measures is warranted.