Arthritis Impact Measurement Scales (AIMS/AIMS2)

Purpose

Disease-specific measure of physical, social, and emotional well-being designed as a measure of outcome in arthritis1.

Content

There are 9 scales: mobility, physical activity (walking, bending, lifting), dexterity, household activity (managing money and medications, housekeeping), social activities, activities of daily living, pain, depression, and anxiety. AIMS2 includes arm function, social support, and work.

Developer / Contact Information

AIMS were developed by Robert F. Meenan, dean, Boston University School of Public Health, 715 Albany St., T-C-306, Boston, MA 02118. Email: rmwwnan@bu.edu.

Versions

There is an original version, shortened version, an expanded version (AIMS2), a short-form of the AIMS2 (AIMS2-SF), a child version, and a version for the elderly (Geri-AIMS). AIMS has been translated into many languages including Portuguese, Canadian French, Italian, Spanish, French, Dutch, Swedish, Turkish, and Norwegian.

Number of items in scale: AIMS 45, Shortened AIMS 18, AIMS2 101, and AIMS2-SF 26.

Subscales: AIMS 9 (listed above); shortened AIMS 9; AIMS2 12.

Populations

Developmental/target. Developed in patients with rheumatoid arthritis and osteoarthritis to assess the outcome of health care.

Other Uses

AIMS have been used in other conditions including: psoriatic arthritis, ankylosing spondylitis, fibromyalgia, carpal tunnel syndrome, colles fracture, hemophilia and in patients undergoing joint replacement surgery. A 1-page summary of results has been developed for use in clinical practice.

WHO ICF Components: Activity limitation, Participation restriction

Administration

Method: Self-administered and relatively easy to complete.

Training: None required.

Time to administer/complete: AIMS 15 minutes, Shortened AIMS 6-8 minutes, AIMS2 20-30 minutes, AIMS2-SF 10 minutes.

Equipment needed: None

Availability / Cost: AIMS are available with user manual from Dr. Meenan (contact information above). It is also available at AIMS2 - free access (Click on free access/disease-specific measures/rheumatology/AIMS2/public domain access/copy of original AIMS2 question/copy of the user's manual). Dutch and Italian translations are available at the same website.

Scoring

Responses: Guttman Scale.

Score range: Range is 0-10 for each section. Total health score 0-60.

Interpretation of scores: Zero represents good health status, 10 and 60 represent poor health status.

Method of scoring: Each section contains a Guttman Scale (a series of questions/statements that are graded so that endorsement of one level of disability automatically indicates disability on all levels below it). In AIMS the number of response options within the Guttman scales varies across sections. In AIMS2, the response format has been standardized across sections to 5-point scales. For scoring, the Guttman scaling is ignored and each item is scored separately without weights. Higher scores indicate greater disability. The score for each section is standardized to a 0-10 scale using a standardization formula. The total health score is calculated by summing the standardized scores for mobility, physical and household activities, dexterity, pain, and depression.

Time to score: Scoring by hand takes around 10 minutes. Computerized scoring can be completed in seconds.

Training to score: Minimal training is required for scoring, users' guides are available.

Training to interpret: No specific training is required for interpretation of scores but familiarity with the range and direction of scoring is helpful.

Norms available: None.

Psychometric Information

Reliability: AIMS: Guttman scale coefficients for scalability >0.6. The Guttman scale coefficients for reproducibility are >0.9. Internal consistency via Cronbach's alpha >0.60 for each of the 9 sections. The test-retest correlations between 2 administrations over a 2-week period in several studies are >0.80.

Shortened AIMS: Internal consistency and test-retest reliability are similar to the original AIMS.

AIMS2 internal consistency via Cronbach's alpha over the 9 sections range from 0.72 to 0.91. Test-retest intraclass correlation coefficients range from 0.65 to 0.90 over a 10-day period and from 0.78 to 0.94 over a 3-week period.

AIMS2-S: Test-retest intraclass correlation coefficients are >0.70 over a 1-week period.

AIMS content validity: Items in AIMS are based on the content of the Rand Health Survey Questionnaires, the Quality of Well-Being Scale, and Katz's Index of Activities of Daily Living. Items on dexterity and pain were added. Factor analysis identified 3 factors (physical function, psychological, and pain), which have been replicated in subsequent studies.

AIMS construct: Relevant subscales of AIMS correlate strongly with other measures of the construct (e.g., physical activity AIMS scale with Health Assessment Questionnaire (HAQ), AIMS pain scale with HAQ pain scale, AIMS and Functional Status Questionnaire). Physical functioning AIMS scales correlate more strongly with measures of disease activity than AIMS psychological or social scales; all scales correlate with increasing age (i.e., reduced function with increasing age).

AIMS2 content: Derived from AIMS but expanded to include arm function, social support, and work giving a 5-factor structure (lower extremity function, upper extremity function, affect, pain, and social interaction).

AIMS2 criterion: Moderate correlations with general health status measures: NHP, SIP and Short Form-36 (SF-36).

AIMS2 construct: Moderate, expected correlations with disease activity (swollen joint count, pain visual analog scale (VAS) and erythrocyte sedimentation rate).

AIMS2-SF content: Derived from AIMS2 using Delphi and nominal group techniques. Principal components factor analysis confirmed the same 5-factor structure as AIMS2.

AIMS2-SF criterion: Comparison between AIMS2 and AIMS2-SF using the Bland and Altman method for measuring agreement found almost complete agreement. Moderate correlations with other general health status measures (MHAQ, SF-36, and SIP) were very similar to the correlations between these measures and AIMS2.

AIMS2-SF construct: Correlations with clinical and disease factors were moderate and as expected.

Responsiveness/sensitivity to change: Responsiveness of AIMS is better than most other generic and disease-specific measures (SIP, QWB, HAQ, Functional Status Index, and McMaster Health Index). AIMS2 and AIMS2-SF have similar responsiveness. Standardized response means for changes in AIMS2-SF scores over 3 months range from 0.36 (small) to 0.8 (high).

Comments and Critique

The AIMS is a widely used disease-specific measure that has a broad scope, measuring many aspects of health status. It is more responsive in patients with arthritis than any of the generic measures. The revised version, AIMS2 has good psychometric properties and the advantage of including measures of satisfaction with health and patients' priorities for improvement. The full-length versions are quite time consuming to complete, and the short-form (AIMS2-SF) that has similar psychometric properties to the full-length versions, may be more appropriate for postal surveys, studies where patients are required to complete several questionnaires, and in clinical practice.

References

  1. (Original) Meenan RF, Gertman PM, Mason JH. Measuring health status in Arthritis: the Arthritis Impact Measurement Scales. Arthritis Rheumatism 1980; 23:146-52.
  2. Guillemin F, Coste J, Pouchot J, Ghezail M, Bregeon C, Sany J, and the French Quality of Life in Rheumatology Group. The AIMS2-SF: a short form of the Arthritis Impact Measurement Scales 2. Arthritis Rheum 1997; 40:1267-74.
  3. Kazis LE, Anderson JJ, Meenan RF. Health status information in clinical practice: the development and testing of patient profile reports. J Rheumatol 1988; 15:338-44.
  4. Liang MH, Fossel AH, Larson MG. Comparisons of five health status instruments for orthopaedic evaluation. Med Care 1990; 28:632-42.
  5. Meenan RF, Mason JH, Anderson JJ, Guccione AA, Kazis LE. AIMS2: the content and properties of a revised and expanded Arthritis Impact Measurement Scales health status questionnaire. Arthritis Rheum 1992; 35:1-10.
  6. Short-form Arthritis Impact Measurement Scales 2: tests of reliability and validity among patients with osteoarthritis. Ren XS, Kazis L, Meenan RF. Arthritis Care Res. 1999 Jun; 12(3):163-71.

ARHP Research Committee - content last reviewed 2015