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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Axial spondyloarthritis &#40;axSpA&#41; is a rheumatic disease characterized by inflammatory back pain&#44; and axial structural changes that may lead to impaired spinal mobility and limitations in daily activities&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> This negative impact on physical functioning poses a significant socioeconomical burden&#44; and it is linked to productivity losses&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">International recommendations for the management of axSpA from the Assessment in SpondyloArthritis International Society &#40;ASAS&#41; and the European Alliance of Associations for Rheumatology &#40;EULAR&#41; advise regular physical activity for all patients&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a> Physical activity has been associated with lower disease activity&#44; and there is mounting evidence that different types of exercise also have positive effects on physical function&#44; pain and mobility in patients with axSpA&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> Despite these promising benefits of exercise&#44; previous findings suggest that patients with axSpA exhibit lower physical activity levels than healthy controls&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a> In this sense&#44; it is critical to reinforce the importance of physical activity in patients with axSpA and develop specific recommendations that are adapted to both patients and healthcare professionals&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical activity may be assessed with measurement tools&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> Particularly&#44; patient-reported outcome measures &#40;PROMs&#41; are easy applicable in daily clinical practice and research&#46; In addition&#44; information about the specific type of activity can be included&#46; To fully benefit from these advantages&#44; a questionnaire should include all daily physical activity domains and measure the duration&#44; frequency and intensity of these activities&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a> Moreover&#44; psychometric properties&#44; such as feasibility&#44; validity&#44; reliability and sensitivity to change&#44; help evaluating the performance of these instruments&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">10&#44;11</span></a> While there are several instruments that aim to assess physical function in axSpA&#44; such as the Bath Ankylosing Spondylitis Functional Index or the Health Assessment Questionnaire&#44; instruments that assess self-reported regular physical activity are scarce&#46; In this regard&#44; the Short QUestionnaire to Assess Health enhancing physical activity &#40;SQUASH&#41; is a physical activity questionnaire that was developed and validated in 2003 in the general Dutch population&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a> Although it showed better performance on measuring daily physical activity in axSpA patients than the International Physical Activity Questionnaire &#40;IPAQ&#41;&#44; modification of the SQUASH was recommended to improve validity in patients with axSpA&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a> Considering this&#44; the modified-SQUASH &#40;mSQUASH&#41; was developed in Dutch in 2021&#44; resulting in a feasible&#44; valid&#44; reliable and responsive questionnaire for the assessment of physical activity&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> Hence&#44; the mSQUASH aims to tackle the unmet need on the assessment of the type and extent of daily physical activity in patients with axSpA&#44; both in clinical practice and research&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This study aims to translate and cross-culturally adapt the mSQUASH into Spanish and to evaluate the equivalence of the translated version in patients with axSpA&#46; The validation of the Spanish version of mSQUASH will provide a tool that allows to assess physical activity in patients with axSpA&#44; both in clinical practice and in research settings&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The translation and cross-cultural adaptation study of the Spanish mSQUASH followed the current international recommendations&#44; according to the Beaton method&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">14&#44;15</span></a> This was done using the forward-backward procedure&#44; which consists of five consecutive steps &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A scientific committee of the project was formed by an expert methodologist &#40;VN-C&#41;&#44; who provided guidance on the process of cross-cultural adaptation and ensured consistency of the methodology&#44; one rheumatologist&#44; and three Dutch-Spanish bilingual translators&#46; The process of translation and cross-cultural adaptation was carried out between April and December 2021&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">mSQUASH questionnaire</span><p id="par0030" class="elsevierStylePara elsevierViewall">The mSQUASH contains five subdomains&#44; namely commuting activities&#44; activity at work or school&#44; household activities&#44; leisure-time activities&#44; and sport-exercise&#46; The domain of commuting activities has four items&#44; the work or school&#44; and household activities each have two items&#44; the leisure-time domain has five items&#44; and the sports-exercise domain can include up to four sports activities written in free text&#46; The total score is calculated by taking a sum of the time spent active in each domain in total in minutes and multiplying by the intensity score &#40;METs-value&#42;demand factor&#41;&#46; Higher scores indicate higher physical activity&#46; The mSQUASH including codebook and syntax was published before&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Translation</span><p id="par0035" class="elsevierStylePara elsevierViewall">Two bilingual translators &#40;AJ&#44; DPS&#44; both native speakers for Spanish&#41; produced independent forward translations of the mSQUASH&#44; including item content&#44; responses&#44; and instructions&#44; from Dutch into Spanish&#46; One of the translators&#44; who had a background in life sciences and rheumatic diseases&#44; was informed of the conceptual content and the clinical background of the questionnaire &#40;i&#46;e&#46;&#44; informed translator&#41; whereas the other translator&#44; who did not have a background in rheumatology&#44; was not &#40;i&#46;e&#46;&#44; uninformed translator&#41;&#46; The different profiles of the translators contributed to ensure agreement and accuracy with the original Dutch version in terms of the terminology and the clinical content&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a> An independent written report of the translations was written by each translator&#44; highlighting any difficulties or uncertainties on the process&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Synthesis of translation</span><p id="par0040" class="elsevierStylePara elsevierViewall">An online consensus meeting was held within the scientific committee including the two translators&#46; The translations of the informed and uninformed translator were compared&#46; After checking and discussing the discrepancies between translations&#44; minor adjustments were made and both versions were harmonized in a consensual version&#46; A written report documenting the synthesis of the two translations&#44; specifying the concerns tackled and the final decisions&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Back translation</span><p id="par0045" class="elsevierStylePara elsevierViewall">Another bilingual translator &#40;GJ&#44; native speaker for Dutch&#41;&#44; who was blind to the original version of the questionnaires&#44; back translated the synthesized version of the first Spanish translation of the mSQUASH into the original Dutch&#46; He was not informed of the content or purpose of the questionnaire&#46; Together with the Dutch back-translation&#44; a translation report was made&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Scientific committee review</span><p id="par0050" class="elsevierStylePara elsevierViewall">The scientific committee reviewed and assessed the back-translation and translation reports for conceptual&#44; experiential&#44; idiomatic and semantic equivalence in an online meeting&#46; This ensured that items and words held the same meaning while capturing the experience of daily life in the Spanish culture&#46; The scientific committee aimed to reach consensus on discrepancies across all versions and developed a pre-final Spanish version of the mSQUASH&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Patient interviews and cognitive debriefing</span><p id="par0055" class="elsevierStylePara elsevierViewall">The pre-final version was assessed in a sample of 10 native Spanish patients with axSpA&#46; A representative sample including patients from different socio-demographic backgrounds was included from the Rheumatology outpatient clinic of the La Paz University Hospital&#44; Madrid&#46; Patients were selected consecutively from the clinics&#44; provided that they were representative of different ages and backgrounds&#46; Inclusion criteria for these patients were &#40;i&#41; diagnosis of axSpA according to the rheumatologist and &#40;ii&#41; able to communicate verbally and in writing in Spanish&#46; Patients were excluded in the presence of conditions that could potentially influence the assessment&#44; such as illiteracy or dementia&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Patients filled mSQUASH and then had either a telephone or a face-to-face interview &#40;cognitive debriefing&#41; with one member of the scientific committee &#40;DB&#41;&#46; The cognitive debriefing interviews aimed to evaluate whether patients adequately understood the questionnaires&#46; Besides&#44; they were probed for their acceptability of the items in order to detect misleading items&#46; Each respondent filled out the mSQUASH and was asked about each questionnaire item and response&#46; The significance of the items as well as the responses were assessed&#44; ensuring that the translated version was equivalent to the original questionnaire in a practical setting&#46; Respondents were indicated that the purpose of the exercise was to test the questionnaire&#44; not to assess themselves&#46; Information on socio-demographic characteristics was collected&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The Dutch mSQUASH served as the original version&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> The mSQUASH was translated and culturally adapted into Spanish&#46; Appendix 1 includes the final version of the Spanish mSQUASH questionnaire&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Translation of the Dutch mSQUASH original version</span><p id="par0070" class="elsevierStylePara elsevierViewall">Both translators reported the initial independent forward translations as straightforward&#46; Some discrepancies arose between them&#46; In general&#44; one of the translators used more colloquial terms&#59; however&#44; no major differences arose in most of the items when the two independent translations were compared&#46; Items in which there were differences were discussed and agreed for a final version&#46; An example of a minor discrepancy is reflected in the translation of the first domain&#44; commuting activities&#46; The original questionnaire reads &#8220;<span class="elsevierStyleItalic">Ander</span><span class="elsevierStyleItalic">transport</span>&#8221;&#44; which refers to the mean of transport and would be literally translated as &#8220;<span class="elsevierStyleItalic">Otros</span><span class="elsevierStyleItalic">transportes</span>&#8221;&#44; as one of the translators reported&#46; However&#44; the other translator reported &#8220;<span class="elsevierStyleItalic">Otros</span><span class="elsevierStyleItalic">desplazamientos</span>&#8221;&#46; To overcome this difficulty&#44; the context was discussed to translate into a semantically and conceptually equivalent domain&#46; In fact&#44; the conceptual meaning referred to the actual commute&#44; and the domain was therefore left as &#8220;<span class="elsevierStyleItalic">Otros</span><span class="elsevierStyleItalic">desplazamientos</span>&#8221;&#46; Another example of a challenging translation was &#8220;<span class="elsevierStyleItalic">Huishoudelijke</span><span class="elsevierStyleItalic">activiteiten</span>&#8221;&#59; as reported by one of the translators&#44; the actual translation would be &#8220;<span class="elsevierStyleItalic">actividades</span><span class="elsevierStyleItalic">dom&#233;sticas</span>&#8221;&#44; but &#8220;<span class="elsevierStyleItalic">tareas</span><span class="elsevierStyleItalic">dom&#233;sticas</span>&#8221; seems to better reflect the conceptual meaning and is more used in Spanish language in this regard&#44; so it prevailed&#46; Similarly&#44; all discrepancies were agreed upon and a first version in Spanish was created&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Back translation of the preliminary version of the Spanish mSQUASH</span><p id="par0075" class="elsevierStylePara elsevierViewall">The back translator reported no major doubts when interpreting the mSQUASH in Spanish&#46; The back translation presented almost complete semantic&#44; experiential and conceptual equivalence with the original version&#46; There were minor discrepancies in the formulation of some items as compared with the original version that were discussed&#46; As an example&#44; item 8 was initially translated in the first version as &#8220;<span class="elsevierStyleItalic">tareas dom&#233;sticas</span><span class="elsevierStyleItalic">extenuantes</span>&#8221;&#46; The word &#8220;<span class="elsevierStyleItalic">extenuante</span>&#8221; has some connotations in Spanish which surpasses the intensity of the actual meaning of the Dutch version and indicates heavily demanding work&#46; For this reason&#44; it was adapted as &#8220;<span class="elsevierStyleItalic">tareas dom&#233;sticas que requieren esfuerzo</span><span class="elsevierStyleItalic">intenso</span>&#8221;&#44; which better reflects the intensity referred in the original version&#46; Another example that raised discussion&#44; in the last domain &#40;sports-exercise&#41;&#44; was the word &#8220;<span class="elsevierStyleItalic">bewegings-&#47;oefentherapie</span>&#8221;&#44; which was initially translated as &#8220;<span class="elsevierStyleItalic">terapia f&#237;sica&#47;ocupacional</span>&#8221;&#46; However&#44; it was agreed that in Spain an activity such as &#8220;<span class="elsevierStyleItalic">bewegings-&#47;oefentherapie</span>&#8221; is not common practice&#44; and a consensus for the equivalent &#8220;<span class="elsevierStyleItalic">fisioterapia&#47;rehabilitaci&#243;n</span>&#8221; was reached&#44; reflecting better the meaning of the original questionnaire&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Patient interviews and cognitive debriefing</span><p id="par0080" class="elsevierStylePara elsevierViewall">The final Spanish version of the mSQUASH was tested in 10 patients with axSpA&#46; Six patients had radiographic axSpA &#40;r-axSpA&#41; and four non-radiographic axSpA&#59; 7 were male&#44; 3 women&#59; mean age &#40;SD&#41; was 38&#46;9 &#40;14&#46;4&#41; years&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the characteristics of the participants&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">All participants found the questionnaire clear and straightforward to complete and confirmed the adequate translation of most of the items&#46; Minor spelling errors were corrected&#44; and the response categories were homogenized following the comments of two of the respondents&#59; in the physical demand categories&#44; the explanation read &#8220;despacio&#47;ligero&#8221;&#44; whereas the responses read &#8220;lento&#47;ligero&#8221;&#46; Finally&#44; the former prevailed&#46; In addition&#44; it was commented that the term &#8220;colegio&#8221; &#8211; translated literally from the Dutch &#8220;school&#8221; &#8211; was not comprehensive enough to reflect possibilities of places of education &#40;i&#46;e&#46; it does not include university&#41;&#44; so it was adapted to &#8220;el lugar de estudio&#8221;&#46; Some other comments did not lead to any change as agreed by the scientific committee&#46; Some patients indicated that options 14&#8211;17 would benefit of an indication that they meant to be self-completed&#44; which is not present in the original questionnaire&#46; Some participants commented that the bicycle was not used by them as a mean of transport&#59; however&#44; this is very dependent on the geography even within Spain&#46; Moreover&#44; some indicated that the sentence &#8220;no aplica&#8221; could be difficult to interpret&#44; but this was attributed to the layout in a plain text document&#44; not in the final format&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">To sum up&#44; in general the participants found the items of the Spanish version of the mSQUASH understandable and clear&#46; The cognitive debriefing provided evidence for face validity&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">This study provides a translated and culturally adapted Spanish version of the mSQUASH following the current international recommendations for this process&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">15&#44;16</span></a> In the translation and back-translations&#44; the meaning preservation and cultural adaptation were ensured&#46; Only very minor modifications to the initial translation were implemented and no major cultural differences were highlighted&#46; The back-translation discrepancies were minor despite the cultural and linguistic differences&#46; The mSQUASH was completed by ten patients in the cognitive debriefing&#44; which suggested good content validity without any patients finding the items unclear or irrelevant&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Patient-reported outcome measures assess disease outcomes from the patient perspective&#44; including health-related quality of life&#44; pain&#44; activity limitations&#44; satisfaction or adherence to treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> They have been progressively more used in recent years&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> following their recognition by the Food and Drug Administration &#40;FDA&#41; and the European Medicines Agency &#40;EMA&#41; as a measure of treatment efficacy&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> In axSpA&#44; PROMs have been frequently used to evaluate functional ability&#44; quality of life&#44; health status&#44; or disease activity&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">19&#44;20</span></a> However&#44; one of the challenges in the development and selection of PROMs is the availability in the required language&#44; which would ensure feasibility of using the instrument in that language&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> In this regard&#44; cross-cultural validation refers to &#8220;the degree to which the performance of the items on a translated or culturally adapted instrument are an adequate reflection of the performance of the items of the original version of the instrument&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> The first step towards a complete cross-cultural validation is to adapt the questionnaire to the translated language to provide conceptual&#44; experiential&#44; idiomatic and semantic equivalence&#46; This was ensured in our study by a systematic five-step process of translation and back-translation&#44; followed by a field testing of the pre-final translated version&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a> This goes beyond a simple word by word translation of the questionnaire and aims to its adaptation to Spanish idiomatic expressions and culture&#46; Of note&#44; Spanish is the second most spoken maternal language in the world&#44; after Mandarin Chinese&#44; and it may be considered the third language for total number of speakers&#46; While this translation was conducted in Spain&#44; Spanish is also spoken in Hispanic America&#44; Equatorial Guinea&#44; Western Sahara and the Philippines&#44; as well as by migrants in numerous countries such as the United States&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Physical activity is a construct of utmost importance in axSpA&#46; Besides being a modifiable risk factor for cardiovascular disease&#44; inactivity has been linked to higher disease activity and worse function&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> Thus&#44; engaging in physical activity has been associated with better overall health and functioning&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> Considering this&#44; a questionnaire to assess physical activity in axSpA is much needed to help promoting patient&#39;s tailored exercise&#46; As the mSQUASH inquires for physical activity during an average week in the past month&#44; this minimizes the weekly variation&#44; as shown in the original validation by a high test&#8211;retest reliability&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> This is to add to the complete validation of the original mSQUASH&#44; which showed to be a valid&#44; reliable&#44; sensitive to change and feasible questionnaire for the measurement of daily physical activity in axSpA patients&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">It is widely acknowledged that just translating a questionnaire into another language is insufficient for achieving cross-cultural validity&#44; but there is no full agreement on the ideal strategy&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a> In this regard&#44; there are several guidelines for cross-cultural adaptation and methodology across them varies substantially&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> The majority of methods include committees&#44; focus groups&#44; and back translations&#46; According to experts&#44; most of these methods would attain similar results&#44; and they could therefore be chosen following the preference of the authors&#46; Currently available adaption methods use either a &#8220;forward&#8211;backward&#8221; translation or &#8220;forward only&#8221;&#46; Beaton method&#44; which employs &#8220;forward&#8211;backward&#8221; translation&#44; was used in our study&#46; In our experience this has proven to be beneficial&#44; as backward translation raised further discussion on items&#44; whose changes were later evidenced by the results&#46; Besides&#44; the field test with patients ensured that the translation was thorough and that the English and Spanish concepts were equivalent&#46; Ten patients were involved in the field test&#46; It may be argued that more patients would be beneficial&#44; but given that this questionnaire has a limited number of items and aims to assess mainly one construct&#44; it was considered that the sample of ten patients including a broad spectrum of socio-demographic background was convenient&#46; This is in agreement with the field test of the health index for axSpA recently developed by ASAS&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The present study is an important step for the world-wide use of the mSQUASH and its face validity&#46; In this sense&#44; a limitation of this study is that patients for cognitive debriefing were recruited in a single centre in Spain&#44; which may hinder geographical variabilities in language and culture&#46; However&#44; the sample was representative of the axSpA population in terms of gender&#44; age&#44; educational level and working status&#46; Besides&#44; all participants involved in the translation&#44; both from the scientific committee and patients&#44; were from Spain&#44; which may lead to some linguistic variations in some items in other Spanish-speaking regions of the world&#46; This will need further research to confirm the validity of this Spanish version in some other Spanish-speaking countries&#46; Of note&#44; all patients in our study were diagnosed with axSpA&#44; and therefore we cannot extrapolate our conclusions to other diseases&#46; Besides&#44; it would have been interesting to measure the time that patients needed to complete the questionnaire&#44; to further assess the feasibility of the instrument&#46; Of note&#44; this study represents only the first step towards the complete validation of the instrument&#59; before the Spanish mSQUASH can be implemented in clinical practice&#44; it is critical to assess its psychometric properties in a larger group of patients&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclusion</span><p id="par0120" class="elsevierStylePara elsevierViewall">The mSQUASH was successfully translated and adapted into Spanish&#44; showing adequate face and content validity and ensuring the feasibility of its use&#46; In this sense&#44; the mSQUASH holds promise to be a useful tool to assess the amount and type of daily physical activity in axSpA for clinicians and researchers&#46; Nevertheless&#44; further steps towards the complete validation are needed before implementing the use of this instrument&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Authors&#8217; contributions</span><p id="par0125" class="elsevierStylePara elsevierViewall">DB&#58; Study design and set up&#44; Presentation of the data&#44; Discussion and interpretation of the translations within the Scientific Committee&#44; Cognitive debriefing with patients&#44; Writing original draft&#46; AJ&#44; DPS&#58; Translation into Spanish&#44; Discussion and interpretation of the translations within the Scientific Committee&#44; Manuscript revision&#46; GJ&#58; Back-translation into Dutch&#44; Discussion and interpretation of the translations within the Scientific Committee&#44; Manuscript revision&#46; CP&#44; SR&#44; SA&#44; AS&#44; AB&#58; Methodology&#44; Discussion and interpretation of the findings&#44; Manuscript revision&#46; VNC&#58; Study design and set up&#44; Methodology&#44; Discussion and interpretation of the translations within the Scientific Committee&#44; Manuscript revision&#44; Supervision&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Ethical approval and consent to participate</span><p id="par0130" class="elsevierStylePara elsevierViewall">The Ethics Committee of Hospital La Paz was consulted and allowed the development study&#46; The need for approval or informed consent was waived&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Consent for publication</span><p id="par0135" class="elsevierStylePara elsevierViewall">Consent for publication from participants was obtained&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Availability of data and materials</span><p id="par0140" class="elsevierStylePara elsevierViewall">The data underlying this article will be shared on request to the corresponding author with permission of the scientific Committee of the project&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">No funding was received for this work&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Conflict of interests</span><p id="par0150" class="elsevierStylePara elsevierViewall">Diego Benavent has received speaker&#39;s honorarium from Jannsen&#44; Roche&#44; Grant&#47;research support from&#58; Novartis&#46; Dora Pascual-Salcedo has received speaker&#39;s honorarium from Pfizer&#44; Menarini&#44; Takeda&#44; Abvvie&#46;&#44; Grant&#47;research support from&#58; Pfizer&#44; Menarini&#44; Takeda&#44; Abvvie&#46; Chamaida Plasencia-Rodr&#237;guez has received speaker&#39;s honorarium from Pfizer&#44; Abbvie&#44; Lilly&#44; Sandoz&#44; Sanofi&#44; Biogen&#44; Roche and Novartis&#44; Grant&#47;research support from&#58; Pfizer and Abbvie&#46; Sofia Ramiro has received speaker&#39;s honorarium from Eli Lilly&#44; MSD&#44; Novartis&#44; UCB&#44; Consultant of&#58; AbbVie&#44; Eli Lilly&#44; MSD&#44; Novartis&#44; Pfizer&#44; UCB&#44; Sanofi&#44; Grant&#47;research support from&#58; AbbVie&#44; Galapagos&#44; Novartis&#44; Pfizer&#44; UCB&#46; Anneke Spoorenberg has been consultant of AbbVie&#44; Novartis&#44; Pfizer&#59; UCB&#44; Lilly&#44; Grant&#47;research support from&#58; AbbVie&#44; Pfizer&#46; Alejandro Balsa has received speaker&#39;s honorarium from Pfizer&#44; Abbvie&#44; Lilly&#44; Galapagos&#44; BMS&#44; Sandoz&#44; Nordic Pharma&#44; Gebro&#44; Roche&#44; Sanofi&#44; UCB&#44; Consultant of&#58; Pfizer&#44; Abbvie&#44; Lilly&#44; Galapagos&#44; BMS&#44; Nordic Pharma&#44; Sanofi&#44; UCB&#44; Grant&#47;research support from&#58; Pfizer&#44; Abbvie&#44; BMS&#44; Nordic Pharma&#44; Gebro&#44; Roche&#44; UCB&#46; Victoria Navarro-Comp&#225;n has received speaker&#39;s honorarium from AbbVie&#44; Eli Lilly&#44; Janssen&#44; MSD&#44; Novartis&#44; Pfizer&#44; UCB Pharma&#44; Consultant of&#58; AbbVie&#44; Eli Lilly&#44; MSD&#44; Novartis&#44; Pfizer&#44; UCB Pharma&#44; Grant&#47;research support from&#58; AbbVie and Novartis&#46; Andrea Jochems&#44; Gijs Jochems and Suzanne Arends declare that they have no conflict of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2022-04-30"
    "fechaAceptado" => "2022-07-22"
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          "palabras" => array:5 [
            0 => "EspAax"
            1 => "Actividad f&#237;sica"
            2 => "Traducci&#243;n"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">There is a lack of outcome measures for the assessment of physical activity in patients with axial spondyloarthritis &#40;axSpA&#41;&#46; For this matter&#44; the modified Short QUestionnaire to Assess Health &#40;mSQUASH&#41; was developed and validated&#44; originally in Dutch&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To translate and cross-culturally adapt the mSQUASH into Spanish and to evaluate the equivalence of the translated version in patients with axSpA&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The mSQUASH was translated following forward-backward procedure according to the protocol of Beaton&#46; Two bi-lingual translators produced independent forward translations of the mSQUASH into Spanish&#44; and the versions were harmonized in a consensual version&#46; Another translator back translated the synthesized version into Dutch&#46; A scientific committee reached consensus on discrepancies and developed a pre-final version of the questionnaire&#46; The field test with cognitive debriefing involved 10 patients with axSpA with different gender&#44; age&#44; disease duration&#44; educational level and working status&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The translation process of the mSQUASH was completed without major issues&#46; The first translation needed several iterations due to small discrepancies in the wording&#46; Back-translation was performed without difficulties&#44; and the scientific committee agreed upon a final version of the questionnaire&#46; Cognitive debriefing showed the Spanish questionnaire to be clear&#44; relevant&#44; understandable and comprehensive&#46; The preliminary version was accepted with minor modifications&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The resulting Spanish version of the mSQUASH showed good linguistic and face validity according to the field test&#44; revealing potential for use in clinical practice and research&#46; In order to conclude the cross-cultural adaptation of the mSQUASH into Spanish&#44; the next step is the assessment of psychometric properties of the Spanish version&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las medidas de resultado para la evaluaci&#243;n de la actividad f&#237;sica en pacientes con espondiloartritis axial &#40;EspAax&#41; son escasas&#46; Por ello&#44; se desarroll&#243; y valid&#243; el modified Short QUestionnaire to Assess Health &#40;mSQUASH&#41;&#44; originalmente en holand&#233;s&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Desarrollar el proceso de traducci&#243;n y adaptaci&#243;n transcultural del mSQUASH al espa&#241;ol&#44; y evaluar la equivalencia de la versi&#243;n traducida en pacientes con EspAax&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El mSQUASH se tradujo siguiendo el procedimiento adelante-atr&#225;s seg&#250;n el protocolo de Beaton&#46; Dos traductores biling&#252;es realizaron traducciones directas independientes del mSQUASH al espa&#241;ol&#44; y las versiones se armonizaron en una versi&#243;n consensuada&#46; Otro traductor volvi&#243; a traducir la versi&#243;n sintetizada al holand&#233;s&#46; Un comit&#233; cient&#237;fico lleg&#243; a un consenso sobre las discrepancias y elabor&#243; una versi&#243;n pre-final del cuestionario&#46; En las entrevistas cognitivas participaron 10 pacientes con EspAax de diferente sexo&#44; edad&#44; duraci&#243;n de la enfermedad&#44; nivel educativo y situaci&#243;n laboral&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El proceso de traducci&#243;n del mSQUASH se complet&#243; sin problemas mayores&#46; La primera traducci&#243;n necesit&#243; varias iteraciones debido a peque&#241;as discrepancias en la redacci&#243;n&#46; La traducci&#243;n inversa se realiz&#243; sin dificultades y el comit&#233; cient&#237;fico acord&#243; la versi&#243;n final del cuestionario&#46; La evaluaci&#243;n cognitiva demostr&#243; que el cuestionario en espa&#241;ol era claro&#44; pertinente&#44; comprensible y completo&#46; La versi&#243;n preliminar fue aceptada con peque&#241;as modificaciones&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La versi&#243;n espa&#241;ola resultante del mSQUASH mostr&#243; una buena validez ling&#252;&#237;stica y aparente&#44; revelando potencial para su uso en pr&#225;ctica cl&#237;nica e investigaci&#243;n&#46; Para concluir la adaptaci&#243;n transcultural del mSQUASH al espa&#241;ol&#44; el siguiente paso es la evaluaci&#243;n de las propiedades psicom&#233;tricas de la versi&#243;n espa&#241;ola&#46;</p></span>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">axSpA&#58; axial spondyloarthritis&#59; r-axSpA&#58; radiographic axial spondyloarthritis&#59; nr-axSpA&#58; non-radiographic axial spondyloarthritis&#59; y&#58; years&#59; NSAID&#58; Non-steroidal anti-inflammatory drugs&#59; ADA&#58; adalimumab&#59; IFN&#58; infliximab&#59; ETA&#58; etanercept&#59; GOL&#58; golimumab&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#35;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Working&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">University&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">r-axSpA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Student&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Secondary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">r-axSpA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NSAIDs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Working&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">University&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">r-axSpA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ADA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retired&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">University&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">r-axSpA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IFN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Working&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">University&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">r-axSpA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ADA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Working&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">University&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">nr-axSpA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NSAIDs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ASDAS 0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Student&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">University&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">nr-axSpA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ETA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Working&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">University&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">r-axSpA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GOL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Working&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Secondary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">nr-axSpA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4 y&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NSAIDs&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ASDAS 1&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">nr-axSpA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 y&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#46;2&nbsp;\t\t\t\t\t\t\n
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