Validation of the Chinese version of joint protection self-efficacy scale in patients with rheumatoid arthritis

  • Wen H. Zhao
  • Li X. Zhang
  • Chan X. Liu
  • Karin Niedermann
  • Han Z. Yang
  • Wen LuoEmail author
Original Article



To develop and validate the Chinese version of the Joint Protection Self-Efficacy Scale (CJP-SES) in patients with rheumatoid arthritis (RA) in China.


(1) Translation of the original German/English version JP-SES and cultural adaptation into the Chinese language; (2)Validation of the CJP-SES with the Chinese versions of the Arthritis Self-Efficacy Scale-8 (ASES-8), the Laffrey Health Conception Scale (LHCS), 10-item Perceived Efficacy in Patient-Physician Interactions Scale (PEPPI-10), Disease Activity Score-28 (DAS-28) and Health Assessment Questionnaire (HAQ). Instrument measurement included reliability testing, item generation, construct validity, test–retest reliability, and correlation with other measurements. Confirmatory factor analysis was applied to determine construct validity and internal consistency. One hundred fifteen patients with RA were investigated.


Finally, 105 RA patients were included in the analysis. Confirmatory factor analysis demonstrated fit for a unidimensional model of the JP-SES. Additionally, the scale showed internal consistency (Cronbach’s α coefficient 0.922), kappa coefficient (0.653), and test–retest reliability (ICC = 0.94). Weak correlations with other scores for the other instruments, such as the Chinese version of ASES-8 (0.263) and PEPPI-10 (0.326). Correlation with duration (0.274), moderate correlation with BMI (− 0.438) and DAS-28 (− 0.493), and strong correlation with HAQ (− 0.644) were found in this research.


This is the first study to adapt and validate the JP-SES into Chinese for use in patients with RA. Our research showing that the CJP-SES has a good construct validity, internal consistency, and test–retest reliability. This scale can help doctors and nurses to assess the self-efficacy of patients with RA.

Trial registration Identifier: TJYY-YLS-036


Joint protection Rheumatoid arthritis Self-efficacy Validation 



Rheumatoid arthritis


Chinese Joint Protection Self-Efficacy Scale


Arthritis Self-Efficacy Scale-8


Laffrey Health Conception Scale


Perceived Efficacy in Patient-Physician Interactions Scale


Disease Activity Score-28


Health Assessment Questionnaire



I would like to express my gratitude to all those who helped me during the writing of this thesis. I gratefully acknowledge the help of nursing professor in Tianjin University of Traditional Chinese Medicine, Ms. Xie Fei, who has offered valuable suggestions in the academic studies. I also owe a special debt of gratitude to all the doctors and nurses in Joint Surgery Department, from whose devoted teaching and enlightening lectures I have benefited a lot and academically prepared for the thesis.

Availability of data and material

No additional data are available.

Authors’ contribution

Huiwen Zhao has received research approval from Tianjin Hospital. Wen Luo has received the authorization of using the JP-SES in Chinese/China from Karin Niedermann. Wen Luo, Xiuli Zhang and Xiuli Liu translated the JP-SES into Chinese; Wen Luo and Karin Niedermann and revised the back-translated scale. Xiuli Zhang, Xiuchan Liu and Zihan Yang performed data collection from participants and data analysis.

Wen H Zhao1 and Li X Zhang wrote the manuscript under the supervision of Wen Luo and advised by Karin Niedermann.

Compliance with ethical standards



Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent for publication

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt, and build upon this work, for commercial use, provided the original work is properly cited. See

Supplementary material

10067_2019_4510_MOESM1_ESM.pdf (299 kb)
ESM 1 (PDF 299 kb)


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • Wen H. Zhao
    • 1
  • Li X. Zhang
    • 2
  • Chan X. Liu
    • 3
  • Karin Niedermann
    • 4
  • Han Z. Yang
    • 5
  • Wen Luo
    • 1
    Email author
  1. 1.Joint Department, The 2nd Ward of Joint SurgeryTianjin HospitalTianjinPeople’s Republic of China
  2. 2.Joint Department, The 1st Ward of Joint SurgeryTianjin HospitalTianjinChina
  3. 3.Department of rheumatologyTianjin HospitalTianjinChina
  4. 4.Institut of Physiotherapy, School of Health ProfessionsZurich University of Applied Sciences ZHAWWinterthurSwitzerland
  5. 5.College of NursingTianjin University of Traditional Chinese MedicineTianjinChina

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