The short health scale for eosinophilic oesophagitis: validation and clinical applicability in 159 Danish patients

Standardised instruments are needed to assess subjective health in eosinophilic oesophagitis (EoE). This study aimed to validate the Short Health Scale (SHS) for adults with EoE by comparing it to the validated Eosinophilic Esophagitis Activity Index (EEsAI), Adult Eosinophilic Esophagitis Quality of Life Questionnaire (EoE-QOL-A) and Hospital Anxiety and Depression Scale (HADS).

Validity and reliability were evaluated. Known-group validity (n = 159) was tested by comparing SHS-EoE scores across EEsAI-defined disease activity groups (mild <20, moderate 21-40, severe >40) using permutation test and non-parametric bootstrapped pairwise comparisons. Concurrent validity was evaluated using Spearman correlations with conceptually related domains. Test-retest reliability was assessed in stable patients (n = 50) using the Bland-Altman analysis, Spearman correlation and the interclass correlation coefficient (ICC).

Among 159 patients completing all questionnaires, SHS-EoE total scores increased significantly with higher EEsAI-defined disease activity (permutation test p < 0.0001), with pairwise differences of 31.6 (moderate vs. mild; 95% CI 7.7-55.5, p = 0.0095), 121.5 (severe vs. mild; 95% CI 96.1-146.3, p < 0.0001), and 89.9 (severe vs. moderate; 95% CI 63.2-116.6, p < 0.0001), confirming known-group validity. SHS-EoE items correlated as expected with EEsAI, EoE-QOL-A and HADS, confirming concurrent validity. In stable patients, test-retest reliability was good for total scores (Spearman ρ = 0.75, ICC = 0.84), with item-level ρ = 0.64-0.70 (three of four ICC > 0.6) and no significant median differences.

The study demonstrated that the SHS-EoE is suitable for assessing subjective health in patient with EoE, although responsiveness to change requires further evaluation. Its short completion time makes it a practical tool for routine collection of patient-reported outcomes.