Reliability, Validity, and Clinical Utility of the Migraine-ACT
Reliability, Validity, and Clinical Utility of the Migraine-ACT
Background: The 4-item Migraine-ACT questionnaire is an assessment tool for use by primary care physicians to identify patients who require a change in their current acute migraine treatment. It has been shown to be easy to use, and to be reliable and accurate in its assessments.
Objectives: To further analyze the Migraine-ACT study database, providing additional information on the reliability, validity, and potential clinical utility of the questionnaire.
Methods: Reliability was assessed by recording the distribution of Migraine-ACT scores recorded at baseline and 1 week later (test–retest reliability). Analyses of consistency of Migraine-ACT scores were conducted on the total sample of patients and for the separate centers, using Pearson and Spearman correlations. Validity was assessed by comparing the t-discrimination values for clinically relevant questions within domains of the original 27-item questionnaire. Reliability and validity were also assessed by constructing an "alternative" (Form B) Migraine-ACT questionnaire, derived from an analysis of the second-best items in each domain in the original study data. Clinical utility was assessed using Pearson pairwise correlations to compare Migraine-ACT scores with clinically defined criteria as analyzed by the SF-36 Quality of Life questionnaire, the Migraine Disability Assessment (MIDAS) questionnaire, and the Migraine Therapy Assessment (MTAQ) questionnaire.
Results: The distribution of Migraine-ACT scores between the 2 completions of the questionnaire was consistent for the total sample (test–retest reliability, r = .81) and between the individual countries (r = .61 to .92). In this study, the validity (assessed as t-discrimination) of the Migraine-ACT "impact" and "global assessment of relief" questions were markedly higher than those of other endpoints used in migraine clinical studies. The Form B Migraine-ACT questionnaire was almost as reliable and accurate as the original Form A questionnaire. The distribution of Migraine-ACT scores was: 0 = 12.6%, 1 = 13.7%, 2 = 14.7%, 3 = 20.5%, and 4 = 38.4%. The change in Migraine-ACT score correlated with, and had a linear relationship with changes in SF-36, MIDAS, and MTAQ scores, and indicated that a Migraine-ACT score of ≤2 corresponded with a need to consider changing the patient's acute medication. About 40% of the migraine patients in the study scored ≤2 and may have had significant unmet treatment needs.
Conclusions: These data confirm the excellent reliability and validity of the Migraine-ACT questionnaire and provide further evidence for its utility in clinical practice.
Migraine has historically been relatively poorly managed in primary care. Population-based studies demonstrated that under-consultation by patients, and under-diagnosis and under-treatment by physicians were the norm a decade ago. It is disappointing, therefore, to see the same pattern still prevalent today, despite the large investment in developing and marketing new therapies over the past decade. Recent studies have demonstrated that only about 50% of those with migraine discuss their migraines with a physician, diagnosis rates remain low in the clinic, and patients still tend to rely on over-the-counter medications.
Despite the availability of effective acute treatments for migraine (eg, the triptans), those with migraine are unlikely to benefit from treatment if they are unable to interact with their physician. Questionnaires have been developed to aid in assessing migraine diagnosis and its impact on migraine patients' everyday activities. However, some have not been used in clinical practice and others have proved to be too complicated to use without supervision. What is required is a simple to use tool for evaluating patients' medications and deciding whether or not current treatments should be changed.
We have developed a 4-item questionnaire, the Migraine Assessment of Current Therapy (Migraine-ACT) questionnaire ( Table 1 ) as a means to identify patients attending primary care clinics who require a change in their current acute migraine treatment. Four clinically important domains of the migraine experience were assessed: consistency of response, global assessment of relief, headache impact, and emotional response. We conducted a multicenter, international study with Migraine-ACT and demonstrated that it was easy to use, and was reliable and accurate in its assessments and suitable for use by the primary care physician. Scoring the questionnaire is by simple summing of the "yes" scores (range: 0 to 4). This article describes further analyses of the Migraine-ACT study database, providing additional information on the reliability, validity, and clinical utility of the questionnaire.
Background: The 4-item Migraine-ACT questionnaire is an assessment tool for use by primary care physicians to identify patients who require a change in their current acute migraine treatment. It has been shown to be easy to use, and to be reliable and accurate in its assessments.
Objectives: To further analyze the Migraine-ACT study database, providing additional information on the reliability, validity, and potential clinical utility of the questionnaire.
Methods: Reliability was assessed by recording the distribution of Migraine-ACT scores recorded at baseline and 1 week later (test–retest reliability). Analyses of consistency of Migraine-ACT scores were conducted on the total sample of patients and for the separate centers, using Pearson and Spearman correlations. Validity was assessed by comparing the t-discrimination values for clinically relevant questions within domains of the original 27-item questionnaire. Reliability and validity were also assessed by constructing an "alternative" (Form B) Migraine-ACT questionnaire, derived from an analysis of the second-best items in each domain in the original study data. Clinical utility was assessed using Pearson pairwise correlations to compare Migraine-ACT scores with clinically defined criteria as analyzed by the SF-36 Quality of Life questionnaire, the Migraine Disability Assessment (MIDAS) questionnaire, and the Migraine Therapy Assessment (MTAQ) questionnaire.
Results: The distribution of Migraine-ACT scores between the 2 completions of the questionnaire was consistent for the total sample (test–retest reliability, r = .81) and between the individual countries (r = .61 to .92). In this study, the validity (assessed as t-discrimination) of the Migraine-ACT "impact" and "global assessment of relief" questions were markedly higher than those of other endpoints used in migraine clinical studies. The Form B Migraine-ACT questionnaire was almost as reliable and accurate as the original Form A questionnaire. The distribution of Migraine-ACT scores was: 0 = 12.6%, 1 = 13.7%, 2 = 14.7%, 3 = 20.5%, and 4 = 38.4%. The change in Migraine-ACT score correlated with, and had a linear relationship with changes in SF-36, MIDAS, and MTAQ scores, and indicated that a Migraine-ACT score of ≤2 corresponded with a need to consider changing the patient's acute medication. About 40% of the migraine patients in the study scored ≤2 and may have had significant unmet treatment needs.
Conclusions: These data confirm the excellent reliability and validity of the Migraine-ACT questionnaire and provide further evidence for its utility in clinical practice.
Migraine has historically been relatively poorly managed in primary care. Population-based studies demonstrated that under-consultation by patients, and under-diagnosis and under-treatment by physicians were the norm a decade ago. It is disappointing, therefore, to see the same pattern still prevalent today, despite the large investment in developing and marketing new therapies over the past decade. Recent studies have demonstrated that only about 50% of those with migraine discuss their migraines with a physician, diagnosis rates remain low in the clinic, and patients still tend to rely on over-the-counter medications.
Despite the availability of effective acute treatments for migraine (eg, the triptans), those with migraine are unlikely to benefit from treatment if they are unable to interact with their physician. Questionnaires have been developed to aid in assessing migraine diagnosis and its impact on migraine patients' everyday activities. However, some have not been used in clinical practice and others have proved to be too complicated to use without supervision. What is required is a simple to use tool for evaluating patients' medications and deciding whether or not current treatments should be changed.
We have developed a 4-item questionnaire, the Migraine Assessment of Current Therapy (Migraine-ACT) questionnaire ( Table 1 ) as a means to identify patients attending primary care clinics who require a change in their current acute migraine treatment. Four clinically important domains of the migraine experience were assessed: consistency of response, global assessment of relief, headache impact, and emotional response. We conducted a multicenter, international study with Migraine-ACT and demonstrated that it was easy to use, and was reliable and accurate in its assessments and suitable for use by the primary care physician. Scoring the questionnaire is by simple summing of the "yes" scores (range: 0 to 4). This article describes further analyses of the Migraine-ACT study database, providing additional information on the reliability, validity, and clinical utility of the questionnaire.
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