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Control of Allergic Rhinitis and Asthma Test (CARAT) can be used to assess individual patients over time

Joao A Fonseca1234*, Luis Nogueira-Silva15, Mario Morais-Almeida67, Ana Sa-Sousa1, Luis F Azevedo12, Jose Ferreira8, Manuel Branco-Ferreira9, Rodrigo Rodrigues-Alves10, Antonio Bugalho-Almeida7 and Jean Bousquet11

Author Affiliations

1 Faculdade de Medicina da Universidade do Porto, Health Information and Decision Sciences Department, Porto, Portugal

2 CINTESIS – Center for Research in Health Technologies and Information Systems, Porto, Portugal

3 Centro Hospitalar S. João, EPE, Allergy and Clinical Immunology Division, Porto, Portugal

4 Hospital and Institute CUF, Allergy Unit, Porto, Portugal

5 Centro Hospitalar S. João, EPE, Internal Medicine Department, Porto, Portugal

6 Hospital CUF-Descobertas, Allergy and Clinical Immunology Division Unit, Lisboa, Portugal

7 Faculdade de Medicina da Universidade de Lisboa, Clínica Universitária de Pneumologia, Lisboa, Portugal

8 Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Allergy and Clinical Immunology Division, VN Gaia, Portugal

9 Centro Hospitalar Lisboa Norte, EPE, Division of Immunoallergology, Lisboa, Portugal

10 Hospital do Divino Espírito Santo, EPE, Immunoallergology Division, Ponta Delgada, Portugal

11 Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire, Montpellier, France

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Clinical and Translational Allergy 2012, 2:16  doi:10.1186/2045-7022-2-16

Published: 30 August 2012

Abstract

Background

The Control of Allergic Rhinitis and Asthma Test (CARAT10) has been proposed as the first tool to implement the Allergic Rhinitis and its Impact on Asthma initiative guidelines in clinical practice. To serve this purpose, it must have adequate properties to assess the control of an individual over time. This study aimed to prospectively assess the test-retest reliability, responsiveness and longitudinal validity of CARAT10.

Methods

Adults with asthma and allergic rhinitis were enrolled at 4 outpatient clinics of Portuguese central hospitals. At each of the two visits, 4 to 6 weeks apart, patients filled out CARAT10 and additional questionnaires, followed by a medical evaluation blinded to the questionnaires’ answers.

Results

From the 62 patients included, 51 patients completely filled out CARAT10 at both visits. The test-retest reliability, computed as an intra-class correlation coefficient, was 0.82. Regarding responsiveness, a significant change (p = 0.002) of CARAT10 score in clinically unstable patients was observed (95%CI -5.08; -1.31) and the Guyatt’s responsiveness index was 1.54. As for the longitudinal validity assessment, the correlation coefficients of the changes of CARAT10 scores with those of ACQ5 and symptoms VAS ranged from 0.49 to 0.65, while with the physician assessment of control they ranged from 0.31 to 0.41.

Conclusion

CARAT10 has good test-retest reliability, responsiveness and longitudinal validity. It can be used to assess control of allergic rhinitis and asthma, both to compare groups in clinical studies and to evaluate individual patients in clinical practice.

Keywords:
Asthma; Allergic rhinitis; Control; Questionnaire