Kilminster Shaun G, Dowson Andrew J, Tepper Stewart J, Baos Vicente, Baudet Francis, D'Amico Domenico
Institute of Naval Medicine, Alverstoke, Hampshire, UK.
Headache. 2006 Apr;46(4):553-62. doi: 10.1111/j.1526-4610.2006.00403.x.
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.
To further analyze the Migraine-ACT study database, providing additional information on the reliability, validity, and potential clinical utility of the questionnaire.
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.
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 <or=2 corresponded with a need to consider changing the patient's acute medication. About 40% of the migraine patients in the study scored <or=2 and may have had significant unmet treatment needs.
These data confirm the excellent reliability and validity of the Migraine-ACT questionnaire and provide further evidence for its utility in clinical practice.
4项偏头痛-急性治疗（Migraine-ACT）问卷是一种供初级保健医生使用的评估工具，用于识别需要改变当前急性偏头痛治疗方案的患者。已证明该问卷易于使用，且评估可靠、准确。
进一步分析偏头痛-急性治疗研究数据库，提供有关该问卷的可靠性、有效性及潜在临床实用性的更多信息。
通过记录基线时和1周后记录的偏头痛-急性治疗得分分布来评估可靠性（重测信度）。使用Pearson和Spearman相关性分析对患者总样本以及各个中心的偏头痛-急性治疗得分一致性进行分析。通过比较原始27项问卷各领域内临床相关问题的t鉴别值来评估有效性。还通过构建一份“替代”（B版）偏头痛-急性治疗问卷来评估可靠性和有效性，该问卷源自对原始研究数据中各领域次优项目的分析。使用Pearson成对相关性比较偏头痛-急性治疗得分与由SF-36生活质量问卷、偏头痛残疾评估（MIDAS）问卷和偏头痛治疗评估（MTAQ）问卷分析得出的临床定义标准，以此评估临床实用性。
问卷两次填写之间偏头痛-急性治疗得分的分布在总样本中是一致的（重测信度，r = 0.81），在各个国家之间也是一致的（r = 0.61至0.92）。在本研究中，偏头痛-急性治疗“影响”和“缓解总体评估”问题的有效性（以t鉴别评估）明显高于偏头痛临床研究中使用的其他终点指标。B版偏头痛-急性治疗问卷几乎与原始A版问卷一样可靠和准确。偏头痛-急性治疗得分的分布为：0 = 12.6%，1 = 13.7%，2 = 14.7%，3 = 20.5%，4 = 38.4%。偏头痛-急性治疗得分的变化与SF-36、MIDAS和MTAQ得分的变化相关且呈线性关系，表明偏头痛-急性治疗得分≤2对应于需要考虑改变患者的急性药物治疗。该研究中约40%的偏头痛患者得分≤2，可能存在显著未满足的治疗需求。
这些数据证实了偏头痛-急性治疗问卷具有出色的可靠性和有效性，并为其在临床实践中的实用性提供了进一步证据。
