King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, NGHA, KAIMRC, KSAU-HS, P,O, Box 22490, 11426, Riyadh, Saudi Arabia.
J Headache Pain. 2013 Feb 21;14(1):16. doi: 10.1186/1129-2377-14-16.
To support better headache management in primary care, the Global Campaign against Headache developed an 8-question outcome measure, the Headache Under-Response to Treatment (HURT) questionnaire. HURT was designed by an expert consensus group with patient-input. It assesses the need for and response to treatment, and provides guidance on actions to optimize therapy. It has proven content validity.We aim to evaluate the Arabic version of HURT for clinical utility in primary care in Saudi Arabia.
HURT was translated according to the Global Campaign's translation protocol. We assessed test-retest reliability in consecutive patients of four primary-care centres, who completed HURT at two visits 4-6 weeks apart while receiving usual care. We then provided training in headache management to the GPs practising in these centres, which were randomized in pairs to control (standard care) or intervention (care guided by implementation of HURT). We assessed responsiveness of HURT to clinical change by comparing base-line responses to HURT questions 1-6 with those at follow up. We assessed clinical utility by comparing outcomes between control and intervention pairs after 3 months, using locally-developed 5-point verbal-rating scales: the patient-satisfaction scale (PSS) and doctor-satisfaction scale (DSS).
For test-retest reliability in 40 patients, intra-class correlation coefficients were 0.66-0.78 for questions 1-4 and 0.90-0.93 for questions 5-7 (all P ≤ 0.001). For the dichotomous response to question 8, Kappa coefficient=1 (P<0.0001). Internal consistency was good (Cronbach's alpha=0.74). In 342 patients, HURT signalled clinical improvement over 3 months through statistically significant changes in responses to questions 1-6. PSS scores were higher among those in whom HURT recorded improvement, and also higher among those with less severe headache at baseline. Patients treated with guidance from HURT (n=207) were more satisfied than controls (n=135), but this did not quite reach statistical significance (P=0.06).
The Arabic HURT Questionnaire is reliable and responsive to clinical change in Arabic-speaking headache patients in primary care. HURT showed clinical utility in this first assessment, conducted in parallel with studies elsewhere in other languages, but this needs further study. Other Arabic instruments are not available as standards for comparison.
为了在初级保健中支持更好的头痛管理，全球头痛防治运动开发了一个 8 个问题的结果衡量标准，即头痛治疗反应不足（HURT）问卷。HURT 是由一个专家共识小组和患者输入设计的。它评估了治疗的需求和反应，并就优化治疗的措施提供了指导。它已被证明具有内容有效性。我们旨在评估 HURT 的阿拉伯语版本在沙特阿拉伯初级保健中的临床实用性。
根据全球运动的翻译方案，对 HURT 进行了翻译。我们评估了来自四个初级保健中心的连续患者的测试-重测信度，这些患者在接受常规护理的同时，在 4-6 周的两次就诊中完成了 HURT。然后，我们为在这些中心行医的全科医生提供了头痛管理培训，这些中心被随机配对为对照组（标准护理）或干预组（根据实施 HURT 指导护理）。我们通过比较基线时对 HURT 问题 1-6 的回答与随访时的回答，评估 HURT 对临床变化的反应性。我们使用本地开发的 5 分语言评定量表（患者满意度量表[PSS]和医生满意度量表[DSS]）比较了 3 个月后对照组和干预组之间的临床效果。
在 40 名患者中进行测试-重测可靠性评估，问题 1-4 的组内相关系数为 0.66-0.78，问题 5-7 的组内相关系数为 0.90-0.93（均 P≤0.001）。对于问题 8 的二分响应，Kappa 系数=1（P<0.0001）。内部一致性良好（Cronbach's alpha=0.74）。在 342 名患者中，通过对问题 1-6 的回答的统计学显著变化，HURT 表明在 3 个月内临床情况有所改善。在 HURT 记录有改善的患者中，PSS 评分较高，基线时头痛程度较轻的患者中 PSS 评分也较高。接受 HURT 指导治疗的患者（n=207）比对照组（n=135）更满意，但这并未达到统计学意义（P=0.06）。
阿拉伯语 HURT 问卷在初级保健中的阿拉伯语头痛患者中具有可靠性和对临床变化的反应性。HURT 在这项首次评估中显示了临床实用性，该评估与其他语言的其他地方的研究同时进行，但需要进一步研究。没有其他阿拉伯语工具可以作为比较的标准。
