Lipton Richard B, Buse Dawn C, Adams Aubrey Manack, Varon Sepideh F, Fanning Kristina M, Reed Michael L
Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
Montefiore Medical Center, Bronx, NY, USA.
Headache. 2017 Apr;57(4):570-585. doi: 10.1111/head.13028. Epub 2017 Feb 10.
To describe the development of the Impact of Migraine on Partners and Adolescent Children (IMPAC) scale.
Although existing data and clinical experience suggest that the impact of migraine is pervasive and extends beyond the individual with migraine, no validated tools exist for assessing the impact of migraine on the family.
The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study is a longitudinal study of people with migraine in the United States. The Family Burden Module (FBM) of the CaMEO Study contained an item pool of 53 questions derived through literature review, clinician input, and patient focus groups pertaining to the following concepts: impact of migraine on family interpersonal relationships, activities, well-being, finances, and health-related quality of life. Respondents with migraine (ie, probands) were categorized into 4 groups based on household composition: migraine probands with partners/spouses and children (M-PC), migraine probands with partners/spouses only (M-P), migraine probands with child(ren) only (M-C), and migraine probands without a partner/spouse or child(ren) (M-O). The IMPAC scale was developed in 3 steps: (1) exploratory factor analysis and item reduction, (2) bifactor analysis, confirmatory factor analysis, and scoring, and (3) reliability and construct validity analyses.
The analysis of data from 13,064 respondents to the FBM meeting criteria for migraine yielded a 12-item IMPAC scale, with 4 items applying to all of the groups, 4 more items applying to the groups with partners (M-P and M-PC), and 4 additional items to the groups with children (M-C and M-PC). Item responses can be summed and converted into a scoring system assessing mild (<0.5 SD below mean; IMPAC scale Grade I), moderate (0.5 SD below to <0.5 SD above mean; Grade II), severe (0.5-<1.5 SD above mean; Grade III), and very severe (≥0.5 SD above mean; Grade IV) family impact. Test information curves relating to the IMPAC scale for each household type indicated adequate reliability across a large range of family burden severity (from ∼1 SD below to ∼3 SD above mean) and IMPAC scores showed moderate-to-large correlations with other validated tools (range, ± 0.38-0.52), providing support for construct validity.
We developed a questionnaire to assess family burden attributed to migraine that is brief, robust, and psychometrically sound, with a simple scoring algorithm that can be applied to various household compositions. This questionnaire may be valuable in research settings to provide quantifiable data on the impact of migraine on family dynamics and in clinical settings to facilitate conversations about family burden as a target and a motivation for better treatment.
描述偏头痛对伴侣及青少年子女的影响（IMPAC）量表的开发过程。
尽管现有数据和临床经验表明偏头痛的影响广泛，且不仅限于偏头痛患者本人，但目前尚无经过验证的工具来评估偏头痛对家庭的影响。
慢性偏头痛流行病学与结局（CaMEO）研究是一项针对美国偏头痛患者的纵向研究。CaMEO研究的家庭负担模块（FBM）包含一个由53个问题组成的项目池，这些问题通过文献综述、临床医生意见以及患者焦点小组得出，涉及以下概念：偏头痛对家庭人际关系、活动、幸福感、财务状况以及健康相关生活质量的影响。患有偏头痛的受访者（即先证者）根据家庭构成分为4组：有伴侣/配偶和子女的偏头痛先证者（M-PC）、仅有伴侣/配偶的偏头痛先证者（M-P）、仅有子女的偏头痛先证者（M-C）以及没有伴侣/配偶或子女的偏头痛先证者（M-O）。IMPAC量表分三步开发：（1）探索性因素分析和项目缩减；（2）双因素分析、验证性因素分析及评分；（3）信度和结构效度分析。
对13,064名符合偏头痛标准的FBM受访者的数据进行分析，得出了一个包含12个项目的IMPAC量表，其中4个项目适用于所有组，另外4个项目适用于有伴侣的组（M-P和M-PC），还有4个项目适用于有子女的组（M-C和M-PC）。项目回答可以相加并转换为一个评分系统，用于评估轻度（低于均值0.5个标准差以下；IMPAC量表I级）、中度（低于均值0.5个标准差至高于均值0.5个标准差以下；II级）、重度（高于均值0.5至低于1.5个标准差；III级）和极重度（高于均值0.5个标准差及以上；IV级）的家庭影响。与每种家庭类型的IMPAC量表相关的测试信息曲线表明，在很大范围的家庭负担严重程度（从低于均值约1个标准差到高于均值约3个标准差）内都具有足够的信度，并且IMPAC分数与其他经过验证的工具显示出中度到高度的相关性（范围为±0.38 - 0.52），为结构效度提供了支持。
我们开发了一份问卷来评估偏头痛所致的家庭负担，该问卷简短、可靠且心理测量学性质良好，具有一种可应用于各种家庭构成的简单评分算法。这份问卷在研究环境中可能很有价值，可提供关于偏头痛对家庭动态影响的量化数据，在临床环境中有助于促进关于家庭负担的讨论，将其作为更好治疗的目标和动力。
