The minimal clinically important difference of the control of allergic rhinitis and asthma test (CARAT): cross-cultural validation and relation with pollen counts

Sander van der Leeuw, Thys van der Molen, P. N. Richard Dekhuijzen, Joao A. Fonseca, Frederik A. van Gemert, Roy Gerth van Wijk, Janwillem W. H. Kocks, Helma Oosterom, Roland A. Riemersma, Ioanna G. Tsiligianni, Letty A. de Weger, H. N. G. Oude Elberink, Bertine M. J. Flokstra-de Blok*

*Corresponding author for this work

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BACKGROUND: The Control of Allergic Rhinitis and Asthma Test (CARAT) monitors control of asthma and allergic rhinitis.

AIMS: To determine the CARAT's minimal clinically important difference (MCID) and to evaluate the psychometric properties of the Dutch CARAT.

METHODS: CARAT was applied in three measurements at 1-month intervals. Patients diagnosed with asthma and/or rhinitis were approached. MCID was evaluated using Global Rating of Change (GRC) and standard error of measurement (s.e.m.). Cronbach's alpha was used to evaluate internal consistency. Spearman's correlation coefficients were calculated between CARAT, the Asthma Control Questionnaire (ACQ5) and the Visual Analog Scale (VAS) on airway symptoms to determine construct and longitudinal validity. Test-retest reliability was evaluated with intra-class correlation coefficient (ICC). Changes in pollen counts were compared with delta CARAT and ACQ5 scores.

RESULTS: A total of 92 patients were included. The MCID of the CARAT was 3.50 based on GRC scores; the s.e.m. was 2.83. Cronbach's alpha was 0.82. Correlation coefficients between CARAT and ACQ5 and VAS questions ranged from 0.64 to 0.76 (P <0.01). Longitudinally, correlation coefficients between delta CARAT scores and delta ACQ5 and VAS scores ranged from 0.41 to 0.67 (P <0.01). Test-retest reliability showed an ICC of 0.81 (P <0.01) and 0.80 (P <0.01). Correlations with pollen counts were higher for CARAT than for ACQ5.

CONCLUSIONS: This is the first investigation of the MCID of the CARAT. The CARAT uses a whole-point scale, which suggests that the MCID is 4 points. The CARAT is a valid and reliable tool that is also applicable in the Dutch population.

Original languageEnglish
Article number14107
Number of pages6
JournalPrimary Care Respiratory Medicine
Publication statusPublished - 8-Jan-2015


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