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Validity of the Childhood Asthma Control Test in diverse populations: A systematic review
Francesca Chu1, Nicole Kappel1, Mary Akel1
1Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, Illinois, USA.
Insights
The Childhood Asthma Control Test (C-ACT) demonstrates good internal consistency for assessing pediatric asthma control. However, recommended thresholds for uncontrolled asthma vary and lack consistent validation across diverse populations.
Area of Science:
- Pediatric Pulmonology
- Clinical Psychometrics
- Asthma Management
Background:
- The Childhood Asthma Control Test (C-ACT) is widely used to assess asthma control in children.
- Establishing reliable thresholds for identifying uncontrolled asthma is crucial for effective clinical management.
- Understanding the psychometric properties and validity of the C-ACT across diverse populations is essential.
Approach:
- A systematic literature review was conducted across multiple databases (PubMed, Ovid Medline, SCOPUS, CINAHL) and conference proceedings.
- Included studies focused on children, asthma control as a primary outcome, test validity or psychometrics, and the use of the C-ACT.
- Risk of bias was assessed using the COSMIN Risk of Bias tool, and the review protocol was registered with PROSPERO.
Key Points:
- Twenty-eight studies published between 2007-2018, with an average of 193 participants, were included.
- The C-ACT demonstrated good internal consistency (Cronbach's α mean=0.78).
- Thirteen studies proposed cut-offs for uncontrolled asthma (≤18-≤24), showing mixed agreement with clinical measures and spirometry.
Conclusions:
- The C-ACT exhibits good internal consistency but shows mixed agreement and correlation with other asthma measures.
- Recommended C-ACT cut-offs for uncontrolled asthma lack consistency and do not correlate with nationality, race, ethnicity, or language.
- Further research is needed to validate the C-ACT across under-studied populations and diverse cultural contexts.
Purpose:
We examined the validity of the Childhood Asthma Control Test (C-ACT) and identified recommended thresholds for uncontrolled asthma in children from varying backgrounds.
Methods:
A systematic literature review was performed utilizing PubMed, Ovid Medline, SCOPUS, CINAHL, and conference proceedings. Studies were included if they enrolled children, had a primary outcome of asthma control, examined test validity or psychometrics, and utilized the C-ACT. Along with study design and demographic data, we extracted all outcomes and comparisons used to validate the C-ACT. We evaluated risk of bias using the COSMIN Risk of Bias tool. Our protocol was registered with PROSPERO (CRD42020211119).
Results:
Of 4924 records screened, 28 studies were included. Studies were conducted internationally and published between 2007 and 2018. Average number of enrolled participants was 193 (SD = 155, range = 22-671). Ten studies calculated Cronbach's α (mean [SD] = 0.78(0.05), range = 0.677-0.83). Thirteen studies recommended cut-offs for uncontrolled asthma (≤18-≤24). Nine studies found significant agreement or correlation between C-ACT and Global Initiative for Asthma guidelines/physician assessment of asthma control (correlation coefficients range = 0.219-0.65). Correlation coefficients between C-ACT and spirometry were <0.6 in five of six studies that included spirometry. Kappa values for C-ACT and various spirometry measurements ranged 0.00-0.34.
Conclusions:
The C-ACT showed good internal consistency and mixed levels of agreement and correlation with various clinical asthma measures. Recommended cut-offs for asthma control varied and had no consistent relationship with nationality, race, ethnicity, or language. Few studies examined cross-cultural validity and multiple populations remain under-studied.
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