Prospective observational study validating the German version of the Control of Allergic Rhinitis and Asthma Test (CARAT10)

Abstract

The Control of Allergic Rhinitis and Asthma Test (CARAT10), developed by Portuguese experts, is the only questionnaire assessing asthma control under additional consideration of a frequently concurrent allergic rhinitis (AR), providing sub-scores for both diseases. Aims of this study were the translation and validation of its German version. Asthma patients both with and without AR were included at three primary care pulmologists´ practices in Southern Germany. After translation process, patients completed the CARAT10, the Asthma Control Questionnaire (ACQ), the Asthma Control Test (ACT), and the Standardised Asthma Quality of Life Questionnaire (AQLQ(S)). Item and scale characteristics as well as measures of reliability and validity of the CARAT10 were determined. A confirmatory factor analysis was conducted to test factorial validity. Data of 213 patients were analysed, 101 (47%) of them with concurrent AR. Missing responses were minimal and unsystematic. Cronbach´s α was 0.87 for the CARAT10 total score (TS) and 0.84 for each sub-score. Spearman´s correlation coefficients for the association of the CARAT10 TS with ACQ, ACT and AQLQ(S) were moderate to high and slightly higher in patients with AR. Higher correlations were found for its lower airway sub-score than the upper airway sub-score (all around 0.8 to all around 0.3). Confirmatory factor analysis confirmed the two-factorial scale structure of the CARAT10, with a two-factor model showing a better fit to the data than a one-factor model. The German version of the CARAT10 is an acceptable, reliable and valid tool. Our results suggest a recommended use in asthma patients with AR.

Turkish language validity and reliability of the Control of Allergic Rhinitis and Asthma Test and its comparison with other scales

“…It is thought that this was due to the shorter time determined for retesting compared with these studies. In the study, the CARAT scale has a with two‐factor structure was in line with previous studies and supports the two‐dimensional structure of the CARAT scale that evaluates the upper and lower airways 22,23 . At the same time, the two‐factor solution was simpler, although the eigenvalue was only just <1.0 and the third factor did account for nearly 10% of the variance.…”

Control of Allergic Rhinitis and Asthma Test: A systematic review of measurement properties and COSMIN analysis

“…Construct (convergent) validity was assessed in 14 studies (published in 20 reports), 18–22,35–46,48–50 but one of them did not report correlation coefficients nor areas under the ROC curve 45 . For CARAT, 12 studies out of 13 studies (92%) showed ‘sufficient’ evidence for construct validity 18–22,35–40,42–44,46,48–50 . Eight studies assessed the construct validity for the CARAT subscales 18–22,35–39,48–50 and ‘sufficient’ evidence for construct validity was found in 6 (75%) studies for the upper airway subscale, 18,20–22,35,38,48–50 and 7 (87.5%) studies for the lower airway subscale 18,20–22,35–38,48–50 …”

“…The original Portuguese version of CARAT was used in 8 studies (11 reports) 17,19,34–39,42,46,47 . There were 2 studies (3 reports) on the Italian, 40,41,45 German and Dutch 18,21,40 versions of CARAT 22,43,44 . The Turkish version was assessed in one study 20 .…”

“…Control of Allergic Rhinitis and Asthma Test displayed good reliability and responsiveness, albeit with some heterogeneity. Regarding cross‐cultural validity, it is important to note that CARAT has been translated, culturally adapted and clinically validated for German, 22,43,44 Dutch 18,21 and Turkish 20 following a protocol which was based on international standards, 12 but no results on measurement invariance were reported, precluding the assessment of cross‐cultural validity. Nevertheless, we found consistent results reported in validation studies of CARAT performed in different countries.…”

“…Control of Allergic Rhinitis and Asthma Test development has been thoroughly documented and has been independently assessed by several studies 18–20 . Moreover, CARAT has been widely used in clinical practice and in scientific research, which led to its prompt translation and cross‐cultural adaptation based on international recommendations and best practices 20–22 . It may be administered on paper during medical visits, but it is also available in digital versions, through a website 23 and mHealth apps for asthma and AR, 24,25 allowing the patient to use it between clinical assessments.…”