A systematic review of patient-reported adherence measures in asthma: Which questionnaire is most useful in clinical practice?

Abstract

Suboptimal adherence to inhaled corticosteroid (ICS) in asthma is a worryingly prevalent yet modifiable factor in uncontrolled disease. Several objective measures of adherence exist, but they are time consuming. The use of patient-reported adherence measures (PRAMs) could therefore offer a time-efficient pragmatic approach to adherence assessment in clinical practice and potentially the appropriate interventions to improve it. To identify the PRAMs available for asthma and assess their psychometric quality, accessibility and usefulness in clinical practice. Moreover, to provide recommendations for clinicians based on the aforementioned findings. A systematic review of six databases was conducted. Articles included in this study were: English language full-text original asthma-specific PRAMs or development/validation studies of a generic PRAM that had been administered to adults with asthma; investigated ICS adherence in adults (≥18 years old); and assessed at least one COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) measurement property. 15 PRAM developmental and/or validation studies were included in this systematic review. Studies evaluated a range of COSMIN measurement properties, but none evaluated them all. On the basis of this review, we recommend that if a PRAM is used, that it be the Test of the Adherence to Inhalers (TAI). However, the Adherence Starts with Knowledge-20 (ASK-20), and Adherence Starts with Knowledge-12 (ASK-12) may also be useful. Our results highlight the need for PRAM developers to robustly assess questionnaires and to provide guidance for clinicians on how to act upon PRAM answers by developing materials such as decision support toolkits.