Abstract
BackgroundCase-finding tools, such as the Identify Chronic Migraine (ID-CM) questionnaire, can improve detection of CM and alleviate its significant societal burden. We aimed to develop and validate the Italian version of the ID-CM (ID-EC) in paper and as a smart app version in a headache clinic-based setting.MethodsThe study investigators translated and adapted to the Italian language the original ID-CM questionnaire (ID-EC) and further implemented it as a smart app. The ID-EC was tested in its paper and electronic version in consecutive patients referring to 9 Italian tertiary headache centers for their first in-person visit. The scoring algorithm of the ID-EC paper version was applied by the study investigators (case-finding) and by patients (self-diagnosis), while the smart app provided to patients automatically the diagnosis. Diagnostic accuracy of the ID-EC was assessed by matching the questionnaire results with the interview-based diagnoses performed by the headache specialists during the visit according to the criteria of International Classification of Headache Disorders, III edition, beta version.ResultsWe enrolled 531 patients in the test of the paper version of ID-EC and 427 in the validation study of the smart app. According to the clinical diagnosis 209 patients had CM in the paper version study and 202 had CM in the smart app study. 79.5% of patients returned valid paper questionnaires, while 100% of patients returned valid and complete smart app questionnaires. The paper questionnaire had a 81.5% sensitivity and a 81.1% specificity for case-finding and a 30.7% sensitivity and 90.7% specificity for self-diagnosis, while the smart app had a 64.9% sensitivity and 90.2% specificity.ConclusionsOur data suggest that the ID-EC, developed and validated in tertiary headache centers, is a valid case-finding tool for CM, with sensitivity and specificity values above 80% in paper form, while the ID-EC smart app is more useful to exclude CM diagnosis in case of a negative result. Further studies are warranted to assess the diagnostic accuracy of the ID-EC in general practice and population-based settings.
Highlights
Chronic migraine (CM) has an estimated prevalence of 2–3% in the general population [1, 2] and is associated with low health-related quality of life, significant loss of productive time and utilization of healthcare resources [3, 4], and a high prevalence of medication overuse [5]
The present study aimed to develop and validate an Italian version of the Identify Chronic Migraine (ID-CM), the IDentificatore di Emicrania Cronica (ID-EC; in English, ‘CM identifier’), in a paper form and in an electronic version as a ‘smart app’ in a nationwide, tertiary headache clinic-based setting
The different diagnostic accuracy of the paper questionnaire compared with the smart app might be attributed to the different composition of the study populations, as the paper questionnaire validation study population had a higher prevalence of CM and a lower proportion of patients without previous headache referral or treatment compared with the smart app study population
Summary
Chronic migraine (CM) has an estimated prevalence of 2–3% in the general population [1, 2] and is associated with low health-related quality of life, significant loss of productive time and utilization of healthcare resources [3, 4], and a high prevalence of medication overuse [5]. Case-finding tools might improve the detection of CM, which remains underdiagnosed and undertreated worldwide despite its substantial burden [6]. Among those tools, the self-administered Identify Chronic Migraine (ID-CM) showed good diagnostic accuracy in a Web-based sample from a research panel [7]. The present study aimed to develop and validate an Italian version of the ID-CM, the IDentificatore di Emicrania Cronica (ID-EC; in English, ‘CM identifier’), in a paper form and in an electronic version as a ‘smart app’ in a nationwide, tertiary headache clinic-based setting. We aimed to develop and validate the Italian version of the ID-CM (ID-EC) in paper and as a smart app version in a headache clinic-based setting
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