title: Caregiver's functional status during a young child's asthma exacerbation: A validated instrument.
abstract: BACKGROUND
  Few instruments exist to measure caregivers' functional status during a young child's asthma exacerbation.
  
  
  OBJECTIVE
  We sought to develop and validate a measure of caregivers' functional status during a preschooler's asthma exacerbation.
  
  
  METHODS
  The psychometric properties of the 21-item questionnaire Effects of a Young Child's Asthma Flare-up on the Parents (ECAP) were tested in a randomized placebo-controlled trial of pre-emptive high-dose fluticasone in preschoolers with virus-induced asthma. Caregivers completed the ECAP questionnaire on the last day their child exhibited symptoms of an upper respiratory tract infection or asthma exacerbation (episode). The mean of each item, scored on a scale of 1 (best) to 7 (worst), provided the ECAP score.
  
  
  RESULTS
  Ninety-three preschoolers (2.5 ± 1.0 years old; 62.4% male) experienced 878 episodes. Feasibility (80% questionnaire return rate; 90% completion) and internal consistency (Cronbach α = 0.97) were high. Of 628 episodes with a completed ECAP questionnaire, 621 (98.9%) had data on exacerbations, and 609 (97.0%) had data on health care use. The ECAP score was significantly higher for children experiencing an asthma exacerbation versus those who were not (mean difference, 0.8; 95% CI, 0.6-1.0) and for episodes resulting versus not resulting in an emergency visit (mean difference, 1.2; 95% CI, 1.0-1.4), systemic corticosteroid use (mean difference, 1.4; 95% CI, 1.1-1.7), or hospitalization (mean difference, 1.9; 95% CI, 1.4-2.5). The ECAP score was significantly lower in children treated with fluticasone versus those treated with placebo (mean difference, -0.7; 95% CI, -1.1 to -0.3).
  
  
  CONCLUSIONS
  The 21-item ECAP questionnaire, showing high feasibility, internal consistency, discriminative validity, and responsiveness, has the psychometric properties to serve as a validated outcome to measure the burden of preschoolers' asthma exacerbations on their caregivers' functional status.
authors.affiliation: Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Jensen
authors.affiliation: Department of Psychology, McGill University, Montreal, Quebec, Canada.
authors.forename: Morton J
authors.initials: MJ
authors.lastname: Mendelson
authors.affiliation: Unité de recherche clinique appliquée, Research Center, Sainte-Justine University Health Centre, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Eve
authors.initials: E
authors.lastname: Desplats
authors.affiliation: Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Xun
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, Montreal, Quebec, Canada; Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Platt
authors.affiliation: Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Université de Montréal, Montreal, Quebec, Canada; Departments of Pediatrics and Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada. Electronic address: francine.m.ducharme@umontreal.ca.
authors.forename: Francine M
authors.initials: FM
authors.lastname: Ducharme
mesh_terms: D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology*; D017028:Caregivers; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011594:Psychometrics; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Asthma; caregivers; discrimination; preschool child; quality of life; questionnaire design; randomized controlled trial; reliability; validity