title: Is the MARS questionnaire a reliable measure of medication adherence in childhood asthma?
abstract: To assess the reliability of the Medication Adherence Report Scale (MARS-5) for assessing adherence in clinical practice and research.
  
  
  
  Prospective cohort study following electronically measured inhaled corticosteroids (ICS) adherence for 1 year in 2-13-year-old children with persistent asthma. The relationship between electronically measured adherence and MARS-5 scores (ranging from 5 to 25) was assessed by Spearman's rank correlation coefficient. A ROC (receiver operating characteristic) curve was performed testing MARS-5 against electronically measured adherence. Sensitivity, specificity, positive and negative likelihood ratios of the closest MARS-5 cut-off values to the top left-hand corner of the ROC curve were calculated.
  
  
  
  High MARS scores were obtained (median 24, interquartile range 22-24). Despite a statistically significant correlation between MARS-5 and electronically assessed adherence (Spearman's rho = 0.47; p < 0.0001), there was considerable variation of adherence rates at every MARS-5 score. The area under the ROC curve was 0.7188. A MARS-5 score ≥23 had the best predictive ability for electronically assessed adherence, but positive and negative likelihood ratios were too small to be useful (1.65 and 0.27, respectively).
  
  
  
  Self-report using MARS-5 is too inaccurate to be a useful measure of adherence in children with asthma, both in clinical practice and in research.
authors.affiliation: a Deparment of General Pediatrics, Arrixaca University Children's Hospital , University of Murcia , Murcia , Spain.|b Princess Amalia Children's Center , Isala Hospital , Zwolle , The Netherlands.
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Garcia-Marcos
authors.affiliation: b Princess Amalia Children's Center , Isala Hospital , Zwolle , The Netherlands.|c UMCG Postgraduate School of Medicine , University Medical Center, University of Groningen , The Netherlands.
authors.forename: Paul L P
authors.initials: PL
authors.lastname: Brand
authors.affiliation: d Unit of Psychology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Adrian A
authors.initials: AA
authors.lastname: Kaptein
authors.affiliation: b Princess Amalia Children's Center , Isala Hospital , Zwolle , The Netherlands.|e Department of Paediatric Pulmonology and Allergology , Wilhelmina Children's Hospital, University Medical Centre Utrecht , The Netherlands.
authors.forename: Ted
authors.initials: T
authors.lastname: Klok
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D000068298:Fluticasone / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011446:Prospective Studies; D057566:Self Report; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D000068298:Fluticasone
keywords: MARS-5; adherence; asthma; children; electronic monitoring; inhaled corticosteroids