Validity and reliability of Adolescent Headache Attributed Restriction, Disability Social Handicap and Impaired Participation (Adolescent HARDSHIP) Questionnaire -Sinhala

Abstract

Background Global burden of headache among adolescents is high. Adolescent Headache Attributed Restriction, Disability Social Handicap and Impaired Participation (Adolescent HARDSHIP) Questionnaire screen for headaches in terms of prevalence and diagnosis of migraine, Tension Type Headache (TTH) according to ICHD-II criteria. It also measures impact by headache attributed restriction, disability, social handicap and impaired participation while last section measuring quality of life (QoL). The purpose of this study was to culturally adapt, translate adolescent HARDSHIP questionnaire into Sinhala language and to assess the validity of (Adolescent HARDSHIP) Questionnaire -Sinhala Methods The adolescent HARDSHIP questionnaire was culturally adapted to suit the Sri Lankan setting using the modified Delphi technique and was translated using the methods prescribed by the Global Campaign to Lifting the Burden. A cross sectional study was carried out among adolescents aged 13 – 15 years (n= 349) to assess criterion validity against a neurologist to diagnose each type of headache. Its ability to detect quality of life was evaluated using concurrent validity against Peds QL and construct validity of impact of headache and quality of life was assessed against headache severity. Test-retest reliability and acceptability were also assessed. Results Sensitivity of Adolescent HARDSHIP questionnaire-Sinhala to detect migraine and TTH were 84.2% (95% CI: 74.4- 91.3) and 76% (95% CI: 64.8 -85.1), respectively while specificity to detect migraine and TTH were 88.1% (95% CI: 83.5 -91.8) and 91.4% (95% CI: 87.4 -94.5), respectively. Mean scores for impact of headache and quality of life (QoL) were increasing with the headache severity and were statistically significant with F (2,174) = 6.78, p<0.0001 and F(2,174)= 5.198, p=0.002 respectively. Quality of life score and PedsQL score showed Pearson correlation coefficient of -0.433 (p<0.001) with increasing headache severity. The Cohen kappa values for test re-test reliability to detect life time, last year and last month headache was 0.75, 0.78 and 0.85, respectively. Conclusion Adolescent HARDSHIP questionnaire-Sinhala was found to be a valid, reliable and an acceptable instrument to screen adolescents aged 13 to 15 years of age in Sri Lankan settings for headache and to assess their quality of life associated with headache.

Keywords

• headache, adolescent, sinhala, adolescent hardship questionnaire, validation