The Patient Needs in Asthma Treatment (NEAT) questionnaire: Further evidence on its psychometric properties

Background: Building on previous psychometric work, we sought to assess the Patient Needs in Asthma Treatment (NEAT) questionnaire's validity, responsiveness to change, and the minimal important change (MIC) over a 3-year period (Study 1) and its reliability and the smallest detectable change (SDC) in a test-retest study (Study 2) among patients self-reporting physician-diagnosed asthma. Methods: In Study 1, a total of 207 patients completed a survey which included the NEAT, the Asthma Control Test (ACT), the Asthma Quality of Life QuestionnaireSydney (AQLQ-S), and a question on treatment satisfaction in 2014 and 2017. In Study 2, a total of 78 patients completed NEAT twice on average four weeks apart in 2018. Results: Concurrent validity: In linear regressions, unmet patient needs were crosssectionally associated with poorer asthma control (beta =-0.21; P = 0.01), asthma-related quality of life (QoL) (beta = 0.31; P < 0.01), and treatment satisfaction (beta =-0.59; P < 0.01). Predictive Validity: Higher unmet needs at baseline predicted worse treatment satisfaction at follow-up (beta =-0.28; P < 0.01), but neither asthma control nor asthma-related QoL. Responsiveness to change was demonstrated by linear regressions of changes in the total NEAT score and changes in AQLQ-S (beta = 0.21; P < 0.01) and treatment satisfaction (beta =-0.36; P < 0.01). MIC: Patients whose NEAT score increased between baseline and follow-up by the identified MIC (0.301) reported lower treatment satisfaction at follow-up (beta = -0.17; P = 0.01). Test-retest reliability was demonstrated by correlations between NEAT baseline and follow-up scores (eg, intra-class correlation coefficients for total score = 0.78). The SDC (0.384) was slightly larger than MIC. Conclusion: NEAT is a promising tool for assessing asthma treatment needs.