The Short-Form Chronic Respiratory Disease Questionnaire was a Valid, Reliable, and Responsive Quality-of-Life Instrument in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

COVID-19 infodemic and health-related quality of life in patients with chronic respiratory diseases: A multicentre, observational study

Background

The explosion of information, misinformation and disinformation (the "infodemic") related to the coronavirus disease 2019 (COVID-19) pandemic on digital and social media is reported to affect mental health and quality of life. However, reports assessing the COVID-19 infodemic on health-related quality of life (HRQL) in patients with chronic diseases are scarce. In this study, we investigated the associations between the infodemic and HRQL in uninfected individuals with pre-existing chronic respiratory diseases (CRDs) such as asthma, chronic obstructive pulmonary disease (COPD) and other CRDs.

Methods

We conducted a multi-national, cross-sectional, observational study in Canada, India, New Zealand and the United Kingdom where we distributed a set of digitised questionnaires among 1018 participants with chronic respiratory diseases who were not infected with the SARS-CoV-2 virus at least three months prior to the study. We collected information about the infodemic such as news watching or social media use more than usual during the pandemic. HRQL was assessed using the short form of the chronic respiratory questionnaire (SF-CRQ). Demographic information, comorbidities, compliance, mental health, behavioural function, and social support were also recorded. We analysed the direct and indirect relationships between infodemic and HRQL using structural equation models (SEM).

Results

Of all participants, 54% were females and had a mean (standard deviation (SD)) age of 53 (17) years. We found that higher infodemic was associated with worse emotional function (regression coefficient β = -0.08; 95% confidence interval (CI) = -0.14 to -0.01), which means a one SD change of the higher infodemic latent variable was associated with a 0.08 SD change of emotional function level. The association between higher infodemic and worse emotional function was mediated by worse mental health and behavioural functions but is marginally ameliorated by improved social support. In stratification analysis, we found significant disease and country-wise variations in the associations between infodemic and SF-CRQ domain scores.

Conclusions

These results provide new evidence that the COVID-19 infodemic significantly influences the HRQL in patients with CRDs through a complex interplay between mental health, behavioural function, and social support. This new dimension of research also opens avenues for further research on infodemic-related health effects in other chronic diseases.

Less Social Deprivation Is Associated With Better Health-Related Quality of Life in Asthma and Is Mediated by Less Anxiety and Better Sleep Quality

BACKGROUND

Previous studies on health-related quality of life (HRQoL) in asthma have mainly focused on clinical and environmental determinants. Little is known about the role of social determinants on HRQoL in asthma.

OBJECTIVES

We aimed to investigate the association between social deprivation and HRQoL in asthma.

METHODS

A total of 691 adult asthmatics from Canada, India, New Zealand, and the United Kingdom were administered a digital questionnaire containing demographic information and questions about social and psychological attributes, sleep disturbances, and alcohol abuse. HRQoL was measured using the Short Form of the Chronic Respiratory Questionnaire (SF-CRQ). We analyzed the direct and indirect relationships between social deprivation and HRQoL using structural equation models with social deprivation as a latent variable. We tested for mediation via anxiety, depression, sleep disturbances, and alcohol abuse.

RESULTS

We found that less social deprivation (latent variable) was directly associated with better SF-CRQ domain scores such as dyspnea (regression coefficient β: 0.33; 95% confidence interval [CI]: 0.07 to 0.58), fatigue (β: 0.39; 95% CI: 0.14 to 0.64), and emotional function (β: 0.37; 95% CI: 0.11 to 0.62), but with the worse mastery score (β: -0.29; 95% CI: -0.55 to -0.03); however, those associations varied across participating countries. We also observed that among all individual social deprivation indicators, education, companionship, emotional support, instrumental support, and social isolation were directly associated with HRQoL, and the relationship between social deprivation and HRQoL was mediated through anxiety and sleep disturbances.

CONCLUSIONS

Our results demonstrated that less social deprivation was directly, and indirectly through less anxiety and better sleep quality, associated with better HRQoL in asthma.

Reliability, Validity, and Responsiveness of the DEG, a Three-Item Dyspnea Measure

BACKGROUND

Dyspnea is a common and debilitating symptom that affects many different patient populations. Dyspnea measures should assess multiple domains.

OBJECTIVE

To evaluate the reliability, validity, and responsiveness of an ultra-brief, multi-dimensional dyspnea measure.

DESIGN

We adapted the DEG from the PEG, a valid 3-item pain measure, to assess average dyspnea intensity (D), interference with enjoyment of life (E), and dyspnea burden with general activity (G).

PARTICIPANTS

We used data from a multi-site randomized clinical trial among outpatients with heart failure.

MAIN MEASURES

We evaluated reliability (Cronbach's alpha), concurrent validity with the Memorial-Symptom-Assessment-Scale (MSAS) shortness-of-breath distress-orbothersome item and 7-item Generalized-Anxiety-Disorder (GAD-7) scale, knowngroups validity with New-York-Heart-Association-Functional-Classification (NYHA) 1-2 or 3-4 and presence or absence of comorbid chronic obstructive pulmonary disease (COPD), responsiveness with the MSAS item as an anchor, and calculated a minimal clinically important difference (MCID) using distribution methods.

KEY RESULTS

Among 312 participants, the DEG was reliable (Cronbach's alpha 0.92). The mean (standard deviation) DEG score was 5.26 (2.36) (range 0-10) points. DEG scores correlated strongly with the MSAS shortness of breath distress-or-bothersome item (r=0.66) and moderately with GAD-7 categories (ρ=0.36). DEG scores were statistically significantly lower among patients with NYHA 1-2 compared to 3-4 [mean difference (standard error): 1.22 (0.27) points, p<0.01], and those without compared to with comorbid COPD [0.87 (0.27) points, p<0.01]. The DEG was highly sensitive to change, with MCID of 0.59-1.34 points, or 11-25% change.

CONCLUSIONS

The novel, ultra-brief DEG measure is reliable, valid, and highly responsive. Future studies should evaluate the DEG's sensitivity to interventions, use anchor-based methods to triangulate MCID estimates, and determine its prognostic usefulness among patients with chronic cardiopulmonary and other diseases.

The prevalence and related factors of fatigue in patients with COPD: a systematic review

BACKGROUND

Fatigue is a distressing symptom in patients with COPD. Little is known about the factors that contribute to fatigue in COPD. This review summarises existing knowledge on the prevalence of fatigue, factors related to fatigue and the instruments most commonly used to assess fatigue in COPD.

METHODS

Pubmed, PsycINFO, EMBASE, Cochrane and CINAHL databases were searched for studies from inception up to 7 January 2020 using the medical subject headings "COPD" and "Fatigue". Studies were reviewed in accordance with PRISMA guidelines.

RESULTS

196 studies were evaluated. The prevalence of fatigue ranged from 17-95%. Age (r=-0.23 to r=0.27), sex (r=0.11), marital status (r=-0.096), dyspnoea (r=0.13 to r=0.78), forced expiatory volume in 1 s % predicted (r=-0.55 to r=-0.076), number of exacerbations (r=0.27 to r=0.38), number of comorbidities (r=0.10), number of medications (r=0.35), anxiety (r=0.36 to r=0.61), depression (r=0.41 to r=0.66), muscle strength (r=-0.78 to r=-0.45), functional capacity (r=-0.77 to r=-0.14) and quality of life (r=0.48 to r=0.77) showed significant associations with fatigue.

CONCLUSIONS

Fatigue is a prevalent symptom in patients with COPD. Multiple physical and psychological factors seem to be associated with fatigue. Future studies are needed to evaluate these underlying factors in integral analyses in samples of patients with COPD.

Pragmatic trial on inhaled corticosteroid withdrawal in patients with COPD in general practice

The therapeutic value of inhaled corticosteroids (ICSs) for COPD is limited. In published RCTs, ICS could be withdrawn in COPD patients without increasing exacerbation risk when bronchodilator treatment is optimized. Here we report on the feasibility and risks of ICS withdrawal in Dutch general practice for COPD patients without an indication for ICSs. In our pragmatic trial, general practitioners decided autonomously which of their COPD patients on ICS treatment could stop this, how this was done, and whether additional bronchodilator therapy was needed. We recruited 62 COPD patients (58 analysed) who were eligible for ICS withdrawal in 79 practices. In 32 patients (55.2%, 95% CI: 42.5–67.3%) ICS was withdrawn successfully, 19 (32.8%, 95% CI: 22.1–45.6%) restarted ICS treatment within six months, 12 patients (20.7%, 95% CI: 12.3–32.8%) had a moderate exacerbation, and one patient had a severe exacerbation. ICS withdrawal was successful in just over half of the patients with COPD without an indication for ICS.

[Evaluation of permanent disability levels in occupational pulmonary diseases]

Compensation for occupational pulmonary diseases requires the establishment of guidelines based on standardized and objective criteria, in order to provide compensation that is as fair as possible to patients who suffer from them. A review of the elements necessary for the examination of an individual file was carried out by a working group. It is accepted that respiratory functional exploration is the key element in assessing the level of permanent disability in all of these conditions, with the exception of thoracic malignancies. Guiding scales have been developed for the respiratory impairment of three types of conditions: occupational asthma, thoracic malignancy, and other respiratory diseases. Additional criteria for increasing the permanent disability level are also proposed in order to take into account professional prejudice, in particular the possibility or not of continuing the occupational activity, in the same job or after changing to another. For certain respiratory diseases, a periodic reassessment of the initially attributed permanent disability level is recommended as well as the initial one at the time of definitive cessation of occupational activity.

Minimal Important and Detectable Differences of Respiratory Measures in Outpatients with AECOPD†

Interpreting clinical changes during acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is challenging due to the absence of established minimal detectable (MDD) and important (MID) differences for most respiratory measures. This study established MDD and MID for respiratory measures in outpatients with AECOPD following pharmacological treatment. COPD assessment test (CAT), modified Borg scale (MBS), modified British Medical Research Council (mMRC) questionnaire, peripheral oxygen saturation (SpO₂), computerised respiratory sounds and forced expiratory volume in one second (FEV₁) were collected within 24-48 hour of an AECOPD and after 45 days of pharmacological treatment. MID and MDD were calculated using anchor- (receiver operating characteristic and linear regression analysis) and distribution-based methods (effect size, SEM, 0.5*SD and MDC95) and pooled using Meta XL. Forty-four outpatients with AECOPD (31♂; 68.2 ± 9.1 years; FEV₁ 51.1 ± 20.3%predicted) participated. Significant correlations with CAT were found for the MBS (r = 0.34), mMRC (r = 0.39) and FEV₁ (r = 0.33), resulting in MIDs of 0.8, 0.5-0.6 and 0.03L, respectively. MDD of 0.5-1.4 (MBS), 0.4-1.2 (mMRC), 0.10-0.28L (FEV₁), 3.6-10.1% (FEV₁%predicted), 0.9-2.4% (SpO₂), 0.7-1.9 (number of inspiratory crackles), 1.1-4.5 (number of expiratory crackles), 7.1-25.8% (inspiratory wheeze rate) and 11.8-63.0% (expiratory wheeze rate) were found. Pooled data of MID/MDD showed that improvements of 0.9 for the MBS, 0.6 for the mMRC, 0.15L for the FEV₁, 7.6% for the FEV₁%predicted, 1.5% for the SpO₂, 1.1 for the inspiratory and 2.4 for the number of expiratory number of crackles, 14.1% for the inspiratory and 32.5% for the expiratory wheeze rate are meaningful following an AECOPD managed with pharmacological treatment on an outpatient basis.

Clinically relevant differences in COPD health status: systematic review and triangulation

The minimal clinically important difference (MCID) quantifies when measured differences can be considered clinically relevant. This study aims to review and triangulate MCIDs of chronic obstructive pulmonary disease (COPD) health status tools.A systematic search in PubMed, EMBASE and Cochrane Library was conducted (Prospero #CRD42015023221). Study details, patient characteristics, MCID methodology and estimates were assessed and extracted by two authors. A triangulated mean was obtained for each tool's MCID, with two-thirds weighting for anchor-based and one-third for distribution-based results. This was then multiplied by a weighted factor based upon the study size and quality rating.Overall, 785 records were reviewed of which 21 studies were included for analysis. MCIDs of 12 tools were presented. General quality and risk of bias were average to good. Triangulated MCIDs for the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) and St. George's Respiratory Questionnaire (SGRQ) were -2.54, -0.43 and -7.43 for improvement. Too few and/or too diverse studies were present to triangulate MCIDs of other tools.Evidence for the MCID of the CAT and CCQ was strong and triangulation was valid. Currently used MCIDs in clinical practice for the SGRQ (4) and Chronic Respiratory Questionnaire (0.5) did not match the reviewed content, for which the MCIDs were much higher. Using too low MCIDs may lead to an overestimation of the interpretation of treatment effects. MCIDs for deterioration were scarce, which highlights the need for more research.

Outcome Measures Used in Pulmonary Rehabilitation in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review

BACKGROUND

Conflicting results about the effects of community-based pulmonary rehabilitation in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) exist, possibly because the variety of outcome measures used and the lack of appropriate measurement properties hinder the development of pulmonary rehabilitation guidelines.

PURPOSE

The purpose of this study was to identify and review the measurement properties of patient-reported outcome measures (PROMs) and clinical outcome measures of AECOPD that are used in pulmonary rehabilitation and that can be easily applied in a community setting.

DATA SOURCES

PubMed, Web of Science, Scopus, and CINAHL were searched up to July 1, 2016.

STUDY SELECTION

Phase 1 identified outcome measures used in pulmonary rehabilitation for AECOPD. Phase 2 reviewed the measurement properties of the identified outcome measures.

DATA EXTRACTION

One reviewer extracted the data and 2 reviewers independently assessed the methodological quality of the studies and the measurement properties of the outcome measures by using the Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) recommendations.

DATA SYNTHESIS

Twenty-three PROMs and 18 clinical outcome measures were found. The outcome measures most used were the St George Respiratory Questionnaire (n = 15/37 studies) and the 6-minute walk test (n = 21/37 studies). Thirty-two studies described the measurement properties of 22 PROMs and 7 clinical outcome measures. The methodological quality of the studies was mostly poor, and the measurement properties were mostly indeterminate. The outcome measure exhibiting more robust properties was the COPD Assessment Test.

LIMITATIONS

A Number of studies were not found with the validated search strategy used and were included a posteriori; the fact that 3 studies presented combined results- for patients who were stable and patients with exacerbation-affected the conclusions that can be drawn.

CONCLUSIONS

A Large variety of outcome measures have been used; however, studies on their measurement properties are needed to enhance the understanding of community pulmonary rehabilitation for AECOPD.

Health coaching to improve self-management and quality of life for low income patients with chronic obstructive pulmonary disease (COPD): protocol for a randomized controlled trial

BACKGROUND

Chronic obstructive pulmonary disease (COPD) severely hinders quality of life for those affected and is costly to the health care system. Care gaps in areas such as pharmacotherapy, inhaler technique, and knowledge of disease are prevalent, particularly for vulnerable populations served by community clinics. Non-professionally licensed health coaches have been shown to be an effective and cost-efficient solution in bridging care gaps and facilitating self-management for patients with other chronic diseases, but no research to date has explored their efficacy in improving care for people living with COPD.

METHOD

This is multi-site, single blinded, randomized controlled trial evaluates the efficacy of health coaches to facilitate patient self-management of disease and improve quality of life for patients with moderate to severe COPD. Spirometry, survey, and an exercise capacity test are conducted at baseline and at 9 months. A short survey is administered by phone at 3 and 6 months post-enrollment. The nine month health coaching intervention focuses on enhancing disease understanding and symptom awareness, improving use of inhalers; making personalized plans to increase physical activity, smoking cessation, or otherwise improve disease management; and facilitating care coordination.

DISCUSSION

The results of this study will provide evidence regarding the efficacy and feasibility of health coaching to improve self-management and quality of life for urban underserved patients with moderate to severe COPD.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT02234284 . Registered 12 August 2014.

Preliminary validation and reliability of the Short Form Chronic Respiratory Disease Questionnaire in a lung cancer population

The Short Form Chronic Respiratory Questionnaire (SF-CRQ) is frequently used in patients with obstructive pulmonary disease and it has demonstrated excellent psychometric properties. Since there is no psychometric information for its use with lung cancer patients, this study explored its validity and reliability in this population. Forty-six patients were assessed at two time points (with a 4-week interval) using the SF-CRQ, the modified Borg Scale, five numerical rating scales related to Perceived Severity of Breathlessness, and the Hospital Anxiety and Depression Scale. Internal consistency reliability was investigated by Cronbach's alpha reliability coefficient, test-retest reliability by Spearman-Brown reliability coefficient (P), content validity as well as convergent validity by Pearson's correlation coefficient between the SF-CRQ, and the conceptual similar scales mentioned above were explored. A principal component factor analysis was performed. The internal consistency was high [α = 0.88 (baseline) and 0.91 (after 1 month)]. The SF-CRQ had good stability with test-retest reliability ranging from r = 0.64 to 0.78, P < 0.001. Factor analysis suggests a single construct in this population. The preliminary data analyses supported the convergent, content, and construct validity of the SF-CRQ providing promising evidence that this can be a valid and reliable instrument for the assessment of quality of life related to breathlessness in lung cancer patients.

Validity and Reliability of the Chronic Respiratory Disease Questionnaire in Elderly Individuals with Mild to Moderate Non-Cystic Fibrosis Bronchiectasis

BACKGROUND

The chronic respiratory disease questionnaire (CRDQ) is designed to assess health-related quality of life (HRQOL) in chronic respiratory conditions, but its reliability, validity and responsiveness in individuals with mild to moderate non-cystic fibrosis (CF) bronchiectasis are unclear.

OBJECTIVES

This study aimed to determine measurement properties of the CRDQ in non-CF bronchiectasis.

METHODS

Participants with non-CF bronchiectasis involved in a randomised controlled trial of exercise training were recruited. Internal consistency was assessed using Cronbach's α. Over 8 weeks, reliability was evaluated using intra-class correlation coefficients and Bland-Altman analysis for measures of agreement. Convergent and divergent validity was assessed by correlations with the other HRQOL questionnaires and the Hospital Anxiety and Depression Scale (HADS). The responsiveness to exercise training was assessed using effect sizes and standardised response means.

RESULTS

Eighty-five participants were included (mean age ± SD, 64 ± 13 years). Internal consistency was adequate (>0.7) for all CRDQ domains and the total score. Test-retest reliability ranged from 0.69 to 0.85 for each CRDQ domain and was 0.82 for the total score. Dyspnoea (CRDQ) was related to St George's respiratory questionnaire (SGRQ) symptoms only (r = 0.38), with no relationship to the Leicester cough questionnaire (LCQ) or HADS. Moderate correlations were found between the total score of the CRDQ, the SGRQ (rs = -0.49) and the LCQ score (rs = 0.51). Lower CRDQ scores were associated with higher anxiety and depression (rs = -0.46 to -0.56). The responsiveness of the CRDQ was small (effect size 0.1-0.24).

CONCLUSIONS

The CRDQ is a valid and reliable measure of HRQOL in mild to moderate non-CF bronchiectasis, but responsiveness was limited.

Assessment of dyspnoea in the emergency department by numeric and visual scales: A pilot study

OBJECTIVE(S)

Dyspnoea is a common and often debilitating symptom that affects up to 50% of patients admitted to acute tertiary care hospitals. The primary purpose of this study was to compare the numeric rating scale (NRS) and the visual analogue scale (VAS) for dyspnoea evaluation in the ED setting.

STUDY DESIGN AND PATIENTS

This was a cohort study of patients admitted to the ED in a university hospital, with dyspnoea as the chief complaint.

METHODS

The agreement of the two dyspnoea scales was assessed using the intraclass correlation coefficient (ICC).

RESULTS

One hundred and seventeen patients were included in this analysis. The median age for the whole study population was 67 years and 42% of patients were male. The aetiology of dyspnoea was acute heart failure (AHF) in 35% of patients. There was good agreement between the two scores (ICC=0.795; 95% CI=0.717-0.853; P<0.001).

CONCLUSIONS

This pilot study demonstrated that numerical rating and visual analogue scales agree well when assessing the severity of dyspnoea in the ED. Further studies with larger cohorts of patients are needed to confirm these preliminary results.

A review of the most common patient-reported outcomes in COPD--revisiting current knowledge and estimating future challenges

Patient-reported outcome (PRO) measures that quantify disease impact have become important measures of outcome in COPD research and treatment. The objective of this literature review was to comprehensively evaluate psychometric properties of available PRO instruments and the ability of each of them to characterize pharmaceutical treatment effects from published clinical trial evidence. Identified in this study were several PRO measures, both those that have been used extensively in COPD clinical trials (St George’s Respiratory Questionnaire and Chronic Respiratory Questionnaire) and new instruments whose full value is still to be determined. This suggests a great need for more information about the patient experience of treatment benefit, but this also may pose challenges to researchers, clinicians, and other important stakeholders (eg, regulatory agencies, pharmaceutical companies) who develop new treatment entities and payers (including but not limited to health technology assessment agencies such as the National Institute for Health and Care Excellence and the Canadian Agency for Drugs and Technologies in Health). The purpose of this review is to enable researchers and clinicians to gain a broad overview of PRO measures in COPD by summarizing the value and purpose of these measures and by providing sufficient detail for interested audiences to determine which instrument may be the most suitable for evaluating a particular research purpose.

Health status during hospitalisations for chronic obstructive pulmonary disease exacerbations: the validity of the Clinical COPD Questionnaire

Hospitalisations for chronic obstructive pulmonary disease (COPD) exacerbations are characterised by a significant worsening of the respiratory symptoms which can impair the health status (HS). However little is known on the HS behaviour during such events. Prospective study evaluating the validity of the Clinical COPD Questionnaire (CCQ) as a HS measure in hospitalisations for COPD exacerbations. The CCQ total score (CCQ-T) correlated with EQ-VAS (-0.51, p < 0.0001), was able to discriminate between longer and shorter duration hospitalisation (CCQ-T 3.83 vs 3.03, respectively p = 0.001), had a Cronbach-α of 0.86, and improved significantly over the hospitalisation period (CCQ-T on day 7 of hospitalisation 2.55 vs 3.77 at baseline, p < 0.0001). CCQ is an excellent tool for the assessment of the HS dynamics in hospitalisations for COPD exacerbations.

A short questionnaire for the assessment of quality of life in patients with chronic obstructive pulmonary disease: psychometric properties of VQ11

BACKGROUND

There is a need for a validated short instrument that can be used in routine practice to quantify potential short-term change in Health-Related Quality of Life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). Our aim is to determine the validity and reliability of the VQ11 questionnaire dedicated to the routine assessment of HRQoL.

METHODS

181 COPD patients (40-85 yrs, I to IV GOLD stages) completed the VQ11, and several tests. One week later, 49 of these patients completed the VQ11 again.

RESULTS

Confirmatory factor analysis supported the two-level hierarchical structure of the VQ11 with 11 items covering three components and HRQoL at a higher level. The VQ11 showed good internal consistency and good reproducibility (r = 0.88). Concurrent validity showed significant correlations between VQ11 total scores and St George's Respiratory Questionnaire-C (r = 0.70), Short Form-36 (r = -0.66 for the physical component and -0.63 for the mental component). We obtained significant correlations with MRC Dyspnea Grades (r = 0.59), the Hospital Anxiety and Depression Scale total score (r = 0.62), and the BODE index (r = 0.53).

CONCLUSION

The VQ11 has good measurement properties and provides a valid and reliable measure of COPD-specific HRQoL. It is ready for use in routine practice.

CLINICAL REGISTRATION

The study was approved by the University of Montpellier 1 Ethics Committee and the Regional Ethics Committee (authorization number: A00332-53).

Patient-reported outcome measures for chronic obstructive pulmonary disease : the exclusion of people with low literacy skills and learning disabilities

BACKGROUND

Patient-reported outcome measures (PROMs) are intended to reflect outcomes relevant to patients. They are increasingly used for healthcare quality improvement. To produce valid measures, patients should be involved in the development process but it is unclear whether this usually includes people with low literacy skills or learning disabilities. This potential exclusion raises concerns about whether these groups will be able to use these measures and participate in quality improvement practices.

METHODS

Taking PROMs for chronic obstructive pulmonary disease (COPD) as an exemplar condition, our review determined the inclusion of people with low literacy skills and learning disabilities in research developing, validating, and using 12 PROMs for COPD patients. The studies included in our review were based on those identified in two existing systematic reviews and our update of this search.

RESULTS

People with low literacy skills and/or learning disabilities were excluded from the development of PROMs in two ways: explicitly through the participant eligibility criteria and, more commonly, implicitly through recruitment or administration methods that would require high-level reading and cognitive abilities. None of the studies mentioned efforts to include people with low literacy skills or learning disabilities.

CONCLUSION

Our findings suggest that people with low literacy skills or learning disabilities are left out of the development of PROMs. Given that implicit exclusion was most common, researchers and those who administer PROMs may not even be aware of this problem. Without effort to improve inclusion, unequal quality improvement practices may become embedded in the health system.

Assessment of COPD wellness tools for use in primary care: an IPCRG initiative

COPD is considered a complex disease and global problem that is predicted to be the third most common cause of death by 2030. While managing this chronic condition, primary health care practitioners are faced with the ongoing challenge of achieving good quality of life and overall "wellness" for those affected. As such, a practical tool for monitoring quality of life in a clinical setting is required. However, due to the wide variety of general and disease-specific tools from which to choose, primary health care practitioners are given minimal guidance as to which tool may be most appropriate. To address these challenges, the International Primary Care Respiratory Group (IPCRG) proposed the creation of a user's guide for primary health care practitioners to assess "wellness" in COPD patients in an everyday clinical setting. This short report outlines the process by which the IPCRG Users' Guide to COPD "Wellness" Tools was developed. It also describes why this guide has the potential to be of great value in guiding primary health care practitioners to improve patient wellness.

Test-retest reliability of multidimensional dyspnea profile recall ratings in the emergency department: a prospective, longitudinal study

BACKGROUND

Dyspnea is among the most common reasons for emergency department (ED) visits by patients with cardiopulmonary disease who are commonly asked to recall the symptoms that prompted them to come to the ED. The reliability of recalled dyspnea has not been systematically investigated in ED patients.

METHODS

Patients with chronic or acute cardiopulmonary conditions who came to the ED with dyspnea (N = 154) completed the Multidimensional Dyspnea Profile (MDP) several times during the visit and in a follow-up visit 4 to 6 weeks later (n = 68). The MDP has 12 items with numerical ratings of intensity, unpleasantness, sensory qualities, and emotions associated with how breathing felt when participants decided to come to the ED (recall MDP) or at the time of administration ("now" MDP). The recall MDP was administered twice in the ED and once during the follow-up visit. Principal components analysis (PCA) with varimax rotation was used to assess domain structure of the recall MDP. Internal consistency reliability was assessed with Cronbach's alpha. Test-retest reliability was assessed with intraclass correlation coefficients (ICCs) for absolute agreement for individual items and domains.

RESULTS

PCA of the recall MDP was consistent with two domains (Immediate Perception, 7 items, Cronbach's alpha = .89 to .94; Emotional Response, 5 items; Cronbach's alpha = .81 to .85). Test-retest ICCs for the recall MDP during the ED visit ranged from .70 to .87 for individual items and were .93 and .94 for the Immediate Perception and Emotional Response domains. ICCs were much lower for the interval between the ED visit and follow-up, both for individual items (.28 to .66) and for the Immediate Perception and Emotional Response domains (.72 and .78, respectively).

CONCLUSIONS

During an ED visit, recall MDP ratings of dyspnea at the time participants decided to seek care in the ED are reliable and sufficiently stable, both for individual items and the two domains, that a time lag between arrival and questionnaire administration does not critically affect recall of perceptual and emotional characteristics immediately prior to the visit. However, test-retest reliability of recall over a 4- to 6-week interval is poor for individual items and significantly attenuated for the two domains.

The development of the S-QoL 18: a shortened quality of life questionnaire for patients with schizophrenia

OBJECTIVE

The S-QoL 41 is a French self-administered questionnaire that assesses quality of life (QoL) among people with schizophrenia. This study aims to validate a shortened version of the S-QoL for more widespread use in clinical practice.

METHODS

We used data from four studies conducted in four psychiatric hospitals in France (n=507). The item reduction and validation processes were based on both item response theory and classical test theory. The final version of the S-QoL was tested for construct validity, reliability, external validity, reproducibility and sensitivity to change. In addition, differential item functioning (DIF) analyses were performed to see whether all items behave in the same way in subgroups divided by age, gender, educational level and clinical form.

RESULTS

The S-QoL 18 evaluates eight dimensions: psychological well-being, self-esteem, family relationships, relationships with friends, resilience, physical well-being, autonomy and sentimental life. The factor structure accounted for 78% of the total variance. Internal consistency was satisfactory (item-internal consistency greater than 0.40; Cronbach's alpha coefficients ranged from 0.72 to 0.84). The scalability was satisfactory, with INFIT statistics within an acceptable range. In addition, the results confirmed the absence of DIF and supported the invariance of the item calibrations.

CONCLUSIONS

The S-QoL 18 is a short self-administered QoL instrument that has a high degree of comparability with S-QoL 41 and presents satisfactory psychometric properties. Future studies should confirm its sensitivity to change.

ED visit volume and quality of care in acute exacerbations of chronic obstructive pulmonary disease

OBJECTIVE

The purpose of this study is to determine whether emergency department (ED) visit volume is associated with ED quality of care in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD).

METHODS

We performed a prospective multicenter cohort study involving 29 EDs in the United States and Canada. Using a standard protocol, we interviewed consecutive ED patients with COPD exacerbation, reviewed their charts, and completed a 2-week telephone follow-up. The associations between ED visit volume and quality of care (process and outcome measures) were examined at both the ED and patient levels.

RESULTS

After adjustment for patient mix in the multivariable analyses, chest radiography was less frequent among patients with COPD exacerbations in the low-volume (odds ratio [OR], 0.2; 95% confidence interval [CI], 0.1-0.4) and high-volume EDs (OR, 0.1; 95% CI, 0.05-0.5), with medium-volume EDs as the reference. Arterial blood gas testing was less frequent in the low-volume EDs (OR, 0.1; 95% CI, 0.02-0.8). Medication use was similar across volume tertiles. With respect to outcome measures, patients in high-volume EDs were more likely to be discharged (OR, 4.2; 95% CI, 2.2-7.7) and to report ongoing exacerbation at a 2-week follow-up (OR, 1.9; 95% CI, 1.02-3.5).

CONCLUSIONS

Traditional positive volume-quality relationships did not apply to emergency care of COPD exacerbation. High-volume EDs used less guideline-recommended diagnostic procedures, had a higher admission threshold, and had a worse short-term patient-centered outcome.

Versão em português do Chronic Respiratory Questionnaire: estudo da validade e reprodutibilidade

OBJETIVO: Verificar a validade e a reprodutibilidade de uma versão em português do Chronic Respiratory Questionnaire (CRQ) em pacientes com DPOC. MÉTODOS: A versão em português do CRQ (fornecida pela Universidade de McMaster, detentora dos direitos do questionário) foi aplicada a 50 pacientes portadores de DPOC (32 homens; 70 ± 8 anos; VEF1 = 47 ± 18% predito) em dois momentos, com intervalo de uma semana. O CRQ tem quatro domínios (dispneia, fadiga, função emocional e autocontrole) e foi aplicado em formato de entrevista. O Saint George's Respiratory Questionnaire (SGRQ), já validado em português, foi utilizado como o critério de validação. A espirometria e o teste da caminhada de seis minutos (TC6) foram realizados para a análise das correlações com os valores do CRQ. RESULTADOS: Não foram observadas diferenças significativas entre a aplicação e a reaplicação do CRQ (p > 0.05 para todos os domínios). O coeficiente de correlação intraclasse entre a aplicação e a reaplicação foi de 0,98; 0,97; 0,98 e 0,95 para os domínios dispneia, fadiga, função emocional e autocontrole, respectivamente. O coeficiente alfa de Cronbach foi 0,91. Os domínios do CRQ se correlacionaram significativamente com os domínios do SGRQ (-0.30 < r < -0.67; p < 0,05). Não houve correlação entre as variáveis espirométricas e os domínios do CRQ e nem entre esses domínios e o TC6, exceto para o domínio fadiga (r = 0,30; p = 0,04). CONCLUSÕES: A versão em português do CRQ demonstrou ser reprodutível e válida em pacientes brasileiros portadores de DPOC.

Racial and ethnic differences in emergency care for acute exacerbation of chronic obstructive pulmonary disease

OBJECTIVES

The objective was to investigate racial and ethnic differences in emergency care for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

METHODS

The authors performed a prospective multicenter cohort study involving 24 emergency departments (EDs) in 15 U.S. states. Using a standard protocol, consecutive ED patients with AECOPD were interviewed, their charts reviewed, and 2-week telephone follow-ups were completed.

RESULTS

Among 330 patients, 218 (66%) were white, 84 (25%) were African American, and 28 (8%) were Hispanic. A quarter of the 24 EDs cared for 59% of all minority patients. Compared with white patients, African American and Hispanic patients were more likely to be uninsured or with Medicaid (19, 49, and 52%, respectively; p < 0.001), were less likely to have a primary care provider (93, 81, and 82%, respectively; p = 0.005), and had more frequent ED visits in the past year (medians = 1, 2, and 3, respectively; p = 0.002). In the unadjusted analyses, minority patients were less likely to receive diagnostic procedures, more likely to receive systemic corticosteroids in the ED, less likely to be admitted, and more likely to have a relapse. After adjustment for patient and ED characteristics, these many racial and ethnic differences in quality of care were nearly completely eliminated.

CONCLUSIONS

Despite pronounced racial and ethnic differences in stable COPD, all racial and ethnic groups received comparable quality of emergency care for AECOPD and had similar short-term outcomes.

Factors associated with short-term recovery of health status among emergency department patients with acute exacerbations of chronic obstructive pulmonary disease

OBJECTIVE

To determine the factors associated with short-term recovery of health status following chronic obstructive pulmonary disease (COPD) exacerbation.

METHODS

In a prospective multicenter cohort study, consecutive emergency department (ED) patients with COPD exacerbation were enrolled. Patients were interviewed and instructed to complete the validated Short Form Chronic Respiratory disease Questionnaire. Follow-up data were collected 2 weeks later, and included the global transition question. The primary outcome was recovery of health status, which was assigned to patients who stated that their COPD was "a little better" or "much better" than at the time of their ED presentation.

RESULTS

Of the 330 patients, 270 [82%; 95% confidence interval (CI), 77-86%] reported recovery of health status following acute exacerbations. Multivariable analysis showed that recovery of health status was associated with having a primary care provider (PCP) [odds ratio (OR), 3.1; 95% CI, 1.5-6.4] and a co-diagnosis of asthma (OR, 2.2; 95% CI, 1.2-3.8). By contrast, frequent exacerbations (two or more exacerbations in the past year) (OR, 0.4; 95% CI, 0.2-0.7) was inversely associated with recovery.

CONCLUSIONS

Reducing exacerbation frequency and provision of adequate PCP follow-up after ED visit may help improve the recovery of health status following acute exacerbations of COPD.