Original Article
The Severe Respiratory Insufficiency Questionnaire scored best in the assessment of health-related quality of life in chronic obstructive pulmonary disease

https://doi.org/10.1016/j.jclinepi.2013.04.013Get rights and content

Abstract

Objective

There are limited data on health-related quality of life (HRQL) in chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure during an admission requiring ventilatory support. The aim was to assess and compare the reliability and validity of the Clinical COPD Questionnaire (CCQ), Chronic Respiratory Questionnaire (CRQ), Maugeri Respiratory Failure-28 (MRF-28) Questionnaire, and Severe Respiratory Insufficiency (SRI) Questionnaire in patients with very severe COPD.

Study Design and Setting

One hundred eighty hospitalized patients filled out the CCQ, CRQ, MRF-28, SRI, Groningen Activity Restriction Scale (GARS), Hospital Anxiety and Depression Scale (HADS), and the Medical Research Council Dyspnea Scale (MRC). Reliability was examined by assessing distribution of total scores, floor and ceiling effects, and internal consistency (using Cronbach α coefficient). Construct validity between questionnaires and also the other measurements were tested with Spearman ρ.

Results

All four questionnaires were feasible in this setting and had reasonable characteristics for distribution of total scores, floor and ceiling effects, internal consistency, and construct validity. On balance, the SRI scored best. Additionally, the SRI had a remarkable high explained variance by HADS, GARS, and MRC (73%).

Conclusion

The SRI performed slightly better than the CCQ, CRQ, and MRF-28, which renders it the preferred questionnaire for scoring HRQL in patients with very severe COPD.

Introduction

What is new?

Key finding

  1. The Clinical COPD Questionnaire, Chronic Respiratory Questionnaire, Maugeri Respiratory Failure-28 Questionnaire, and Severe Respiratory Insufficiency (SRI) Questionnaire showed to be reliable and valid questionnaires in chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure requiring ventilatory support.

What this adds to what was known?
  1. On balance, the SRI scored best, making it the preferred questionnaire for measurement of health-related quality of life in patients with very severe COPD.

What is the implication and what should change now?
  1. We suggest that future studies on the effects of chronic noninvasive ventilation in COPD use the SRI in addition to a more general disease-specific questionnaire.

Health-related quality of life (HRQL) assessment in patients with chronic obstructive pulmonary disease (COPD) has become more common over the last two decades, and its importance in clinical trials has been recognized by many health care institutions [1]. Quite a few disease-specific questionnaires in the field of COPD have been developed, some of which have been shown to be valid, reliable, and responsive in several stages of severity of this disease; for example, the Chronic Respiratory Questionnaire (CRQ) [2] and Clinical COPD Questionnaire (CCQ) [3]. Others were designed for a more specific subset of COPD patients. Both the Maugeri Respiratory Failure-28 (MRF-28) Questionnaire [4] and the Severe Respiratory Insufficiency (SRI) Questionnaire [5] were originally developed for a mixed group of patients with respiratory failure (not necessarily COPD) receiving chronic noninvasive positive pressure ventilation (NPPV). In addition, they have also shown to be valid and reliable specifically in COPD patients with stable chronic hypercapnic respiratory failure (CHRF) [6]. One trial on chronic NPPV in COPD with CHRF [7] showed that the SRI was more related to anxiety and depression, whereas the MRF-28 added the cognitive domain compared with the CRQ and therefore suggested using both the SRI and the MRF-28 as they assess different aspects of HRQL in these patients.

The lack of agreement on which HRQL questionnaire to use has contributed to the fact that evidence for the use of chronic NPPV in patients with stable COPD is still contradictory [8], [9], [10]. Among others, the pooling of results on HRQL is hampered in this way.

Not only is chronic NPPV in stable COPD of interest but also the role of chronic NPPV in COPD after an episode of acute respiratory failure requiring ventilatory support in hospital [11]. In Europe, a few studies on chronic NPPV after acute exacerbation are currently in process, and therefore, it is of importance to find the appropriate questionnaires for this precise area. As there are limited data on HRQL in this specific group, the aim of the present study is to assess and compare the reliability and validity of the CCQ, CRQ, MRF-28, and SRI in COPD patients with CHRF during an admission requiring ventilatory support.

Section snippets

Patients

Between 2008 and August 2011, 180 patients from 45 Dutch hospitals were included. These data are part of a larger randomized controlled trial studying the effects of chronic NPPV. Patients met the following inclusion criteria: Chronic Obstructive Pulmonary Disease Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage III or IV, invasive or noninvasive ventilation during acute respiratory failure and minimally 48 hours without ventilatory support (maximally until discharge), and

Patients

Of the 180 patients included in the study, 170 completed the questionnaires (Table 1). Six patients withdrew and four patients died because of respiratory failure. Demographic data and other possible determinants are presented in Table 1. Forty patients were not able or refused to come off oxygen for arterial blood gas analysis. PaCO2 and FEV1 from this group were not different.

Distribution of scores

Distribution of all total scores is illustrated graphically (Fig. 1). The CCQ and SRI show a normal distribution,

Discussion

The present study shows that CCQ, CRQ, MRF-28, and SRI are all reliable and valid questionnaires in hospitalized patients with CHRF who are still hypercapnic 48 hours after ending (noninvasive or invasive) ventilatory support for an acute COPD exacerbation. The SRI is superior when taking the different aspects studied into account. This is the first study comparing all four questionnaires in this specific homogeneous group of patients with end-stage COPD.

First, the distribution of scores is of

Acknowledgments

The authors thank J. Vonk (Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands) for statistical advice.

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    Conflict of interest: T.v.d.M. developed the Clinical COPD Questionnaire and holds the copyright. All other authors have no conflicts of interest to disclose.

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