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Interpretation of change and longitudinal validity of the quality of life for respiratory illness questionnaire (QoLRIQ) in inpatient pulmonary rehabilitation

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Abstract

The quality of life for respiratory illness questionnaire (QoLRIQ) is an outcome measure for patients with asthma or chronic obstructive pulmonary disease (COPD). This study assessed the longitudinal validity, reliability of the change score and the interpretation of changes on the QoLRIQ in inpatient pulmonary rehabilitation, completed by 108 patients with moderate to severe asthma (39) or COPD (69). Domains and total score of the QoLRIQ changed significant (all p < 0.0002) with standardized response means from 0.46 to 0.90. All QoLRIQ-change scores were significantly correlated with self-rated change in health and in disease symptoms and with change in self-assessed health status (r from 0.2 to 0.61). There were several significant correlations between QoLRIQ-change scores and change in experienced invalidity, emotional well-being, anxiety, depressive symptoms and Rand-36-domains (r from 0.2 to 0.68). The intraclass correlation coefficient of change was 0.90. The size of a minimal important difference (MID), computed from a retrospective global rating of change by the patients and with the standard error of measurement, was 0.5 points on a 7-point response scale. Computation of the MID from retrospective assessment of change may not be valid because this change was significantly correlated to post-treatment health status and significantly higher than serial assessment of change. We conclude that the QoLRIQ is sensitive to change, longitudinally valid and reliable, with a MID of 0.5 points. These results enable the use of the QoLRIQ as an outcome measure in clinical trials with patients with moderate to severe asthma or COPD. The longitudinal measurement properties in less severe patients still need to be studied.

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References

  1. Maillé AR, Koning CJM, Zwinderman AH, Willems LN, Dijkman JH, Kaptein AA. The development of the 'Quality-of-life for Respiratory Illness Questionnaire (QOLRIQ)': A disease-specific quality-of-life questionnaire for patients with mild to moderate chronic non-specific lung disease. Respir Med 1997; 91(5): 297–309.

    Google Scholar 

  2. Maillé AR. Quality of life in asthma and COPD. Development of a Disease-specific Questionnaire (thesis). Amsterdam: University of Amsterdam, 2000.

    Google Scholar 

  3. Guyatt GH, Kirshner B, Jaeschke R. Measuring health status: What are the necessary measurement properties? J Clin Epidemiol 1992; 45: 1341–1345.

    Google Scholar 

  4. Husted JA, Cook RJ, Farewell VT, Gladman DD. Methods for assessing responsiveness: A critical review and recommendations. J Clin Epidemiol 2000; 53: 459–468.

    Google Scholar 

  5. Beaton DE, Bombardier C, Katz JN, Wright JG. A taxonomy for responsiveness. J Clin Epidemiol 2001; 54(12): 1204–1217.

    Google Scholar 

  6. Terwee CB, Dekker FW, Wiersinga W, Prummel MF, Bossuyt PPM. On assessing responsiveness of health-related quality of life instruments: Guidelines for instrument evaluation. Thela thesis, Amsterdam: 2000.

  7. Lydick E, Epstein RS. Interpretation of quality of life changes. Qual Life Res 1993; 2: 221–226.

    Google Scholar 

  8. Liang MH, Fossel AH, Larson MG. Comparisons of five health status instruments for orthopedic evaluation. Med Care 1990; 28: 632–642.

    Google Scholar 

  9. Streiner DL, Norman GR. Health Measurement Scales. A Practical Guide to Their Development and Use. 2nd ed. Oxford: Oxford University Press, 1995.

    Google Scholar 

  10. Norman GR, Stratford P, Regehr G. Methodological problems in the retrospective computation of responsiveness to change: The lesson of Cronbach. J Clin Epidemiol 1997; 50: 869–879.

    Google Scholar 

  11. Fischer D, Stewart AL, Bloch DA, Lorig KR, Laurent D, Holman H. Capturing the patient's view of change as a clinical outcome measure. JAMA 1999; 282: 1157–1162.

    Google Scholar 

  12. Wyrwich KW, Nienaber NA, Tierney WM, Wolinsky FD. Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life. Med Care 1999; 37(5): 469–478.

    Google Scholar 

  13. Wyrwich KW, Tierney WM, Wolinsky FD. Further evidence supporting an SEM-based criterion for identifying meaningful intra-individual changes in health-related quality of life. J Clin Epidemiol 1999; 52: 861–873.

    Google Scholar 

  14. Wyrwich KW, Tierney WM, Wolinsky FD. Using the standar error of measurement to identify important changes in the Asthma Quality of Life Questionnaire. Qual Life Res 2002; 11: 1–7.

    Google Scholar 

  15. Samsa G, Edelman D, Rothman ML, Williams GR, Lipscomb J, Matchar D. Determining clinically important differences in health status measures: A general approach with illustration to the Health Utilities Index Mark II. Pharmacoeconomics 1999; 15: 141–155.

    Google Scholar 

  16. Lacasse Y, Wong E, Guyatt GH, King D, Cook DJ, Goldstein RS. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet 1996; 348: 1115–1119.

    Google Scholar 

  17. Cambach W, Wagenaar RC, Koelman TW, van Keimpema AR, Kemper HC. The long-term effects of pulmonary rehabilitation in patients with asthma and chronic obstructive pulmonary disease: A research synthesis. Arch Phys Med Rehabil 1999; 80(1): 103–111.

    Google Scholar 

  18. Siafakas NM, Vermeire P, Pride NB, et al. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. Eur Respir J 1995; 8(8): 1398–1420.

    Google Scholar 

  19. National Heart Lung and Blood Institute. Expert Panel Report 2: Guidelines for The Diagnosis and Management of Asthma. Bethesda: National Institutes of Health, 1997.

    Google Scholar 

  20. Donner CF, Muir JF. Selection criteria and programmes for pulmonary rehabilitation in COPD patients. Rehabilitation and Chronic Care Scientific Groupof the European Respiratory Society. Eur Respir J 1997; 10(3): 744–757.

    Google Scholar 

  21. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Eur Respir J 1993; 6 (suppl. 16): 5–40.

    Google Scholar 

  22. van der Lende R, Orie NG. The MRC-ECCS questionnaire on respiratory symptoms (use in epidemiology). Scan J Respir D 1972; 52: 218–226.

    Google Scholar 

  23. König-Zahn C, Furer JW, Tax B. Health Status Measurement: Description and Evaluation of Questionnaires. Part 1: General Health (Het meten van de gezondheidstoestand: Beschrijving en Evaluatie van Vragenlijsten. 1: Algemene gezondheid). Assen: van Gorcum, 1993.

    Google Scholar 

  24. Erdman RAM, Cox NJM, Duivenvoorden HJ. Handleiding Medisch Psychologische Vragenlijst voor CARA-patienten [Manual Medical Psychological Questionnaire for Lung patients]. Lisse: Swets & Zeitlinger, 1992.

    Google Scholar 

  25. Arrindell WA, Ettema JHM. SCL-90 Manual for a Multidimensional Indicator for Psychopathology [Handleiding bij een multidimensionele psychopathologie-indicator]. Lisse: Swets & Zeitlinger, 1986.

    Google Scholar 

  26. van der Zee KI, Sanderman R. Measuring General Health Status Using the RAND-36: A manual [Het meten van de algemene gezondheidstoestand met de RAND-36: een handleiding]. Groningen: Noordelijk Centrum voor Gezondheidsvraagstukken, 1993.

    Google Scholar 

  27. Altman DG. Practical Statistics for Medical Research. London: Chapman & Hall, 1991.

    Google Scholar 

  28. Cohen J. Statistical Power Analysis for The Behavioral Sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates, 1988.

    Google Scholar 

  29. van der Heijden GJ, Leffers P, Bouter LM. Shoulder disability questionnaire design and responsiveness of a functional status measure. J Clin Epidemiol 2000; 53: 29–38.

    Google Scholar 

  30. Hyland ME, Singh SJ, Sodergren SC, Morgan MP. Development of a shortened version of the Breathing Problems Questionnaire suitable for use in a pulmonary rehabilitation clinic: A purpose-specific, disease-specific questionnaire. Qual Life Res 1998; 7(3): 227–233.

    Google Scholar 

  31. Guyatt GH, King DR, Feeny DH, Stubbing D, Goldstein RS. Generic and specific measurement of health-related quality of life in a clinical trial of respiratory rehabilitation. J Clin Epidemiol 1999; 52: 187–192.

    Google Scholar 

  32. Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 1989; 10: 407–415.

    Google Scholar 

  33. Juniper EF, Guyatt GH, Willan A, Griffith LE. Determining a minimal important change in a disease-specific Quality of Life Questionnaire. J Clin Epidemiol 1994; 47: 81–87.

    Google Scholar 

  34. Altman DG, Machin D, Bryant TN, Gardner MJ. Statistics with Confidence. 2nd ed. London: BMJ Books, 2000.

    Google Scholar 

  35. Anderson JJ, Chernoff MC. Sensitivity to change of rheumatoid arthritis clinical trial outcome measures. J Rheumatol 1993; 20: 535–537.

    Google Scholar 

  36. Liang MH. Evaluating measurement responsiveness. J Rheumatol 1995; 22: 1191–1192.

    Google Scholar 

  37. Guyatt GH, Walter S, Norman GR. Measuring change over time: Assessing the usefulness of evaluative instruments. J Chron Dis 1987; 40: 171–178.

    Google Scholar 

  38. Guyatt GH, Osoba D, Wu AW, Wyrwich KW, Norman GR. Methods to explain the clinical significance of health status measures. Mayo Clin Proc 2002; 77(4): 371–383.

    Google Scholar 

  39. Herrmann D. Reporting current, past, and changed health status. What we know about distortion. Med Care 1995; 33: AS89–AS94.

    Google Scholar 

  40. Sprangers MAG, Schwartz CE. Integrating response shift into health-related quality of life research: A theoretical model. Soc Sci Med 1999; 48(11): 1507–1515.

    Google Scholar 

  41. Kaplan RM, Atkins CJ, Timms RM. Validity of a quality of well-being scale as an outcome measure in Chronic Obstructive Pulmonary Disease. J Chron Dis 1984; 37: 85–95.

    Google Scholar 

  42. Guyatt GH, Berman LB, Townsend M, Pugsley SO, Chambers LW. A measure of quality of life for clinical trials in chronic lung disease. Thorax 1987; 42: 773–778.

    Google Scholar 

  43. Marks GB, Dunn SM, Woolcock AJ. An evaluation of an asthma quality of life questionnaire as a measure of change in adults with asthma. J Clin Epidemiol 1993; 46: 1103–1111.

    Google Scholar 

  44. Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE. Measuring quality of life in asthma. Am Rev Respir Dis 1993; 147: 832–838.

    Google Scholar 

  45. Tu SP, McDonell MB, Spertus JA, Steele BG, Fihn SD. A new self-administered questionnaire to monitor health-related quality of life in patients with COPD. Ambulatory Care Quality Improvement Project (ACQUIP) Investigators. Chest 1997; 112(3): 614–622.

    Google Scholar 

  46. Barley EA, Quirk FH, Jones PW. Asthma health status measurement in clinical practice: Validity of a new short and simple instrument. Respir Med 1998; 92(10): 1207–1214.

    Google Scholar 

  47. Hajiro T, Nishimura K, Jones PW, et al. A novel, short, and simple questionnaire to measure health-related quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 159: 1874–1878.

    Google Scholar 

  48. Stavem K, Erikssen J, Boe J. Performance of a short lung-specific health status measure in outpatients with chronic obstructive pulmonary disease. Respir Med 1999; 93: 467–475.

    Google Scholar 

  49. Redelmeier DA, Guyatt GH, Goldstein RS. Assessing the minimal important difference in symptoms: A comparison of two techniques. J Clin Epidemiol 1996; 49: 1215–1219.

    Google Scholar 

  50. Jones PW, Quirk FH, Baveystock CM. The St George's respiratory questionnaire. Respir Med 1991; 85 Suppl B: 25–31.

    Google Scholar 

  51. Jones PW, Bosh TK. Quality of life changes in COPD patients treated with salmeterol. Am J Respir Crit Care Med 1997; 155: 1283–1289.

    Google Scholar 

  52. Terwee CB, Dekker FW, Mourits MP, et al. Interpretation and validity of changes in scores on the Graves' ophthalmopathy quality of life questionnaire (GO-QOL) after different treatments. Clin Endocrinol (Oxf) 2001; 54(3): 391–398.

    Google Scholar 

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Authors and Affiliations

  1. Asthmacenter Heideheuvel, Hilversum, The Netherlands

    Henk F. van Stel & Vivian T. Colland

  2. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands

    Henk F. van Stel & A. Rianne Maillé

  3. Department of Health Psychology, Utrecht University, Utrecht, The Netherlands

    Vivian T. Colland

  4. Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands

    Walter Everaerd

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  1. Henk F. van Stel
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  2. A. Rianne Maillé
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  3. Vivian T. Colland
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van Stel, H.F., Maillé, A.R., Colland, V.T. et al. Interpretation of change and longitudinal validity of the quality of life for respiratory illness questionnaire (QoLRIQ) in inpatient pulmonary rehabilitation. Qual Life Res 12, 133–145 (2003). https://doi.org/10.1023/A:1022213223673

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