Skip to main content

Advertisement

SpringerLink
Log in

Clinically important changes in health-related quality of life for patients with chronic obstructive pulmonary disease

An expert consensus panel report

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BOJECTIVE: Without clinical input on what constitutes a significant change, health-related quality of life (HRQoL) measures are less likely to be adopted by clinicians for use in daily practice. Although standards can be determined empirically by within-person change studies based on patient self-reports, these anchor-based methods incorporate only the patients’ perspectives of important HRQoL change, and do not reflect an informed clinical evaluation. The objective of this study was to establish clinically important difference standards from the physician’s perspective for use of 2 HRQoL measures among patients with chronic obstructive pulmonary disease (COPD).

DESIGN: We assembled a 9-person expert panel of North American physicians familiar with the use of the Chronic Respiratory Questionnaire (CRQ), a disease-specific HRQoL measure, or the generic Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36, Version 2.0) among patients with COPD.

RESULTS: Using 2 rounds of the Delphi process, 1 in-person meeting, and an iterative improvement process for circulating and correcting the final report, the expert panel established small, moderate, and large clinically important change levels for the CRQ and SF-36.

CONCLUSIONS: For this expert physician panel, levels for detecting clinically important differences on the CRQ were equal to or slightly higher than previous studies based on patient-reported differences. Clinically important differences on the SF-36, Version 2.0, were noticeably larger than previous estimates based on cross-sectional differences between clinically defined patient groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Murray C, Lopez A. Evidence-based health policy—lessons from the global burden of disease study. Science. 1996;274:740–3.

    Article  PubMed  CAS  Google Scholar 

  2. Eakin E, Sassi-Dambron D, Ries A, Kaplan R. Reliability and validity of dyspnea measures in patients with obstructive lung diseases. Int J Behav Med. 1995;2:118–34.

    Article  PubMed  CAS  Google Scholar 

  3. Mahler D, Weinberg D, Wells C, Feinstein A. The measurement of dyspnea. Contents, interobserver agreement, and physiologic correlates of two new clinical indexes. Chest. 1984;85:751–8.

    PubMed  CAS  Google Scholar 

  4. Fletcher C, Elmes P, Fairbairn A, Wood C. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. BMJ. 1959;2:257–66.

    PubMed  CAS  Google Scholar 

  5. American Thoracic Society. Recommended respiratory disease questionnaire for use with adults and children in epidemiological research. Am Rev Respir Dis. 1978;118(suppl):7–53.

    Google Scholar 

  6. McGavin C, Artvinli M, Naoe H, McHardy G. Dyspnoea, disability, and distance walked: comparison of estimates of exercise performance in respiratory disease. BMJ. 1978;2:241–3.

    PubMed  CAS  Google Scholar 

  7. Daughton D, Fix A, Kass I, Bell C, Patil K. Maximum oxygen consumption and the ADAPT quality-of-life scale. Arch Phys Med Rehabil. 1992;63:620–2.

    Google Scholar 

  8. Stoller J, Ferranti R, Feinstein A. Further specification and evaluation of a new clinical index for dyspnea. Am Rev Respir Dis. 1986;134:1129–34.

    PubMed  CAS  Google Scholar 

  9. Weaver T, Narsavage G. Reliability and validity of Pulmonary Impact Profile Scale. Am Rev Respir Dis. 1989;139:A244.

    Google Scholar 

  10. Moody L. Measurement of psychophysiologic response variables in chronic bronchitis and emphysema. Appl Nurs Res. 1990;3:36–8.

    Article  PubMed  CAS  Google Scholar 

  11. Wigal J, Creer T, Kotses H. The COPD self-efficacy scale. Chest. 1991;99:1193–6.

    PubMed  CAS  Google Scholar 

  12. Cox N, Hendriks J, Dijkhuizen R, Binkhorst R, van Herwaarden C. Usefulness of a medicopsychological questionnaire for lung patients. Int J Rehabil Res. 1991;14:267–72.

    Article  PubMed  CAS  Google Scholar 

  13. Lareau S, Carrieri-Kohlman V, Janson-Bjerklie S, Ross P. Development and testing of the pulmonary functional status and dyspnea questionnaire (PFSDQ). Heart Lung. 1994;23:242–50.

    PubMed  CAS  Google Scholar 

  14. Guyatt G, Berman L, Townsend M, Pugsley S, Chambers L. A measure of quality of life for clinical trials in chronic lung disease. Thorax. 1987;42:773–8.

    Article  PubMed  CAS  Google Scholar 

  15. Tu S, McDonnell M, Spertus J, Steele B, Fihn S. A new self-administered questionnaire to monitor health-related quality of life in patients with COPD. Chest. 1997;112:614–22.

    PubMed  CAS  Google Scholar 

  16. Barr J, Schumacher G, Freeman S, LeMoine M, Bakst A, Jones P. American translation, modification, and validation of the St. George’s Respiratory Questionnaire. Clin Ther. 2000;22:1121–45.

    Article  PubMed  CAS  Google Scholar 

  17. Guyatt G, King D, Feeny D, Stubbing D, Goldstein R. Generic and specific measurement of health-related quality of life in a clinical trial of respiratory rehabilitation. J Clin Epidemiol. 1999;52:187–92.

    Article  PubMed  CAS  Google Scholar 

  18. Hajiro T, Nishimura M, Tsukino M, Ikeda A, Koyama H, Izumi T. Comparison of discriminative properties among disease-specific questionnaires for measuring health-related quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157:785–90.

    PubMed  CAS  Google Scholar 

  19. Harper R, Brazier J, Waterhouse J, Walters S, Jones N, Howard P. Comparison of outcome measures for patients with chronic obstructive pulmonary disease (COPD) in an outpatient setting. Thorax. 1997;52:879–87.

    Article  PubMed  CAS  Google Scholar 

  20. Lacasse Y, Wong E, Guyatt G. A systematic overview of the measurement properties of the Chronic Respiratory Questionnaire. Can Respir J. 1997;4:131–9.

    Google Scholar 

  21. Jaeschke R, Singer J, Guyatt G. Measurement of health status: ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10:407–15.

    Article  PubMed  CAS  Google Scholar 

  22. Juniper E, Guyatt G, Willan A, Griffith L. Determining a minimal important change in a disease-specific quality of life questionnaire. J Clin Epidemiol. 1994;47:81–7.

    Article  PubMed  CAS  Google Scholar 

  23. Barber B, Santanello N, Epstein R. Impact of the global on patient perceivable change in an asthma-specific QOL instrument. Qual Life Res. 1996;5:115–22.

    Article  Google Scholar 

  24. Osoba D, Rodriques G, Myles J, Zee B, Pater J. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998;16:139–44.

    PubMed  CAS  Google Scholar 

  25. Norman G, Stratford P, Regehr G. Methodological problems in the retrospective computation of responsiveness to change: the lessons of Cronbach. J Clin Epidemiol. 1997;50:869–79.

    Article  PubMed  CAS  Google Scholar 

  26. Wyrwich K, Tierney W, Wolinsky F. Further evidence supporting a SEM-based criterion for identifying meaningful intra-individual changes in health-related quality of life. J Clin Epidemiol. 1999;52:861–73.

    Article  PubMed  CAS  Google Scholar 

  27. Wyrwich K, Nienaber N, Tierney W, Wolinsky F. Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life. Med Care. 1999;37:469–78.

    Article  PubMed  CAS  Google Scholar 

  28. Redelmeier D, Guyatt G, Goldstein R. Assessing the minimal important difference in symptoms: a comparison of two techniques. J Clin Epidemiol. 1996;49:1215–9.

    Article  PubMed  CAS  Google Scholar 

  29. Lydick E, Epstein R. Interpretation of quality of life changes. Qual Life Res. 1993;2:221–6.

    Article  PubMed  CAS  Google Scholar 

  30. McHorney C, Ware J, Rogers W, Raczek AE, Lu JF. The validity and relative precision of MOS short and long-form health status scales and Dartmouth COOP charts: results from the Medical Outcomes Study. Med Care. 1992;30(suppl):253–65.

    Article  Google Scholar 

  31. Brazier J, Harper R, Jones N, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992;305:160–4.

    PubMed  CAS  Google Scholar 

  32. Stewart A, Greenfield S, Hays R, et al. Functional status and well-being of patients with chronic medical conditions: results from the Medical Outcomes Study. JAMA. 1989;262:907–13.

    Article  PubMed  CAS  Google Scholar 

  33. Brook R, Chassin M, Fink A, Solomon D, Kosecoff J, Park R. A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care. 1986;2:53–63.

    PubMed  CAS  Google Scholar 

  34. Moore A, Morton S, Beck J, et al. A new paradigm for alcohol use in older persons. Med Care. 1999;37:165–79.

    Article  PubMed  CAS  Google Scholar 

  35. Campbell S, Hann M, Roland M, Quayle J, Shekelle P. The effect of panel membership and feedback on ratings in a two-round delphi survey. Med Care. 1999;37:964–8.

    Article  PubMed  CAS  Google Scholar 

  36. McGlynn E, Kosecoff J, Brook R. Format and conduct of consensus development conferences: multi-nation comparison. Int J Technol Assess Health Care. 1990;6:450–69.

    PubMed  CAS  Google Scholar 

  37. Dalkey N. The Delphi Method: An Experimental Study of Group Opinion. Santa Monica: Rand Corporation; 1969.

    Google Scholar 

  38. Clancy C, Eisenberg J. Outcomes research: measuring the end results of health care. Science. 1998;282:245–6.

    Article  PubMed  CAS  Google Scholar 

  39. Stewart A, Hays R, Ware J Jr. The MOS Short-Form General Health Survey: reliability and validity in a patient population. Med Care. 1988;26:724–35.

    Article  PubMed  CAS  Google Scholar 

  40. Shekelle P, Kahan J, Bernstein S, Leape L, Kamberg C, Park RE. The reproducibility of a method to identify the overuse and underuse of medical procedures. N Engl J Med. 1998;338:1888–95.

    Article  PubMed  CAS  Google Scholar 

  41. Stasser G, Kerr N, Davis JH. Influence processes and consensus models in decision-making groups. In: Paulus P. ed. Psychology of Group Influence, 2nd ed Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.; 1989.

    Google Scholar 

  42. Neymark N, Kiebert W, Torfs K, et al. Methodological and statistical issues of quality of life (QOL) and economic evaluation in cancer clinical trials-report of a workshop. Eur J Cancer. 1998;34(9):1317–33.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Research Methodology, Received from Saint Louis University, St. Louis, Mo

    Kathleen W. Wyrwich PhD

  2. School of Public Health, St. Louis, Mo

    Kathleen W. Wyrwich PhD & Fredric D. Wolinsky PhD

  3. School of Medicine, St. Louis, Mo

    Ajit N. Babu MBBS, MPH & Fredric D. Wolinsky PhD

  4. Veterans’ Administration Medical Center, St. Louis, Mo

    Ajit N. Babu MBBS, MPH

  5. University of Washington Medical Center, Seattle, Wash

    Stephan D. Fihn MD

  6. VA Puget Sound Health Care System, Seattle, Wash

    Stephan D. Fihn MD

  7. Regrenstrief Institute for Health Care, Indianapolis, Ind

    William M. Tierney MD & Kurt Kroenke MD

  8. Indiana University School of Medicine, Indianapolis, Ind

    William M. Tierney MD & Kurt Kroenke MD

  9. Roudebush Veterans’ Administration Medical Center, Indianapolis, Ind

    William M. Tierney MD

Authors
  1. Kathleen W. Wyrwich PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephan D. Fihn MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William M. Tierney MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kurt Kroenke MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ajit N. Babu MBBS, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fredric D. Wolinsky PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathleen W. Wyrwich PhD.

Additional information

This research was funded by grants from the Agency for Healthcare Research and Quality to Dr. Wolinsky (R01 HS10234) and Dr. Wyrwich (K02 HS11635).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wyrwich, K.W., Fihn, S.D., Tierney, W.M. et al. Clinically important changes in health-related quality of life for patients with chronic obstructive pulmonary disease. J GEN INTERN MED 18, 196–202 (2003). https://doi.org/10.1046/j.1525-1497.2003.20203.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1046/j.1525-1497.2003.20203.x

Key words

Search

Navigation