What is it about?
The St. George's Respiratory Questionnaire (SGRQ) and COPD Assessment test (CAT) are measures used to assess health status. This study aims to examine the responsiveness of these tools by severity of dyspnoea category in patients with chronic obstructive pulmonary disease (COPD). The need to identify a tool having a good responsiveness, is of importance for COPD patients considering that between 8.3% to 49.6% of those referred for PR do not attend, and between 9.7% and 31.8% fail to complete the programme. Obstacles cited by COPD patients in relation to non-completion of PR, include severity of breathlessness, transportation difficulties, depression, programme perceived as too long and lack of perceived benefit. Consequently, there is the need to identify a tool having a good responsiveness in relation to health status measures, such as the severity of breathlessness, which has been identified as a significant predictor of non-completion of PR programmes. This would also facilitate the introduction of individualised PR programmes to enhance adherence, as recommended by The UK National Audit on PR. This study showed that on completion of PR, the SGRQ demonstrates a greater responsiveness with COPD patients, especially in relation to the mMRC 3-4 category, whilst both the CAT and SGRQ show comparable responsiveness on follow up.
Featured Image
Why is it important?
The need to select an appropriate tool to evaluate health status is of importance as it well documented that a poor health status is associated with adverse outcomes amongst which depression. In addition , depression has been demonstrated to be a significant predictor of non-completion of pulmonary rehabilitation programmes, which are so essential in the care of persons with COPD. Thus, the present study highlights the greater responsiveness of the SGRQ relative to the CAT, in particular with patients having severe dyspnoea at the end of the PR programme. Whilst a similar level of responsiveness, for both the CAT and SGRQ, were obtained at the 28 week follow-up period. Hence, by identifying changes in health status in such patients, one may provide individualised programmes which are responsive to their needs.
Perspectives
The present study contributes to available literature by comparing the responsiveness of the CAT and SGRQ by severity of dyspnoea category. Furthermore the present study has demonstrated that the specific domains of the SGRQ also show good responsiveness, hence providing the clinician with information regarding changes experienced in relation to symptoms, activity and impact of the disease. The present study has identified that at the end of the 12 week PR programme, the impact domain showed the highest responsiveness and the activity domain the least responsiveness by total sample and for the mMRC 1-2 category (mild-moderate dyspnoea). However, for participants in the severe-very severe dyspnoea category (mMRC 3-4) the symptom domain showed the highest responsiveness (ES=0.85) and the activity domain (ES=0.76) showed the least responsiveness. This is of importance as severity of breathlessness is a predictor of non–adherence to PR programmes and hence, the use of the SGRQ enables the clinician to assess any symptoms which might gauge the progression of treatment for that patient. Moreover, the levels of various symptoms experienced by COPD patients can be predictors for COPD exacerbations and increased risk of mortality Thus, the findings from this study demonstrate that although both tools have good responsiveness at the end of PR, the SGRQ provides an additional advantage of displaying a greater responsiveness, especially in relation to patients with severe-very severe dyspnoea (mMRC3-4). This identification of a tool which can detect a change in health status is of importance,
Anabel Sciriha
University of Malta
Read the Original
This page is a summary of: Health status of COPD patients undergoing pulmonary rehabilitation: A comparative responsiveness of the CAT and SGRQ, Chronic Respiratory Disease, March 2017, SAGE Publications,
DOI: 10.1177/1479972317694622.
You can read the full text:
Contributors
The following have contributed to this page
