Quality of Life Research

, Volume 24, Issue 4, pp 999–1009 | Cite as

Correlation of PROMIS scales and clinical measures among chronic obstructive pulmonary disease patients with and without exacerbations

  • Debra E. IrwinEmail author
  • Charles A. AtwoodJr.
  • Ron D. Hays
  • Karen Spritzer
  • Honghu Liu
  • James F. Donohue
  • Nancy Kline Leidy
  • Susan E. Yount
  • Darren A. DeWalt



The Patient-Reported Outcomes Measurement Information System (PROMIS®) initiative was developed to advance the methodology of PROs applicable to chronic diseases. Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease associated with poor health. This study was designed to examine the correlation of PROMIS health-related quality of life (HRQOL) scales and clinical measures among COPD patients.


A cross-sectional analysis was conducted comparing patients who were stable (n = 100) with those currently experiencing a COPD exacerbation (n = 85). All PROMIS measures for adults available at the time of the study (2008), disease-targeted and other HRQOL instruments, health literacy, percent predicted FEV1, and a 6-min walk distance were assessed when patients were considered clinically stable.


Stable COPD patients reported significantly (p ≤ 0.05) better health-related quality of life on PROMIS domains than patients experiencing an exacerbation. PROMIS domain scores were significantly (p ≤ 0.01) correlated with each of legacy measures. Six-min walk scores were most highly correlated with the PROMIS physical function domain scores (r = 0.53) followed by the fatigue (r = −0.26), social (r = 0.24) and to a lesser extent depression (r = −0.23), and anxiety (r = −0.22) domain scores. Percent predicted FEV1 score was significantly associated with PROMIS physical function scores (r = 0.27).


This study provides support for the validity of the PROMIS measures in COPD patients.


Patient-reported outcomes Health-related quality of life Chronic obstructive pulmonary disease 



Activities of daily living


Body mass index


Computerized adaptive testing


Chronic obstructive pulmonary disease


Discretionary social activities


Emergency room


EXAcerbations of Chronic pulmonary disease Tool—Patient Reported Outcomes


Functional assessment of chronic illness therapy


Forced expiratory volume in 1 s


Global initiative for chronic obstructive lung disease


Health-related quality of life


Institutional Review Board


Item response theory


National Institutes of Health


Medical Research Council Dyspnea Scale


Patient Reported Outcomes


Patient Reported Outcomes Measurement Information System


Pittsburgh Sleep Quality Index


St. George’s Respiratory Questionnaire


Social roles


Short test of functional health literacy in adults



This work was supported by the National Institutes of Health [Grants U01AR052181 and U01AR052177]. The patient-reported outcomes measurement information system (PROMIS) is an NIH Roadmap initiative to develop a computerized system measuring PROs in respondents with a wide range of chronic diseases and demographic characteristics. PROMIS II was funded by cooperative agreements with a Statistical Center (Northwestern University, PI: David Cella, PhD, 1U54AR057951), a Technology Center (Northwestern University, PI: Richard C. Gershon, PhD, 1U54AR057943), a Network Center (American Institutes for Research, PI: Susan (San) D. Keller, PhD, 1U54AR057926), and thirteen Primary Research Sites which may include more than one institution (State University of New York, Stony Brook, PIs: Joan E. Broderick, PhD and Arthur A. Stone, PhD, 1U01AR057948; University of Washington, Seattle, PIs: Heidi M. Crane, MD, MPH, Paul K. Crane, MD, MPH, and Donald L. Patrick, PhD, 1U01AR057954; University of Washington, Seattle, PIs: Dagmar Amtmann, PhD and Karon Cook, PhD, 1U01AR052171; University of North Carolina, Chapel Hill, PI: Darren A. DeWalt, MD, MPH, 2U01AR052181; Children’s Hospital of Philadelphia, PI: Christopher B. Forrest, MD, PhD, 1U01AR057956; Stanford University, PI: James F. Fries, MD, 2U01AR052158; Boston University, PIs: Stephen M. Haley, PhD and David Scott Tulsky, PhD (University of Michigan, Ann Arbor), 1U01AR057929; University of California, Los Angeles, PIs: Dinesh Khanna, MD and Brennan Spiegel, MD, MSHS, 1U01AR057936; University of Pittsburgh, PI: Paul A. Pilkonis, PhD, 2U01AR052155; Georgetown University, PIs: Carol. M. Moinpour, PhD (Fred Hutchinson Cancer Research Center, Seattle) and Arnold L. Potosky, PhD, U01AR057971; Children’s Hospital Medical Center, Cincinnati, PI: Esi M. Morgan DeWitt, MD, MSCE, 1U01AR057940; University of Maryland, Baltimore, PI: Lisa M. Shulman, MD, 1U01AR057967; and Duke University, PI: Kevin P. Weinfurt, PhD, 2U01AR052186). NIH Science Officers on this project have included Deborah Ader, PhD, Vanessa Ameen, MD, Susan Czajkowski, PhD, Basil Eldadah, MD, PhD, Lawrence Fine, MD, DrPH, Lawrence Fox, MD, PhD, Lynne Haverkos, MD, MPH, Thomas Hilton, PhD, Laura Lee Johnson, PhD, Michael Kozak, PhD, Peter Lyster, PhD, Donald Mattison, MD, Claudia Moy, PhD, Louis Quatrano, PhD, Bryce Reeve, PhD, William Riley, PhD, Ashley Wilder Smith, PhD, MPH, Susana Serrate-Sztein,MD, Ellen Werner, PhD, and James Witter, MD, PhD. This manuscript was reviewed by PROMIS reviewers before submission for external peer review. See the Web site at for additional information on the PROMIS initiative.

Conflict of interest



  1. 1.
    Ader, D. N. (2007). Developing the patient-reported outcomes measurement information system (PROMIS). Medical Care, 45(Suppl 1), S1–S2.CrossRefGoogle Scholar
  2. 2.
  3. 3.
    Center for disease control. Accessed August 2014.
  4. 4.
  5. 5.
    Schmier, J. K., Halpern, M. T., Higashi, M. K., & Bakst, A. (2005). The quality of life impact of acute exacerbations of chronic bronchitis (AECB): a literature review. Quality of Life Research, 14(2), 329–347.CrossRefPubMedGoogle Scholar
  6. 6.
    Doll, H., Grey-Amante, P., Duprat-Lomon, I., Sagnier, P. P., Thate-Waschke, I., Lorenz, J., et al. (2002). Quality of life in acute exacerbation of chronic bronchitis: results from a German population study. Respiratory Medicine, 96(1), 39–51.CrossRefPubMedGoogle Scholar
  7. 7.
    Doll, H., Duprat-Lomon, I., Ammerman, E., & Sagnier, P.-P. (2003). Validity of the St George’s respiratory questionnaire at acute exacerbation of chronic bronchitis: comparison with the nottingham health profile. Quality of Life Research, V12(2), 117–132.CrossRefGoogle Scholar
  8. 8.
    Paterson, C., Langan, C. E., McKaig, G. A., Anderson, P. M., Maclaine, G. D., Rose, L. B., et al. (2000). Assessing patient outcomes in acute exacerbations of chronic bronchitis: the measure your medical outcome profile (MYMOP), medical outcomes study 6-item general health survey (MOS-6A) and EuroQol (EQ-5D). Quality of Life Research, V9(5), 521–527.CrossRefGoogle Scholar
  9. 9.
    Yohannes, A. M., Roomi, J., Baldwin, R. C., & Connolly, M. J. (1998). Depression in elderly outpatients with disabling chronic obstructive pulmonary disease. Age and Ageing, 27(2), 155–160.CrossRefPubMedGoogle Scholar
  10. 10.
    Wamboldt, F. S. (2005). Anxiety and depression in COPD: a call (and need) for further research. Copd: Journal of Chronic Obstructive Pulmonary Disease, 2(2), 199–201.CrossRefPubMedGoogle Scholar
  11. 11.
    Kapella, M. C., Larson, J. L., Patel, M. K., Covey, M. K., & Berry, J. K. (2006). Subjective fatigue, influencing variables, and consequences in chronic obstructive pulmonary disease. Nursing Research, 55(1), 10–17.CrossRefPubMedGoogle Scholar
  12. 12.
    Guyatt, G. H., Berman, L. B., Townsend, M., Pugsley, S. O., & Chambers, L. W. (1987). A measure of quality of life for clinical trials in chronic lung disease. Thorax, 42(10), 773–778.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Reardon, J. Z., Lareau, S. C., & ZuWallack, R. (2006). Functional status and quality of life in chronic obstructive pulmonary disease. The American Journal of Medicine., 119(10, Suppl 1), 32–37.CrossRefPubMedGoogle Scholar
  14. 14.
    Pauwels, R. A., Buist, A. S., Calverley, P. M. A., Jenkins, C. R., & Hurd, S. S. (2001). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO global initiative for chronic obstructive lung disease (GOLD) workshop summary. American Journal of Respiratory and Critical Care Medicine, 163(5), 1256–1276.CrossRefPubMedGoogle Scholar
  15. 15.
    Rabe, K. F., Hurd, S., Anzueto, A., Barnes, P. J., Buist, S. A., Calverley, P., et al. (2007). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American Journal of Respiratory and Critical Care Medicine, 176(6), 532–555.CrossRefPubMedGoogle Scholar
  16. 16.
    Vestbo, J. (2004). The TORCH (towards a revolution in COPD health) survival study protocol. European Respiratory Journal, 24(2), 206–210.CrossRefPubMedGoogle Scholar
  17. 17.
    Calverley, P., Pauwels, R., Vestbo, J., Jones, P., Pride, N., Gulsvik, A., et al. (2003). Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomised controlled trial. Lancet, 361(9356), 449–456.CrossRefPubMedGoogle Scholar
  18. 18.
    St. George’s respiratory questionnaire website. Accessed August 2014.
  19. 19.
    Bestalib, J. C., Paula, E. A., Garroda, R., Garnhamma, R., Jones, P. W., & Wedzicha, J. A. (1999). Usefulness of the Medical Research Council (MRC) dyspnoea scale as measure of disability in patients with chronic obstructive pulmonary disease. Thorax, 54, 581–586.CrossRefGoogle Scholar
  20. 20.
    Hinchcliff, M., Beaumont, J. L., Thavarajah, K., Varga, J., Chung, A., Podlusky, S., et al. (2011). Validity of two new patient-reported outcome measures in systemic sclerosis: patient-reported outcomes measurement information system 29-item health profile and functional assessment of chronic illness therapy-dyspnea short form. Arthritis Care Research (Hoboken)., 63(11), 1620–1628.CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Leidy, N. K., Wilcox, T., Jones, P. W., Murray, L., Winnette, R., Howard, K., et al. (2010). Development of the EXAcerbations of chronic obstructive pulmonary disease tool (EXACT): a patient-reported outcome measure. Value in Health., 13(8), 965–975.CrossRefPubMedGoogle Scholar
  22. 22.
    Leidy NK, Wilcox T, Jones PW, Roberts L, Powers J, Sethi S. and the EXACT-PRO Study Group. (2011). Standardizing measurement of COPD exacerbations: reliability and validity of a patient-reported diary. American Journal of Respiratory and Critical Care Medicine, 183(3), 287–288.Google Scholar
  23. 23.
    Jones, PW, Chen WH, Wilcox T, Sethi S, Leidy NK for the EXACT-PRO Study Group. (2010). Characterizing and quantifying the symptomatic features of COPD exacerbations. Chest, 139(6), 1388–94.Google Scholar
  24. 24.
    Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.CrossRefPubMedGoogle Scholar
  25. 25.
    Reybrouck, T. (2003). Clinical usefulness and limitations of the 6-minute walk test in patients with cardiovascular or pulmonary disease. Chest, 123, 325–327.CrossRefPubMedGoogle Scholar
  26. 26.
    Ingle, L., Rigmy, A.S., Carroll, S., Butterly, R., King, R.F., Cooke, C.B., Cleland, J.G.J.F., Clark, A.L. (2007). Prognostic value of the 6 minute walk test and self-perceived symptom severity in older patients with chronic heart failure. European Heart Journal, 28(5), 560–568.Google Scholar
  27. 27.
    Baker, D. W., Williams, M. V., Parker, R. M., Gazmararian, J. A., & Nurss, J. (1999). Development of a brief test to measure functional health literacy. Patient Education and Counseling, 38, 33–42.CrossRefPubMedGoogle Scholar
  28. 28.
    Rothrock, N. E., Hays, R. D., Spritzer, K., Yount, S. E., Riley, W., & Cella, D. (2010). Relative to the general US population, chronic diseases are associated with poorer health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). Journal of Clinical Epidemiology., 63, 1195–1204.CrossRefPubMedCentralPubMedGoogle Scholar
  29. 29.
    Fan, V. S., Curtis, J. R., Tu, S. P., McDonell, M. B., & Fihn, D. S. (2002). Using quality of life to predict hospitalization and mortality in patients with obstructive lung diseases. Chest, 122(2), 429–436.CrossRefPubMedGoogle Scholar
  30. 30.
    Almagro, P., Calbo, E., de Echaguen, A. O., Barreiro, B., Quintana, S., Heredia, J. L., et al. (2002). Mortality after hospitalization for COPD. Chest Journal, 121(5), 1441–1448.CrossRefGoogle Scholar
  31. 31.
    Yeo, J., Karimova, G., & Bansal, S. (2006). Co-morbidity in older patients with COPD—its impact on health service utilization and quality of life, a community study. Age and Ageing, 35, 33–37.CrossRefPubMedGoogle Scholar
  32. 32.
    Tsiligianni, I., Kocks, J., Tzanakis, N., Siafakas, N., & van der Molen, T. (2011). Factors that influence disease-specific quality of life or health status in patients with COPD: a systematic review and meta-analysis of pearson correlations. Primary Care Respiratory Journal, 20(3), 257–268.CrossRefPubMedGoogle Scholar
  33. 33.
    Kaplan, R. M., Ries, A. L., Reilly, J., & Mohsenifar, Z. (2004). Measurement of health-related quality of life in the national emphysema treatment trial. Chest, 126(3), 781–789.CrossRefPubMedGoogle Scholar
  34. 34.
    Pereira, E. D. B., Pinto, R., Alcantara, M., & Medeiros, M. (2009). Influence of respiratory runction parameters on the quality of life of COPD patients. Jornal Brasileiro de Pneumologia, 35(8), 730–736.CrossRefPubMedGoogle Scholar
  35. 35.
    Pickard, A. S., Yang, Y., Lee, T. A. (2011). Comparison of health-related quality of life measures in chronic obstructive pulmonary disease. Health and Qual Life Outcomes, 9(26), 1–6.Google Scholar
  36. 36.
    Paap, M. C. S., Bode, C., Lenferink, L. I. M., Groen, L. C., Terwee, C. B., Ahmed, S., et al. (2014). Identifying key domains of health-related quality of life for patients with chronic obstructive pulmonary disease: the patient perspective. Health Qual Life Outcomes, 12, 106.CrossRefPubMedCentralPubMedGoogle Scholar
  37. 37.
    Lin, F. J., Pickard, A. S., Krishnan, J. A., Joo, M. J., Au, D. H., Carson, S. S., et al. (2014). Measuring health-related quality of life in chronic obstructive pulmonary disease: properties of the EQ-5D-%L and PROMIS-43 short form. BMC Medical Research Methodology, 14, 78.CrossRefPubMedCentralPubMedGoogle Scholar
  38. 38.
    Meguro, M., Barley, E. A., Spencer, S., & Jones, P. W. (2006). Development and validation of an improved COPD-specific version of the St George’s respiratory questionnaire. Chest, 132, 456–463.CrossRefGoogle Scholar
  39. 39.
    Cella, D., Gershon, R., Lai, J. S., & Choi, S. (2007). The future of outcomes measurement: item banking, tailored short-forms, and computerized adaptive assessment. Quality of Life Research, 16(Suppl1), 131–141.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Debra E. Irwin
    • 1
    Email author
  • Charles A. AtwoodJr.
    • 2
  • Ron D. Hays
    • 3
  • Karen Spritzer
    • 3
  • Honghu Liu
    • 4
  • James F. Donohue
    • 5
  • Nancy Kline Leidy
    • 6
  • Susan E. Yount
    • 7
  • Darren A. DeWalt
    • 8
  1. 1.Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina–Chapel HillChapel HillUSA
  2. 2.Division of Pulmonary MedicineUniversity of Pittsburgh and the Pittsburgh Veterans Affairs Medical CenterPittsburghUSA
  3. 3.Department of MedicineUniversity of California, Los AngelesLos AngelesUSA
  4. 4.Department of DentistryUniversity of California, Los AngelesLos AngelesUSA
  5. 5.Division of Pulmonary MedicineUniversity of North Carolina School of Medicine–Chapel HillChapel HillUSA
  6. 6.United Biosource CorporationBethesdaUSA
  7. 7.Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoUSA
  8. 8.Division of General Medicine and Clinical Epidemiology and the Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina School of MedicineChapel HillUSA

Personalised recommendations