Skip to main content

Advertisement

SpringerLink
Log in

Measuring Patient and Clinician Perspectives to Evaluate Change in Health-Related Quality of Life Among Patients with Chronic Obstructive Pulmonary Disease

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

Context

Many treatments aim to improve patients’ health-related quality of life (HRQoL), and many care guidelines suggest assessing symptoms and their impact on HRQoL. However, there is a lack of consensus regarding which HRQoL outcome measures are appropriate to assess, and how much change on those measures depict significant HRQoL improvement.

Objective

We used triangulation methods to identify and understand clinically important differences (CIDs) for the amount of change in HRQoL that reflects both health professionals and patients’ values, among patients with chronic obstructive pulmonary disease (COPD).

Design, Setting, and Participants

We incorporated three perspectives: (1) an expert panel of physicians familiar with the measurement of HRQoL in COPD patients; (2) 610 primary care COPD outpatients who completed baseline and bimonthly follow-up HRQoL interviews over the 12-month study; and (3) the primary care physicians (PCPs; n = 43) of these outpatients who assessed their patients’ disease at baseline and at subsequent PCP visits during the year long study.

Measurements

The Chronic Respiratory Disease Questionnaire (CRQ), the Medical Outcomes Study Short Form 36-item survey (SF-36, version 2.0), and global assessments of change from each of the three perspectives for all HRQoL domains.

Results

With few exceptions, the CRQ was able to detect small changes at levels reported by the patients (1–2 points) and their PCPs (1–5 points). These results confirm minimal important difference standards developed in 1989 by Jaeschke et al. anchored on patient-perceived changes in HRQoL. In general, the expert panel and PCP CIDs were larger than the patient CIDs.

Conclusion

This triangulation methodology yielded improved interpretation, understanding, and insights on stakeholder perspectives of CIDs for patient-reported outcomes.

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

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. Food and Drug Administration. Innovation or Stagnation: Challenges And Opportunities on the Critical Path to New Medical Products. Washington, DC: US Department of Health and Human Services; March 2004.

  2. Schunemann H, Guyatt GH. Commentary—goodbye M(C)ID! Hello MID, where do you come from? Health Serv Res. 2005;40(2):593.

    Article  PubMed  Google Scholar 

  3. 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 

  4. Global Initiative for Chronic Obstructive Lung Disease (GOLD). http://www.goldcopd.com; October 26, 2001.

  5. 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.

    PubMed  CAS  Google Scholar 

  6. Ware J, Kosinski M, Dewey J. How to Score Version Two of the SF-36 Health Survey. Lincoln, RI: QualityMetric Inc.; 2000.

    Google Scholar 

  7. Lacasse Y, Wong E, Guyatt G. A systematic overview of the measurement properties of the chronic respiratory questionnaire. Can Respir J. 1997;4(3):131–9.

    Google Scholar 

  8. Schunemann H, Griffith L, Jaeschke R, et al. A comparison of the original chronic respiratory questionnaire with a standardized version. Chest. 2003;124(4):1421–9.

    Article  PubMed  Google Scholar 

  9. 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(9):861–73.

    Article  PubMed  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  11. Patrick D, Deyo R. Generic and disease-specific measures in assessing quality of life. Med Care. 1989;27:S217–32.

    Article  PubMed  CAS  Google Scholar 

  12. Wyrwich K, Fihn S, Tierney W, Kroenke K, Babu A, Wolinsky F. Clinically important differences in health-related quality of life for patients with chronic obstructive pulmonary disease: an expert panel report. J Gen Intern Med. 2003;18(3):196–202.

    Article  PubMed  Google Scholar 

  13. Cella D, Hahn EA, Dineen K. Meaningful change in cancer-specific quality of life scores: differences between improvement and worsening. Qual Life Res. 2002;11:207–21.

    Article  PubMed  Google Scholar 

  14. Wyrwich KW, Tierney WM, Babu AN, Kroenke K, Wolinsky FD. A comparison of clinically important differences in health-related quality of life for patients with chronic lung disease, asthma, or heart disease. Health Serv Res. 2005;40(2):577–92.

    Article  PubMed  Google Scholar 

  15. Curtis JR, Patrick DL. The assessment of health status among patients with COPD. Eur Respir J. 2003;21:36S–45S.

    Article  Google Scholar 

  16. Webster GD. Final Report of the ABIM Patient Satisfaction Project. Philadelphia: American Board of Internal Medicine; 1988.

  17. McHorney CA, Lerner J. The 1990 NORC National Health Survey: Documentation and Codebook. Chicago: National Opinion Research Council; 1991.

    Google Scholar 

  18. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32:705–14.

    Article  PubMed  CAS  Google Scholar 

  19. Mirowsky J, Ross CE. Eliminating defense and agreement bias from measures of the sense of control: a 2 × 2 index. Soc Psychol Q. 1991;54:127–45.

    Article  Google Scholar 

  20. Fetzer Institute. Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research. Kalamazoo: John E. Fetzer Institute; 1999.

    Google Scholar 

  21. 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 

  22. Statistical Package for the Social Sciences. SPSS for Windows, release 13.0.0. Chicago: SPSS, Inc.; 2005.

    Google Scholar 

  23. Streiner D, Norman G. Reliability. In: Health Measurement Scales, 3rd edn., Chap. 8. Oxford: Oxford University Press; 2003.

  24. Jones G, Jenkinson C, Kennedy S. Evaluating the responsiveness of the endometriosis health profile questionnaire: the EHP-30. Qual Life Res. 2004;13:705–13.

    Article  PubMed  Google Scholar 

  25. Singh S, Sodergren S, Hyland M, Williams J, Morgan M. A comparison of three disease-specific and two generic health-status measures to evaluate the outcome of pulmonary rehabilitation in COPD. Respir Med. 2001;95:71–7.

    Article  PubMed  CAS  Google Scholar 

  26. Juniper E, Price D, Stampone P, Creemers J, Mol S, Fireman P. Clinically important improvements in asthma-specific quality of life, but no difference in conventional clinical indexes in patients changed from conventional beclomethasone dipropionate to approximately half the dose of extrafine beclomethasone dipropionate. Chest. 2002;121:1824–32.

    Article  PubMed  CAS  Google Scholar 

  27. Chauhan C, Eppard W, Perroti J. The patient advocate perspective on assessing the clinical significance for quality-of-life measures. J Cancer Integr Med. 2004;2(4):155–7.

    Google Scholar 

  28. Naylor CD, Llewellyn-Thomas HA. Can there be a more patient-centred approach to determining clinically important effect sizes for randomised trials? J Clin Epidemiol. 1994;47:787–95.

    Article  PubMed  CAS  Google Scholar 

  29. 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(8):869–79.

    Article  PubMed  CAS  Google Scholar 

  30. Guyatt G, Norman G, et al. A critical look at transition ratings. J Clin Epidemiol. 2002;55:900–8.

    Article  PubMed  Google Scholar 

  31. Stratford P, Binkley J, Solomon P, et al. Defining the minimal level of detectable change for the Roland Morris Questionnaire. Phys Ther. 1996;76:359–65.

    PubMed  CAS  Google Scholar 

  32. Schwartz C, Sprangers M. Methodological approaches for assessing response shift in longitudinal health-related quality-of-life research. Soc Sci Med. 1999;48:1531–48.

    Article  PubMed  CAS  Google Scholar 

  33. Pulmonary Allergy Drugs Advisory Committee. New Drug Application (NDA) 21-395, Spiriva (Tiotropium bromide). Gaithersburg, MD: Food and Drug Administration; 2002.

    Google Scholar 

Download references

Acknowledgement

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

Potential Financial Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Research Methodology and Health Services Research, Saint Louis University, 3750 Lindell Blvd., McGannon Hall, Room 230, St. Louis, MO, 63108, USA

    Kathleen W. Wyrwich PhD

  2. Saint Louis University School of Public Health, St. Louis, MO, USA

    Kathleen W. Wyrwich PhD & Fredric D. Wolinsky PhD

  3. Department of Health, West Chester University, West Chester, PA, USA

    Stacie M. Metz MPH

  4. Regrenstrief Institute for Health Care, Indianapolis, IN, USA

    Kurt Kroenke MD & William M. Tierney MD

  5. Indiana University School of Medicine, Indianapolis, IN, USA

    Kurt Kroenke MD & William M. Tierney MD

  6. Veterans Administration Medical Center, St. Louis, MO, USA

    Ajit N. Babu MBBS, MPH

  7. Amrita Institute of Medical Sciences, Kochi, India

    Ajit N. Babu MBBS, MPH

  8. Health Management and Policy, University of Iowa, Iowa City, IA, USA

    Fredric D. Wolinsky PhD

  9. Health Services Research, Veterans Affairs Medical Center, Iowa City, IA, USA

    Fredric D. Wolinsky PhD

Authors
  1. Kathleen W. Wyrwich PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stacie M. Metz MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kurt Kroenke MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. William M. Tierney 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.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wyrwich, K.W., Metz, S.M., Kroenke, K. et al. Measuring Patient and Clinician Perspectives to Evaluate Change in Health-Related Quality of Life Among Patients with Chronic Obstructive Pulmonary Disease. J GEN INTERN MED 22, 161–170 (2007). https://doi.org/10.1007/s11606-006-0063-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-006-0063-6

Key words

Search

Navigation