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Mike Morgan - One of the best experts on this subject based on the ideXlab platform.
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A self-management programme of activity coping and education (SPACE) for COPD: 6 week results from a randomised controlled trial
European Respiratory Journal, 2012Co-Authors: Katy Wagg, Mike Morgan, Louise Sewell, Vicki Warrington, Lindsay Apps, John Bankart, Mc Steiner, Sally SinghAbstract:Introduction: SPACE for COPD is a self-management programme which individuals follow independently with telephone support. Objective: To test the effectiveness of SPACE on health related quality of life (HRQoL) and exercise capacity compared with usual GP care at 6 weeks. Methods: 184 patients with COPD [101male; mean (SD) age 69(9.19) yrs; FEV 1 1.45(0.56) l; BMI 27.56(5.2)] were recruited from primary care and randomised to SPACE or usual care. Blinded measurements were taken at baseline and 6 weeks and included Chronic Respiratory Questionnaire-SR [CRQ-dyspnoea (primary outcome)], Incremental Shuttle Walk Test (ISWT), Endurance Shuttle Walk Test (ESWT), and the Hospital Anxiety Depression Scale (HADS). Results: See Table1 Conclusion: SPACE is effective in improving HRQoL and exercise capacity, when compared with usual care. SPACE could be used to facilitate self-management of patients with COPD in primary care.
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Evaluation of Patient-Reported Outcomes and Quality of Life with the I-neb AAD System in Patients with Chronic Obstructive Pulmonary Disease
Journal of Aerosol Medicine and Pulmonary Drug Delivery, 2010Co-Authors: Nicola Goodman, Mike Morgan, Kurt Nikander, Sarah Hinch, Steven CoughlinAbstract:Abstract Background: The I-neb Adaptive Aerosol Delivery (AAD) System is a novel portable mesh nebulizer that provides patient feedback regarding adherence to prescribed treatment and compliance with the correct use of the device. Methods: This multicenter study was composed of 98 patients aged 53–80 years with Chronic Obstructive Pulmonary Disease (COPD). The primary variables were ease of use and satisfaction, which were assessed after 3 months of use of the I-neb AAD System (assessed at visit 2) and after 3 months of use of the patient's previous nebulizer system (assessed at visit 1) using matched questions from pre- and poststudy Questionnaires. Quality of life was also assessed at visits 1 and 2 using the validated Chronic Respiratory Questionnaire (CRQ), which consists of dyspnea, emotional function, fatigue, and mastery domains. Differences in the distribution of responses between the pre- and poststudy ease of use and satisfaction questions were analyzed using the Marginal Homogeneity test. Diffe...
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Health status measurement: sensitivity of the self-reported Chronic Respiratory Questionnaire (CRQ-SR) in pulmonary rehabilitation
Thorax, 2003Co-Authors: Johanna Williams, Sonal Singh, Louise Sewell, Mike MorganAbstract:Background: A self-reported CRQ (CRQ-SR) has recently been developed and found to be a reproducible and reliable measure of health status. This study explores both the sensitivity of the CRQ-SR and relative sensitivity compared with the conventional interviewer led CRQ (CRQ-IL) in patients undergoing pulmonary rehabilitation. Methods: Eighty patients with stable Chronic obstructive pulmonary disease who had been referred for pulmonary rehabilitation completed the CRQ-SR at initial assessment and at the end of the 7 week programme. A further 35 patients completed both the CRQ-SR and the CRQ-IL, administered 1 week apart, before starting rehabilitation and again at the end of the programme. Results: There were large statistically and clinically significant changes in mean score per dimension following rehabilitation in all dimensions of the CRQ-SR (dyspnoea mean difference 0.87 (95% CI 0.61 to 1.14); fatigue 0.76 (0.53 to 1.0); emotion 0.60 (0.35 to 0.86); mastery 0.76 (0.52 to 1.0); p 0.05). Conclusion: The self-reported CRQ is as sensitive to change as the interviewer led CRQ in patients undergoing pulmonary rehabilitation but has the advantage of being less time consuming to administer.
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Development of a self-reported Chronic Respiratory Questionnaire (CRQ-SR)
Thorax, 2001Co-Authors: Johanna Williams, Gordon H. Guyatt, Sonal Singh, Louise Sewell, Mike MorganAbstract:BACKGROUND The Chronic Respiratory Questionnaire (CRQ) is an established measure of health status for Chronic obstructive pulmonary disease (COPD). It has been found to be reproducible and sensitive to change, but as an interviewer led Questionnaire is very time consuming to administer. A study was undertaken to develop a self-reported version of the CRQ (CRQ-SR) and to compare the results of this Questionnaire with the conventional interviewer led CRQ (CRQ-IL). METHODS Fifty two patients with moderate to severe COPD participated in the study. Subjects completed the CRQ-SR 1 week after completing the CRQ-IL, and a further CRQ-SR was administered 1 week later. For patients in group A (n=27) the dyspnoea provoking activities that they had previously selected were transcribed onto the second CRQ-SR, while patients in group B (n=25) were not informed of their previous dyspnoea provoking activities when they completed the second CRQ-SR. To assess the short term reproducibility and reliability of the CRQ-SR it was then administered twice at an interval of 7–10 days to a further group of 21 patients. The CRQ-IL was not administered. Longer term reproducibility was examined in 39 stable patients who completed the CRQ-SR at initial assessment and then again 7 weeks later. RESULTS Mean scores per dimension, mean differences, and limits of agreement are given for each dimension in the comparison of the two Questionnaires. There were no statistically significant differences between the CRQ-IL and CRQ-SR in the mastery and fatigue dimensions (p>0.05). A statistically significant difference between the two scores was found in the dyspnoea dimension (p=0.006) and the emotional function dimension (p=0.04), but these differences were well within the minimum clinically important threshold. No statistically significant difference in the mean dyspnoea score was seen between groups A and B. The CRQ-SR was found to be reproducible both in the short term and after the longer period of 7 weeks, with no statistically or clinically significant differences in any dimension. Test-retest reliability was found to be high in each dimension, both in the short and longer term. CONCLUSIONS The CRQ-SR is a reproducible, reliable, and stable measure of health status. It compares well with the CRQ-IL but cannot be used interchangeably. The main advantage of the CRQ-SR over the CRQ-IL is that is quick to administer, reducing assessment time and hence cost.
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A comparison of three disease-specific and two generic health-status measures to evaluate the outcome of pulmonary rehabilitation in COPD
Respiratory medicine, 2001Co-Authors: Sally Singh, Johanna Williams, Samantha C. Sodergren, Michael E. Hyland, Mike MorganAbstract:The use of health status as an outcome measure is becoming more widespread in pulmonary rehabilitation. There are a number of health status measures but the choice remains uncertain. Three disease specific measures and two generic measures of health status were employed to observe their relative sensitivity to a 7-week course of pulmonary rehabilitation. Patients with stable Chronic obstructive pulmonary disease (COPD) were recruited into a rehabilitation programme. They completed a shuttle-walking test and three disease-specific Questionnaires: the Chronic Respiratory Questionnaire (CRQ), the St. George's Hospital Respiratory Questionnaire (SGRQ) and the Breathing Problems Questionnaire (BPQ). Patients also completed two generic Questionnaires: a global quality-of-life scale and an activity checklist. Ninety-seven patients [58 male mean (SD) age 67 (8.7) years] completed the course over a 12-month period. The mean pre-rehabilitation (SD) FEV1 was 1.06 (0.59) l. The shuttle-walking test and the treadmill-endurance test increased significantly after rehabilitation (P
Gordon H. Guyatt - One of the best experts on this subject based on the ideXlab platform.
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the validity and sensitivity to change of the spanish self administered version of the Chronic Respiratory Questionnaire crq sas
Archivos De Bronconeumologia, 2011Co-Authors: Laura Vigil, Gordon H. Guyatt, Fatima Morante, Ma Rosa Guell, Elena Lopez De Santamaria, Francesca Sperati, Holger J SchunemannAbstract:Abstract Introduction The interviewer-administered Chronic Respiratory Questionnaire (CRQ-IA) is widely used and has demonstrated excellent properties for measuring health-related quality of life (HRQL) in patients with Chronic obstructive pulmonary disease (COPD). However, the self-administered version (CRQ-SAS) in Spanish has not been validated. The aim of this trial was to evaluate the validity and the sensitivity of the Spanish version of the CRQ-SAS in patients with COPD. Material and methods We randomized 40 patients with COPD (33 treated with pulmonary rehabilitation and 7 with liquid oxygen therapy) to one of the two methods of administration of CRQ (SAS vs IA) both before and 8 weeks after the treatment. In addition, patients completed the SF-36 Questionnaire, pulmonary function tests, and 6-min walk test. Results The CRQ-SAS demonstrated good longitudinal construct validity on all domains with a range of correlations, for the change scores, between 0.46 ( P =.05) and 0.71 ( P =.01). Regarding sensitivity to change, we observed a minimal clinically significant change in most domains (fatigue 0.71 [ P =.02], emotional factor 0.62 [ P =.04], and control of the disease 0.83 [ P =.06]). Conclusions The Spanish version of CRQ-SAS is valid for evaluating HRQL in COPD patients. The correlations of the CRQ-SAS with other tools provide construct validity and show good sensitivity to change.
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original articles the minimal detectable change cannot reliably replace the minimal important difference
2010Co-Authors: Dan Turner, Anne M Griffiths, Jeff Critch, Lauren Griffith, Dorcas E Beaton, Gordon H. GuyattAbstract:Objective: We compared the minimal important difference (MID) with the minimal detectable change (MDC) generated by distribution-based methods. Study Design: Studies of two quality-of-life instruments (Chronic Respiratory Questionnaire [CRQ] and Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ]) and two physician-rated disease-activity indices (Pediatric Ulcerative Colitis Activity Index [PUCAI] and Pediatric Crohn’s Disease Activity Index [PCDAI]) provided longitudinal data. The MID values were calculated from global ratings of change (small change for CRQ and RQLQ; moderate for PUCAI and PCDAI) using receiver-operating characteristic (ROC) curve and mean change. Results were compared with five distribution-based strategies. Results: Of the methods used to calculate the MDC, the 95% limits of agreement and the reliable change index yielded the largest estimates. In the patient-rated psychometric instruments, 0.5 SD was always greater than 1 standard error of measurements (SEM), and both fell between the mean change and the ROC estimates, on two of four occasions. The reliable change index came closest to MID of moderate change. Conclusion: For patient-rated psychometric instruments, 0.5 SD and 1 SEM provide values closest to the anchor-based estimates of MID derived from small change, and the reliable change index for physician-rated clinimetric indices based on moderate change. Lack of consistency across measures suggests that distribution-based approaches should act only as temporary substitutes, pending availability
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Effect of Oxygen on Health Quality of Life in Patients with Chronic Obstructive Pulmonary Disease with Transient Exertional Hypoxemia
American journal of respiratory and critical care medicine, 2007Co-Authors: Mika Nonoyama, Gordon H. Guyatt, Dina Brooks, Roger S GoldsteinAbstract:Rationale: Ambulatory oxygen improves acute exercise performance in people with Chronic obstructive pulmonary disease (COPD). This improvement may not translate into symptomatic benefit for patients during activities of daily living.Objectives: We undertook a series of individual randomized controlled trials (N-of-1 RCTs) to measure the effect of oxygen in patients with COPD who do not meet criteria for mortality reduction with long-term oxygen therapy.Methods: Twenty-seven patients completed blinded N-of-1 RCTs, each comprising three pairs of 2-week home treatment periods, with oxygen provided during one period of each pair and a placebo mixture during the other.Measurements and Main Results: Patients completed the Chronic Respiratory Questionnaire (CRQ), the St. George's Respiratory Questionnaire, and a home five-minute-walk test at the end of each period. We defined a positive response as a CRQ dyspnea score greater (less dyspnea) on oxygen than placebo during all three pairs of treatment periods, with...
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Relative responsiveness of the Chronic Respiratory Questionnaire, St. Georges Respiratory Questionnaire and four other health-related quality of life instruments for patients with Chronic lung disease
Respiratory medicine, 2006Co-Authors: Milo A Puhan, Lauren Griffith, Gordon H. Guyatt, Roger S Goldstein, Douglas A Mckim, Elisabeth Stahl, Jeff Mador, Holger J SchunemannAbstract:Summary Background Selection of heath-related quality of life (HRQL) instruments that are most responsive to changes in HRQL prevents investigators from drawing false-negative conclusions about the effectiveness of an intervention. The objective of this study was to compare the responsiveness of the Chronic Respiratory Questionnaire (CRQ), the St. Georges Respiratory Questionnaire (SGRQ) and four other HRQL instruments. Methods We enrolled 177 patients with Chronic lung disease, primarily COPD (93%), who completed 8 weeks of Respiratory rehabilitation. Patients completed the CRQ, the SGRQ and four generic measures (SF-36, Feeling Thermometer, Standard Gamble and Health Utilities index 3) at the beginning of the rehabilitation program and 12 weeks thereafter. We calculated standardized response means (SRMs) for each instrument, from the change score divided by the standard deviation of the change score. Results We observed the largest SRM for the CRQ (0.24–0.66 for the four CRQ domains on the interviewer-administered and 0.56–0.84 for the self-administered format) and the SGRQ (0.33–0.51 for the three SGRQ domains and total score). The CRQ dyspnea domain was statistically significantly more responsive than any other instrument including the SGRQ. For the SGRQ, the total and impacts domain were significantly more responsive than the generic and preference-based instruments. Conclusions This study confirms that the CRQ and SGRQ are substantially more responsive than generic measures, and suggests particularly strong responsiveness for the self-administered CRQ.
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Measurement properties and interpretability of the Chronic Respiratory disease Questionnaire (CRQ).
COPD, 2005Co-Authors: Holger J Schunemann, Roger S Goldstein, Milo A Puhan, Roman Jaeschke, Gordon H. GuyattAbstract:The Chronic Respiratory Questionnaire, available as an interviewer and a self-administered instrument, includes 20 items across four domains: dyspnea (5 items), fatigue (4 items), emotional function (7 items), and mastery (4 items). When completing this instrument, patients rate their experience on a 7-point scale ranging from 1 (maximum impairment) to 7 (no impairment). The Chronic Respiratory Questionnaire has demonstrated excellent measurement properties for both discriminative and evaluative purposes and served as a model in numerous methodological studies in Chronic airflow limitation and patients with Chronic obstructive pulmonary disease. We performed a systematic review of the literature on the Chronic Respiratory Questionnaire to summarize the key qualities of the Chronic Respiratory Questionnaire and to appraise the work regarding the minimal important difference of the Chronic Respiratory Questionnaire. This paper includes a revision of our initial definition of the minimal important difference and a methodological framework for using anchor based approaches to establish the minimal important difference pioneered by Jaeschke and colleagues. Other approaches to evaluate the minimal important difference include distribution-based methods and panel-based methods. Investigators have used all of these approaches to establish the minimal important difference for the Chronic Respiratory Questionnaire and the results are in general agreement with the minimal important difference of 0.5 for the mean domain scores of the Chronic Respiratory Questionnaire. As a result of this literature review and discussion at the workshop, we established several research objectives. These objectives include the exploration of presentation of quality of life information and prospective anchor-based approaches.
Holger J Schunemann - One of the best experts on this subject based on the ideXlab platform.
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the validity and sensitivity to change of the spanish self administered version of the Chronic Respiratory Questionnaire crq sas
Archivos De Bronconeumologia, 2011Co-Authors: Laura Vigil, Gordon H. Guyatt, Fatima Morante, Ma Rosa Guell, Elena Lopez De Santamaria, Francesca Sperati, Holger J SchunemannAbstract:Abstract Introduction The interviewer-administered Chronic Respiratory Questionnaire (CRQ-IA) is widely used and has demonstrated excellent properties for measuring health-related quality of life (HRQL) in patients with Chronic obstructive pulmonary disease (COPD). However, the self-administered version (CRQ-SAS) in Spanish has not been validated. The aim of this trial was to evaluate the validity and the sensitivity of the Spanish version of the CRQ-SAS in patients with COPD. Material and methods We randomized 40 patients with COPD (33 treated with pulmonary rehabilitation and 7 with liquid oxygen therapy) to one of the two methods of administration of CRQ (SAS vs IA) both before and 8 weeks after the treatment. In addition, patients completed the SF-36 Questionnaire, pulmonary function tests, and 6-min walk test. Results The CRQ-SAS demonstrated good longitudinal construct validity on all domains with a range of correlations, for the change scores, between 0.46 ( P =.05) and 0.71 ( P =.01). Regarding sensitivity to change, we observed a minimal clinically significant change in most domains (fatigue 0.71 [ P =.02], emotional factor 0.62 [ P =.04], and control of the disease 0.83 [ P =.06]). Conclusions The Spanish version of CRQ-SAS is valid for evaluating HRQL in COPD patients. The correlations of the CRQ-SAS with other tools provide construct validity and show good sensitivity to change.
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Relative responsiveness of the Chronic Respiratory Questionnaire, St. Georges Respiratory Questionnaire and four other health-related quality of life instruments for patients with Chronic lung disease
Respiratory medicine, 2006Co-Authors: Milo A Puhan, Lauren Griffith, Gordon H. Guyatt, Roger S Goldstein, Douglas A Mckim, Elisabeth Stahl, Jeff Mador, Holger J SchunemannAbstract:Summary Background Selection of heath-related quality of life (HRQL) instruments that are most responsive to changes in HRQL prevents investigators from drawing false-negative conclusions about the effectiveness of an intervention. The objective of this study was to compare the responsiveness of the Chronic Respiratory Questionnaire (CRQ), the St. Georges Respiratory Questionnaire (SGRQ) and four other HRQL instruments. Methods We enrolled 177 patients with Chronic lung disease, primarily COPD (93%), who completed 8 weeks of Respiratory rehabilitation. Patients completed the CRQ, the SGRQ and four generic measures (SF-36, Feeling Thermometer, Standard Gamble and Health Utilities index 3) at the beginning of the rehabilitation program and 12 weeks thereafter. We calculated standardized response means (SRMs) for each instrument, from the change score divided by the standard deviation of the change score. Results We observed the largest SRM for the CRQ (0.24–0.66 for the four CRQ domains on the interviewer-administered and 0.56–0.84 for the self-administered format) and the SGRQ (0.33–0.51 for the three SGRQ domains and total score). The CRQ dyspnea domain was statistically significantly more responsive than any other instrument including the SGRQ. For the SGRQ, the total and impacts domain were significantly more responsive than the generic and preference-based instruments. Conclusions This study confirms that the CRQ and SGRQ are substantially more responsive than generic measures, and suggests particularly strong responsiveness for the self-administered CRQ.
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a randomised trial to evaluate the self administered standardised Chronic Respiratory Questionnaire
European Respiratory Journal, 2005Co-Authors: Holger J Schunemann, Roger S Goldstein, M J Mador, Douglas A Mckim, Elisabeth Stahl, Milo A Puhan, Lauren E Griffith, Brydon J B Grant, Peggy Austin, R CollinsAbstract:The original Chronic Respiratory Questionnaire (CRQ), one of the most widely used measures of health-related quality of life (HRQL) in Chronic Respiratory disease (CRD), is traditionally interviewer administered (IA) and includes an individualised dyspnoea domain. The present authors studied the impact of self-administered (SA) and standardised dyspnoea questions on CRQ measurement properties. In a factorial design multicentre trial, 177 patients with CRD (mean age 67.7 yrs; mean forced expiratory volume in one second per cent predicted 44.6%) were randomised to CRQ-IA (n = 86) or CRQ-SA (n = 91), and to initially complete the standardised or individualised items before and after Respiratory rehabilitation. While maintaining validity, the CRQ-SA proved more responsive to changes in HRQL than the CRQ-IA in all domains. Compared with the standardised dyspnoea domain, the individualised dyspnoea domain indicated greater responsiveness. The correlations of baseline scores and change scores with other HRQL instruments indicated good validity of the CRQ-SA. In conclusion, self-administration and standardisation of the Chronic Respiratory Questionnaire maintains validity and responsiveness relative to the interviewer-administered Chronic Respiratory Questionnaire. These results challenge the assumption that interviewer-administered Questionnaires are superior to self-administered Questionnaires in older patients with Chronic Respiratory disease.
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Measurement properties and interpretability of the Chronic Respiratory disease Questionnaire (CRQ).
COPD, 2005Co-Authors: Holger J Schunemann, Roger S Goldstein, Milo A Puhan, Roman Jaeschke, Gordon H. GuyattAbstract:The Chronic Respiratory Questionnaire, available as an interviewer and a self-administered instrument, includes 20 items across four domains: dyspnea (5 items), fatigue (4 items), emotional function (7 items), and mastery (4 items). When completing this instrument, patients rate their experience on a 7-point scale ranging from 1 (maximum impairment) to 7 (no impairment). The Chronic Respiratory Questionnaire has demonstrated excellent measurement properties for both discriminative and evaluative purposes and served as a model in numerous methodological studies in Chronic airflow limitation and patients with Chronic obstructive pulmonary disease. We performed a systematic review of the literature on the Chronic Respiratory Questionnaire to summarize the key qualities of the Chronic Respiratory Questionnaire and to appraise the work regarding the minimal important difference of the Chronic Respiratory Questionnaire. This paper includes a revision of our initial definition of the minimal important difference and a methodological framework for using anchor based approaches to establish the minimal important difference pioneered by Jaeschke and colleagues. Other approaches to evaluate the minimal important difference include distribution-based methods and panel-based methods. Investigators have used all of these approaches to establish the minimal important difference for the Chronic Respiratory Questionnaire and the results are in general agreement with the minimal important difference of 0.5 for the mean domain scores of the Chronic Respiratory Questionnaire. As a result of this literature review and discussion at the workshop, we established several research objectives. These objectives include the exploration of presentation of quality of life information and prospective anchor-based approaches.
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Self-administration and interviewer-administration of the German Chronic Respiratory Questionnaire: instrument development and assessment of validity and reliability in two randomised studies
Health and Quality of Life Outcomes, 2004Co-Authors: Milo A Puhan, Gordon H. Guyatt, Michaela Behnke, Alfred Lichtenschopf, Otto Brändli, Martin Frey, Thomas Grueter, Holger J SchunemannAbstract:Background Assessment of health-related quality of life (HRQL) is important in patients with Chronic obstructive pulmonary disease (COPD). Despite the high prevalence of COPD in Germany, Switzerland and Austria there is no validated disease-specific instrument available. The objective of this study was to translate the Chronic Respiratory Questionnaire (CRQ), one of the most widely used Respiratory HRQL Questionnaires, into German, develop an interviewer- and self-administered version including both standardised and individualised dyspnoea questions, and validate these versions in two randomised studies. Methods We recruited three groups of patients with COPD in Switzerland, Germany and Austria. The 44 patients of the first group completed the CRQ during pilot testing to adapt the CRQ to German-speaking patients. We then recruited 80 patients participating in pulmonary rehabilitation programs to assess internal consistency reliability and cross-sectional validity of the CRQ. The third group consisted of 38 patients with stable COPD without an intervention to assess test-retest reliability. To compare the interviewer- and self-administered versions, we randomised patients in groups 2 and 3 to the interviewer- or self-administered CRQ. Patients completed both the standardised and individualised dyspnoea questions. Results For both administration formats and all domains, we found good internal consistency reliability (Crohnbach's alpha between 0.73 and 0.89). Cross-sectional validity tended to be better for the standardised compared to the individualised dyspnoea questions and cross-sectional validity was slightly better for the self-administered format. Test-retest reliability was good for both the interviewer-administered CRQ (intraclass correlation coefficients for different domains between 0.81 and 0.95) and the self-administered format (intraclass correlation coefficients between 0.78 and 0.86). Lower within-person variability was responsible for the higher test-retest reliability of the interviewer-administered format while between person variability was similar for both formats. Conclusions Investigators in German-speaking countries can choose between valid and reliable self-and interviewer-administered CRQ formats.
Johanna Williams - One of the best experts on this subject based on the ideXlab platform.
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Does body mass index influence the outcomes of a Waking-based pulmonary rehabilitation programme in COPD?
Chronic respiratory disease, 2012Co-Authors: Neil J. Greening, Johanna Williams, Sally Singh, Rachael A. Evans, Ruth H. Green, Michael C SteinerAbstract:Body mass index (BMI) is an important prognostic measure in Chronic obstructive pulmonary disease (COPD). However, its effects on pulmonary rehabilitation (PR) are unknown. This study aimed to evaluate the effectiveness of a walking-based PR programme across the BMI range and the impact of BMI on exercise performance and health status. A total of 601 patients with COPD completed a PR programme. The effects of BMI on exercise capacity (incremental and endurance shuttle walk tests (ISWT and ESWT)) and health status (Chronic Respiratory Questionnaire (CRQ)) before and after PR were evaluated. 16% of patients were underweight, with 53% overweight or obese. At baseline, the obese had worse ISWT (-54 m ± 14 m; p = 0.001) despite a higher predicted forced expiratory volume in 1 s (7.4m ± 1.6%; p 30, 65 m (p = < 0.001). All four domains of the CRQ increased above the level of clinical significance for all BMI categories (all p < 0.001). The majority of patients with COPD were overweight associated with a lower walking capacity. A walking-based PR programme was comparably effective across the BMI spectrum. Patients with COPD should be referred for standard PR, independent of BMI.
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Health status measurement: sensitivity of the self-reported Chronic Respiratory Questionnaire (CRQ-SR) in pulmonary rehabilitation
Thorax, 2003Co-Authors: Johanna Williams, Sonal Singh, Louise Sewell, Mike MorganAbstract:Background: A self-reported CRQ (CRQ-SR) has recently been developed and found to be a reproducible and reliable measure of health status. This study explores both the sensitivity of the CRQ-SR and relative sensitivity compared with the conventional interviewer led CRQ (CRQ-IL) in patients undergoing pulmonary rehabilitation. Methods: Eighty patients with stable Chronic obstructive pulmonary disease who had been referred for pulmonary rehabilitation completed the CRQ-SR at initial assessment and at the end of the 7 week programme. A further 35 patients completed both the CRQ-SR and the CRQ-IL, administered 1 week apart, before starting rehabilitation and again at the end of the programme. Results: There were large statistically and clinically significant changes in mean score per dimension following rehabilitation in all dimensions of the CRQ-SR (dyspnoea mean difference 0.87 (95% CI 0.61 to 1.14); fatigue 0.76 (0.53 to 1.0); emotion 0.60 (0.35 to 0.86); mastery 0.76 (0.52 to 1.0); p 0.05). Conclusion: The self-reported CRQ is as sensitive to change as the interviewer led CRQ in patients undergoing pulmonary rehabilitation but has the advantage of being less time consuming to administer.
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Development of a self-reported Chronic Respiratory Questionnaire (CRQ-SR)
Thorax, 2001Co-Authors: Johanna Williams, Gordon H. Guyatt, Sonal Singh, Louise Sewell, Mike MorganAbstract:BACKGROUND The Chronic Respiratory Questionnaire (CRQ) is an established measure of health status for Chronic obstructive pulmonary disease (COPD). It has been found to be reproducible and sensitive to change, but as an interviewer led Questionnaire is very time consuming to administer. A study was undertaken to develop a self-reported version of the CRQ (CRQ-SR) and to compare the results of this Questionnaire with the conventional interviewer led CRQ (CRQ-IL). METHODS Fifty two patients with moderate to severe COPD participated in the study. Subjects completed the CRQ-SR 1 week after completing the CRQ-IL, and a further CRQ-SR was administered 1 week later. For patients in group A (n=27) the dyspnoea provoking activities that they had previously selected were transcribed onto the second CRQ-SR, while patients in group B (n=25) were not informed of their previous dyspnoea provoking activities when they completed the second CRQ-SR. To assess the short term reproducibility and reliability of the CRQ-SR it was then administered twice at an interval of 7–10 days to a further group of 21 patients. The CRQ-IL was not administered. Longer term reproducibility was examined in 39 stable patients who completed the CRQ-SR at initial assessment and then again 7 weeks later. RESULTS Mean scores per dimension, mean differences, and limits of agreement are given for each dimension in the comparison of the two Questionnaires. There were no statistically significant differences between the CRQ-IL and CRQ-SR in the mastery and fatigue dimensions (p>0.05). A statistically significant difference between the two scores was found in the dyspnoea dimension (p=0.006) and the emotional function dimension (p=0.04), but these differences were well within the minimum clinically important threshold. No statistically significant difference in the mean dyspnoea score was seen between groups A and B. The CRQ-SR was found to be reproducible both in the short term and after the longer period of 7 weeks, with no statistically or clinically significant differences in any dimension. Test-retest reliability was found to be high in each dimension, both in the short and longer term. CONCLUSIONS The CRQ-SR is a reproducible, reliable, and stable measure of health status. It compares well with the CRQ-IL but cannot be used interchangeably. The main advantage of the CRQ-SR over the CRQ-IL is that is quick to administer, reducing assessment time and hence cost.
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A comparison of three disease-specific and two generic health-status measures to evaluate the outcome of pulmonary rehabilitation in COPD
Respiratory medicine, 2001Co-Authors: Sally Singh, Johanna Williams, Samantha C. Sodergren, Michael E. Hyland, Mike MorganAbstract:The use of health status as an outcome measure is becoming more widespread in pulmonary rehabilitation. There are a number of health status measures but the choice remains uncertain. Three disease specific measures and two generic measures of health status were employed to observe their relative sensitivity to a 7-week course of pulmonary rehabilitation. Patients with stable Chronic obstructive pulmonary disease (COPD) were recruited into a rehabilitation programme. They completed a shuttle-walking test and three disease-specific Questionnaires: the Chronic Respiratory Questionnaire (CRQ), the St. George's Hospital Respiratory Questionnaire (SGRQ) and the Breathing Problems Questionnaire (BPQ). Patients also completed two generic Questionnaires: a global quality-of-life scale and an activity checklist. Ninety-seven patients [58 male mean (SD) age 67 (8.7) years] completed the course over a 12-month period. The mean pre-rehabilitation (SD) FEV1 was 1.06 (0.59) l. The shuttle-walking test and the treadmill-endurance test increased significantly after rehabilitation (P
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Respiratory Questionnaires in COPD
Thorax, 2000Co-Authors: Johanna Williams, Sally Singh, Mike MorganAbstract:The use of health status as an outcome measure in Chronic obstructive pulmonary disease (COPD) is becoming more popular. We therefore welcome the publication of information which improves the choice of appropriate Questionnaire. The recent paper by Rutten-van Molken and colleagues could have made an important contribution to this area.1 However, we are seriously concerned about the validity of their comparison between the St George's Questionnaire (SGRQ) and the Chronic Respiratory Questionnaire (CRQ). The clinical usefulness of the CRQ is limited because it is interviewer led while the SGRQ is self-administered. The development of a validated self-administered …
Sally Singh - One of the best experts on this subject based on the ideXlab platform.
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Results of the SPACE FOR COPD programme in comparison to pulmonary rehabilitation at 6 months
European Respiratory Journal, 2014Co-Authors: Elizabeth Horton, Katy E. Mitchell, Vicki Johnson-warrington, Lindsey Apps, Hannah Young, Sally SinghAbstract:Home based self management (SM) rehabilitation programmes for patients with COPD offer an alternative to pulmonary rehabilitation (PR). There is a lack of evidence of such programmes and furthermore how effective they are in maintaining change compared to PR. We have developed a manual based SM programme for patients with COPD and aim to assess the effectiveness of the SPACE for COPD programme at 6 months. 145 patients (95 males: mean (SD) age 68 (9) yrs; FEV1 pred 47% (18%)) with COPD were randomised to SPACE or PR. Those in the SPACE group received an introduction to SPACE and 2 telephone calls. PR received 14, 2 hour sessions of education and exercise over 7 weeks. The primary outcome was Chronic Respiratory Questionnaire (CRQ) dyspnoea, with secondary measures of Hospital Anxiety and Depression Scale (HADS), Incremental Shuttle Walk Test (ISWT) and Endurance Shuttle Walk Test (ESWT). Analysis is presented for HADS of those scoring ≥8 at baseline. Measures were taken at baseline, 7 weeks and six months. A Repeated measures ANOVA was conducted. Results. See table 1. View this table: The SPACE FOR COPD programme improves dyspnoea, anxiety and endurance time which are maintained at 6 months. There are no differences in outcome measures at 6 months between SPACE and PR groups.
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A self-management programme of activity coping and education (SPACE) for COPD: 6 week results from a randomised controlled trial
European Respiratory Journal, 2012Co-Authors: Katy Wagg, Mike Morgan, Louise Sewell, Vicki Warrington, Lindsay Apps, John Bankart, Mc Steiner, Sally SinghAbstract:Introduction: SPACE for COPD is a self-management programme which individuals follow independently with telephone support. Objective: To test the effectiveness of SPACE on health related quality of life (HRQoL) and exercise capacity compared with usual GP care at 6 weeks. Methods: 184 patients with COPD [101male; mean (SD) age 69(9.19) yrs; FEV 1 1.45(0.56) l; BMI 27.56(5.2)] were recruited from primary care and randomised to SPACE or usual care. Blinded measurements were taken at baseline and 6 weeks and included Chronic Respiratory Questionnaire-SR [CRQ-dyspnoea (primary outcome)], Incremental Shuttle Walk Test (ISWT), Endurance Shuttle Walk Test (ESWT), and the Hospital Anxiety Depression Scale (HADS). Results: See Table1 Conclusion: SPACE is effective in improving HRQoL and exercise capacity, when compared with usual care. SPACE could be used to facilitate self-management of patients with COPD in primary care.
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Does body mass index influence the outcomes of a Waking-based pulmonary rehabilitation programme in COPD?
Chronic respiratory disease, 2012Co-Authors: Neil J. Greening, Johanna Williams, Sally Singh, Rachael A. Evans, Ruth H. Green, Michael C SteinerAbstract:Body mass index (BMI) is an important prognostic measure in Chronic obstructive pulmonary disease (COPD). However, its effects on pulmonary rehabilitation (PR) are unknown. This study aimed to evaluate the effectiveness of a walking-based PR programme across the BMI range and the impact of BMI on exercise performance and health status. A total of 601 patients with COPD completed a PR programme. The effects of BMI on exercise capacity (incremental and endurance shuttle walk tests (ISWT and ESWT)) and health status (Chronic Respiratory Questionnaire (CRQ)) before and after PR were evaluated. 16% of patients were underweight, with 53% overweight or obese. At baseline, the obese had worse ISWT (-54 m ± 14 m; p = 0.001) despite a higher predicted forced expiratory volume in 1 s (7.4m ± 1.6%; p 30, 65 m (p = < 0.001). All four domains of the CRQ increased above the level of clinical significance for all BMI categories (all p < 0.001). The majority of patients with COPD were overweight associated with a lower walking capacity. A walking-based PR programme was comparably effective across the BMI spectrum. Patients with COPD should be referred for standard PR, independent of BMI.
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A comparison of three disease-specific and two generic health-status measures to evaluate the outcome of pulmonary rehabilitation in COPD
Respiratory medicine, 2001Co-Authors: Sally Singh, Johanna Williams, Samantha C. Sodergren, Michael E. Hyland, Mike MorganAbstract:The use of health status as an outcome measure is becoming more widespread in pulmonary rehabilitation. There are a number of health status measures but the choice remains uncertain. Three disease specific measures and two generic measures of health status were employed to observe their relative sensitivity to a 7-week course of pulmonary rehabilitation. Patients with stable Chronic obstructive pulmonary disease (COPD) were recruited into a rehabilitation programme. They completed a shuttle-walking test and three disease-specific Questionnaires: the Chronic Respiratory Questionnaire (CRQ), the St. George's Hospital Respiratory Questionnaire (SGRQ) and the Breathing Problems Questionnaire (BPQ). Patients also completed two generic Questionnaires: a global quality-of-life scale and an activity checklist. Ninety-seven patients [58 male mean (SD) age 67 (8.7) years] completed the course over a 12-month period. The mean pre-rehabilitation (SD) FEV1 was 1.06 (0.59) l. The shuttle-walking test and the treadmill-endurance test increased significantly after rehabilitation (P
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Respiratory Questionnaires in COPD
Thorax, 2000Co-Authors: Johanna Williams, Sally Singh, Mike MorganAbstract:The use of health status as an outcome measure in Chronic obstructive pulmonary disease (COPD) is becoming more popular. We therefore welcome the publication of information which improves the choice of appropriate Questionnaire. The recent paper by Rutten-van Molken and colleagues could have made an important contribution to this area.1 However, we are seriously concerned about the validity of their comparison between the St George's Questionnaire (SGRQ) and the Chronic Respiratory Questionnaire (CRQ). The clinical usefulness of the CRQ is limited because it is interviewer led while the SGRQ is self-administered. The development of a validated self-administered …