Minimal clinically important differences for fatigue, cough and sputum patient-reported outcome in COPD

• Autor(a) principal: Rebelo, Patrícia Filipa Sobral
• Data de Publicação: 2019
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10773/25679
• topic: Measurement characteristics; Symptoms; Patient-reported outcome measures; Pulmonary rehabilitation; COPD

Background: Fatigue, cough and sputum are highly prevalent symptoms in patients with chronic obstructive pulmonary disease (COPD), which evaluation is commonly performed using patient-reported outcome measures (PROMs). Pulmonary rehabilitation (PR) has shown to be effective in managing these symptoms. However, the interpretation of the magnitude of PR effects is hindered by the lack of cut-off points to identify clinically relevant changes for patients and health professionals (i.e., minimal clinically important differences - MCIDs). Aim: To establish MCIDs, after PR, for the following PROMs: checklist of individual strength – fatigue subscale (CIS-20 FS), functional assessment of chronic illness therapy – fatigue (FACIT-F), Leicester cough questionnaire (LCQ) and cough and sputum assessment questionnaire (CASA-Q), in patients with COPD. Methods: An observational prospective study was conducted in patients with COPD who participated in a community-based PR programme. All PROMs were assessed pre/post PR. Anchor- (i.e., mean change, the receiver operating characteristic curves and linear regression analysis) and distribution-based methods (i.e., 0.5 times the standard deviation; standard error of measurement (SEM); 1.96 times the SEM; minimal detectable change (MDC95) and effect size) were used to compute the MCIDs. The anchors used were: i) patients and physiotherapists global rating of change scale, ii) COPD assessment test, iii) St. George’s respiratory questionnaire and iv) the occurrence of exacerbations during PR. Pooled MCIDs, combing anchor- and distribution-based methods, were computed using a quality effects model. Results: Forty-nine patients with COPD (81.6% male, 69.8±7.4 years, FEV1 49.4±19.2%predicted) were used in the analysis. The pooled MCIDs were: 7.3 (4.1 to 10.6) for CIS-20 FS, 4.2 (1.7 to 6.7) for FACIT-F, 1.3 (0.4 to 2.2) for LCQ, 10 for CASA-Q cough symptoms/ impact and sputum symptoms domains and 7.8 for sputum impact, ranging from 0 to 19.5. Conclusion: The MCIDs found in this study, 7.3 for CIS-20 FS, 4.2 for FACIT-F, 1.3 for LCQ, 10.6 and 10.1 for the cough symptoms and impact dimensions, and 9.7 and 7.8 for the sputum dimensions of CASA-Q, are potential estimates that can be used by health professionals to interpret PR effects in these symptoms and guide future interventions.