| |
We have
entered a complicated phase of symptom research: in this mix are
increasing numbers of multi-item scales intended to detect minimal
clinically important differences in either generic or disease--specific
health-related quality of life (Kroenke,
2001). A simple count of PubMed citations confirms that since
the mid--1970s the number of investigations measuring health status
merely with the Medical Outcomes Study 36--item Short Form (SF--36)
-- including those involving patients with obstructive airway
disease (OADQOFL) -- has risen exponentially.
| Figure
26.1: Scatterplot of the Number of PUBMED Citations
Using the SF-36 in any Study (Red Dots) or in Studies
of Obstructive Airway Disease (Green Dots) Since 1970
|
|---|
|
|
|
There is no best way
yet to organize our menu of over 200 quality of life measures.
Some efforts attend to particular dimensions of experience such
as health status, functional status, and symptoms (http://www.atsqol.org/).
Other efforts, such as those evident in the 1999 American Thoracic
Society statement on pulmonary rehabilitation (American
Thoracic Society, 1999), are aligned with the World Health
Organization's international classification of impairments, disabilities,
and handicaps.
| Table
26.2: Commonly Used Outcome Measures in Pulmonary Rehabilitation
Arranged by the WHO's International Classification System
of Impairment, Disability, and Handicap
|
|---|
| Outcome
Measures
|
Impairment
|
Disability
|
Handicap
|
Symptoms
|
|---|
| Exercise
ability | | | | |
| Incremental
exercise tests |
X
|
|
|
|
| Submaximal
exercise tests |
X
|
|
|
|
| Walking
tests |
|
X
|
|
|
| General
health status |
|
|
|
|
| Sickness
Impact Profile (SIP) |
|
X
|
X
|
|
| Quality
of Well Being Scale (QWB) |
|
X
|
X
|
|
| Medical
Outcomes Study, Short-Form 36 (SF-36) |
|
X
|
X
|
P
|
| Respiratory-specific
health status |
|
|
|
|
| St.
George's Respiratory Questionnaire (SGRQ) |
|
X
|
X
|
D
|
| Chronic
Respiratory Disease Questionnaire (CRQ or CRDQ) |
|
X
|
X
|
F
|
| Respiratory-specific
functional status |
|
|
|
|
| Pulmonary
Functional Statu and Dyspnea Questionnaire (PFSDQ) |
|
X
|
X
|
D
|
| Modified
version (PFSDQ-M) |
|
X
|
X
|
D/F
|
| Pulmonary
Functional Status Scale (PFSS) |
|
X
|
X
|
|
| Exertional
dyspnea |
|
|
|
|
| Visual
analog scale rating during exercise testing (VAS) |
|
|
|
D/F/P
|
|
Category rating (Borg) during exercise
testing |
|
|
|
D/F/P
|
| Overall
dyspnea |
|
|
|
|
| Medical
Research Council Scale (MRC) |
|
X
|
|
|
| Baseline
and Transitional Dyspnea Indexes (BDI and TDI) |
|
X
|
|
|
|
|