Abstract
BackgroundOver the years, the scope of outcomes assessment in chronic obstructive pulmonary disease (COPD) has broadened, allowing for the evaluation of various patient-reported outcomes (PROs). As it still remains unclear whether and to what extent PROs mirror the exercise performance of patients with COPD, the current study aimed to assess the association between different exercise test outcomes and PROs, before and after pulmonary rehabilitation (PR).MethodsCorrelations between PROs used to describe health-related quality of life (HRQoL), mood status, level of care dependency and dyspnea in patients with COPD and commonly used laboratory- and field-based exercise test outcomes were evaluated in 518 individuals with COPD attending PR.ResultsOverall, correlations between PROs and exercise test outcomes at baseline were statistically significant. The correlation between modified Medical Research Council (mMRC) dyspnea score and 6-min walking distance (6MWD) was strongest (ρ:-0.65; p<0.001). HRQoL related PROs showed weak correlations with exercise outcomes at baseline. Moderate correlations were found between St George’s Respiratory Questionnaire total score and 6MWD (r:-0.53; p<0.001) and maximal workload achieved during cardiopulmonary exercise testing (ρ:-0.48; p<0.001); and between Clinical COPD Questionnaire (CCQ) total score and 6MWD (r:-0.48; p<0.001) and maximal workload (ρ:-0.43; p<0.001). When significant, correlations between changes in exercise test outcomes and changes in PROs after PR were generally very weak or weak. The highest correlation was found between changes in CCQ total score and changes in 6MWD (ρ: − 0.36; p<0.001).ConclusionsPROs and exercise test outcomes, although significantly correlated with each other, assess different disease features in patients with COPD. Individual PROs need to be supported by additional functional measurements whenever possible, in order to get a more detailed insight in the effectiveness of a PR program.Trial registrationNetherlands Trial Register (NL3263/NTR3416). Registered 2 May 2012.
Highlights
Over the years, the scope of outcomes assessment in chronic obstructive pulmonary disease (COPD) has broadened, allowing for the evaluation of various patient-reported outcomes (PROs)
Individual PROs need to be supported by additional functional measurements whenever possible, in order to get a more detailed insight in the effectiveness of a pulmonary rehabilitation (PR) program
The PROs showed a high degree of dyspnea (80.7% with modified Medical Research Council (mMRC) dyspnea grade of two or higher) [22], anxiety (34.8% with ≥10 points) [32], depression (33.4% with ≥10 points) [32], care dependency (28.5% with Care Dependency Scale (CDS) total score of ≤68 points) [25], and an impaired health-related quality of life (HRQoL) (81.9% with a St. George’s Respiratory Questionnaire (SGRQ) total score of ≥44 points; 75.0% with a COPD Assessment Test (CAT) total score of ≥18 points; 76.7% Clinical COPD Questionnaire (CCQ) total score of ≥1.9 points) [22]
Summary
The scope of outcomes assessment in chronic obstructive pulmonary disease (COPD) has broadened, allowing for the evaluation of various patient-reported outcomes (PROs). Patients with chronic obstructive pulmonary disease (COPD), a highly-prevalent chronic lung disease, frequently suffer from symptoms of dyspnea, exercise intolerance, an impaired mood status and a reduced health status [1,2,3]. These features are typically weakly related to the degree of lung function impairment [4]. The use of additional assessments such as exercise tests and patient-reported outcomes (PROs) has been advocated [3, 5, 6] Appraisal of these extra-pulmonary features is necessary to better understand the patients’ daily needs or problems, to identify possible treatable traits for integrated COPD care programs, and to evaluate its efficacy [7]. Important aspects from the patient’s perspective like health-related quality of life (HRQoL), dyspnea, anxiety, depression, and the level of care dependency, all of which have a direct impact on daily life [10], are measured using PROs
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