Measuring the responsiveness of the SF-36 in the Cardiac and Pulmonary Rehabilitation Literature: Combined Results of a Comparative Effectiveness Review and Meta-Analysis

Abstract

Research Objectives Objective; To investigate the responsiveness of Patient Outcome Measures (POMs) in Cardiac (CR) and Pulmonary (PR) Rehabilitation programs. Design Data Sources: Data was sourced from the main medical databases with the search terms; Rehabilitation programs, Quality of Life measures and Cardiac and Pulmonary Rehabilitation. Setting Study Selection: 1557 articles were selected from the original database search of study terms. The study team decided articles were excluded if the Quality of Life POMs were other than questionnaires, if the rehabilitation did not involve a multi-disciplinary team, and if the outcome of interest was not rehabilitation (e.g. drug therapy). Articles included were studies involving outpatient rehabilitation programs and those with a pre to post rehabilitation assessment. Participants N/A. Interventions Data extraction: The 83 articles for the comparative effectiveness review used a modified version of the Cochrane Database assessment of bias. The meta-analysis conducted correlation analysis between SF-36 pre and post “within” (per interventional group) mean scores for the CR literature. In the PR literature a correlation analysis between SF-36 and Chronic Respiratory Questionnaire (CRQ) “within” change scores was undertaken. Main Outcome Measures N/A. Results Data synthesis: The most commonly used POM was the SF-36. In the CR literature the SF-36 MCS domain is the most responsive of the composite SF-36 domains. In the individual domains Role Emotional scored r = 0.52, p <= 0.001 with only 27% of the variance explained and Role Physical with r = 0.49, p <=0.005 had only 24% of the variance explained. In the PR literature Spearman's rank correlation coefficient shows that SF-36 PCS has a weaker correlation to the CRQ at 0.39, than the SF-36 MCS which was 0.63. Conclusions The surveyed literature found no "gold standard" POM for either CR or PR and the meta-analysis found that the SF-36 is not suited as a pre to post program assessment tool for CR and PR. Author(s) Disclosures The authors are not aware of any conflicts of interest at this time. Objective; To investigate the responsiveness of Patient Outcome Measures (POMs) in Cardiac (CR) and Pulmonary (PR) Rehabilitation programs. Data Sources: Data was sourced from the main medical databases with the search terms; Rehabilitation programs, Quality of Life measures and Cardiac and Pulmonary Rehabilitation. Study Selection: 1557 articles were selected from the original database search of study terms. The study team decided articles were excluded if the Quality of Life POMs were other than questionnaires, if the rehabilitation did not involve a multi-disciplinary team, and if the outcome of interest was not rehabilitation (e.g. drug therapy). Articles included were studies involving outpatient rehabilitation programs and those with a pre to post rehabilitation assessment. N/A. Data extraction: The 83 articles for the comparative effectiveness review used a modified version of the Cochrane Database assessment of bias. The meta-analysis conducted correlation analysis between SF-36 pre and post “within” (per interventional group) mean scores for the CR literature. In the PR literature a correlation analysis between SF-36 and Chronic Respiratory Questionnaire (CRQ) “within” change scores was undertaken. N/A. Data synthesis: The most commonly used POM was the SF-36. In the CR literature the SF-36 MCS domain is the most responsive of the composite SF-36 domains. In the individual domains Role Emotional scored r = 0.52, p <= 0.001 with only 27% of the variance explained and Role Physical with r = 0.49, p <=0.005 had only 24% of the variance explained. In the PR literature Spearman's rank correlation coefficient shows that SF-36 PCS has a weaker correlation to the CRQ at 0.39, than the SF-36 MCS which was 0.63. The surveyed literature found no "gold standard" POM for either CR or PR and the meta-analysis found that the SF-36 is not suited as a pre to post program assessment tool for CR and PR.