RESPONSIVENESS OF THE DYSPNEA MANAGEMENT QUESTIONNAIRE COMPUTER ADAPTIVE TEST (DMQ-CAT) FOLLOWING PULMONARY REHABILITATION

Abstract

SESSION TITLE: Pulmonary Rehabilitation Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The Dyspnea Management Questionnaire Computer Adaptive Test (DMQ-CAT) is a recently developed dyspnea patient-reported outcome measure for adults with chronic obstructive pulmonary disease (COPD). The study purpose was to establish the responsiveness and minimal detectable change (MDC) of the DMQ-CAT. METHODS: A prospective, multicenter observational study of 90 subjects with COPD, with repeated measures before and after outpatient pulmonary rehabilitation (PR), was conducted. Subjects’ mean ±SD of forced expiratory volume in 1 second was 50.49±17.63% predicted (n=84). Data were collected at three outpatient PR centers; PR programs had durations between 8 and 12 weeks. The DMQ-CAT, Chronic Respiratory Questionnaire (CRQ), modified Medical Research Council scale (mMRC), Borg scale (0–10), and University of California, San Diego Shortness of Breath Questionnaire (UCSD) were concurrently administered to compare responsiveness. Previously established test-retest reliability coefficients for dyspnea measures were used to calculate the MDC at the 90% confidence interval (MDC-90). RESULTS: DMQ-CAT scale change scores correlated significantly with change scores of the CRQ and UCSD (r=0.3–0.58). The DMQ-CAT demonstrated comparable responsiveness to change relative to other widely used dyspnea measures. There were no statistically significant differences in effect sizes across instruments. The effect sizes (95% CI) of PR using the DMQ-CAT were 0.67 (0.44,0.96) for Anxiety, 0.63 (0.41,0.91) for Activity Avoidance, 0.64 (0.42,0.88) for Intensity, and 0.60 (0.37,0.88) for Self-efficacy. PR effect sizes using comparison measures were 0.51–0.75 for CRQ, -0.45 for mMRC, -0.42 for Borg, and -0.59 for UCSD. Standard error of measurement (SEM) for DMQ-CAT were 1.99 for Anxiety, 1.73 for Activity Avoidance, 3.21 for Intensity, and 3.56 for Self-efficacy. Distribution-based MDC-90 threshold values of the DMQ-CAT were 4.6 for Anxiety, 4.0 for Activity Avoidance, 7.5 for Intensity, and 8.3 for Self-efficacy. CONCLUSIONS: Results support the responsiveness of the DMQ-CAT for use in both COPD clinical trials and clinical practice to measure multidimensional dyspnea improvement outcomes. The DMQ-CAT is as responsive to pulmonary rehabilitation gains as other widely used dyspnea and quality of life measures. CLINICAL IMPLICATIONS: Newly estimated, distribution-based SEM and MDC-90 can be used to interpret DMQ-CAT outcome scores to determine if the magnitude of changes are beyond measurement error. The selection of a dyspnea outcome measure as a primary endpoint in PR clinical trials depends on the dyspnea domain of interest and hypothesized treatment mechanism(s). DISCLOSURES: Consultant relationship with GlaxoSmithKline Please note: $5001 - $20000 by Ravi Kalhan, source=Admin input, value=Consulting fee Speaker/Speaker's Bureau relationship with GlaxoSmithKline Please note: $5001 - $20000 by Ravi Kalhan, source=Admin input, value=Royalty Consultant relationship with Boehringer Ingelheim Please note: $5001 - $20000 by Ravi Kalhan, source=Admin input, value=Consulting fee Consultant relationship with AstraZeneca Please note: $5001 - $20000 by Ravi Kalhan, source=Admin input, value=Consulting fee Consultant relationship with Boston Scientific Please note: $5001 - $20000 by Ravi Kalhan, source=Admin input, value=Consulting fee Advisory Committee Member relationship with Pfizer Please note: $20001 - $100000 Added 02/14/2020 by Elizabeth Klings, source=Web Response, value=Grant/Research Support Advisory Committee Member relationship with Micelle Please note: $1001 - $5000 Added 02/14/2020 by Elizabeth Klings, source=Web Response, value=Consulting fee Site PI for clinical trial relationship with Bayer Please note: $5001 - $20000 Added 02/14/2020 by Elizabeth Klings, source=Web Response, value=Grant/Research Support Site PI for clinical trial relationship with Actelion Please note: $5001 - $20000 Added 02/14/2020 by Elizabeth Klings, source=Web Response, value=Grant/Research Support Site PI for clinical trial relationship with Reata Please note: $5001 - $20000 Added 02/14/2020 by Elizabeth Klings, source=Web Response, value=Grant/Research Support site PI for clinical trial relationship with Arena/United Therapeutics Please note: $5001 - $20000 Added 02/14/2020 by Elizabeth Klings, source=Web Response, value=Grant/Research Support Research support relationship with Novartis Please note: $5001 - $20000 Added 07/10/2020 by Elizabeth Klings, source=Web Response, value=Consulting fee No relevant relationships by Kyle MacDonald, source=Web Response No relevant relationships by Pengsheng Ni, source=Web Response No relevant relationships by Anna Norweg, source=Web Response No relevant relationships by Jonathan Whiteson, source=Web Response