Chest
Volume 107, Issue 6, June 1995, Pages 1585-1589
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Clinical Investigations: COPD
Evaluation of the Short-Form 36-Item Questionnaire to Measure Health-Related Quality of Life in Patients With COPD

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Study objective

To evaluate the short-form 36-item questionnaire (SF-36) as an instrument for measuring health-related quality of life (HRQL) in patients with symptomatic COPD.

Design

Observational data at a single point in time.

Setting

Outpatient pulmonary clinic.

Patients

Fifty male patients with COPD and no significant comorbidity.

Measurements and results

HRQL was assessed with the SF-36, which consists of 36 questions that cover nine health domains. Clinical ratings of dyspnea were measured by the multidimensional baseline dyspnea index (BDI). Pulmonary function tests included forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and maximal inspiratory mouth pressure (PImax). The mean (± SD) age of the patients was 72 ± 8 years. The BDI focal score was 5.6 ± 2.3, FEV1 was 1.32 ± 0.60 L (48 ± 22% pred), and PImax was 62 ± 23 cm H2O. The BDI focal score was significantly correlated with seven of nine components of the SF-36 (range of r, 0.42 to 0.91; p<0.05). The FEV1 percent of predicted and PImax were significantly correlated with five of nine health components (range of r, 0.30 to 0.65 and 0.31 to 0.61, respectively). Using linear regression model analysis with the different SF-36 components as the dependent variable and BDI, FVC, FEV1, and PImax as independent variables, the BDI score was the only significant predictor of social and physical functioning, role-physical, vitality, pain, health perceptions, and health transition (p<0.05).

Conclusions

The SF-36 is a valid instrument to measure HRQL in patients with COPD. The severity of dyspnea but not respiratory function was a significant predictor of various components of HRQL.

Section snippets

Study Population

A group of 50 male patients with COPD, as defined by the American Thoracic Society,15 with no significant comorbidity were recruited from the outpatient clinic at Dartmouth-Hitch-cock Medical Center. Inclusion criteria were as follows: diagnosis of symptomatic COPD; FEV1/FVC ratio less than 70%; and dyspnea on exertion. Exclusion criteria included the following: cancer; uncontrolled diabetes, hypertension, or psychiatric illness; exertional chest pain; musculoskeletal or neurologic disease with

Results

Between January and December 1992, 50 patients were recruited into the study. Age was 72 ± 8 years (range, 44 to 84 years), height was 173 ± 6 cm (range, 160 to 185 cm), and weight was 75.6 ± 12.9 kg (range, 52 to 107 kg).

Values for the nine components of the SF-36, dyspnea ratings, and physiologic function tests for the group are listed in Table 1. Based on the FEV1 percent of predicted, 9 patients (18%) had mild disease (>65%), 10 patients (20%) had moderate disease (50 to 64%), and 31

Discussion

In 1992, Ware and Sherbourne14 described the conceptual framework and item selection for the SF-36 as part of the Medical Outcomes Study (MOS). Based on experience with the 20-item MOS short-form survey initially reported by Stewart and colleagues12 in 1988, the investigators developed the SF-36 to expand the number of health domains (from six to nine) and to improve the precision of the scales compared with the MOS-20.14 According to Ware and Sherbourne,14 “the comprehensiveness of SF-36 was

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    Supported by a grant from Glaxo Research Institute.

    revision accepted September 27.

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