Validation of the IPF-specific version of St. George's Respiratory Questionnaire

Thomas Skovhus Prior, Nils Hoyer, Saher Burhan Shaker, Jesper Rømhild Davidsen, Janelle Yorke, Ole Hilberg, Elisabeth Bendstrup, Thomas Skovhus Prior, Nils Hoyer, Saher Burhan Shaker, Jesper Rømhild Davidsen, Janelle Yorke, Ole Hilberg, Elisabeth Bendstrup

Abstract

Background: Patients with idiopathic pulmonary fibrosis (IPF) have impaired health-related quality of life (HRQL). To measure HRQL, an IPF-specific version of the St. George's Respiratory Questionnaire (SGRQ-I) was developed, but not sufficiently validated. This study aimed to assess the validity (i.a. known-groups validity and concurrent validity) and test-retest reliability of SGRQ-I in IPF patients with different disease durations.

Methods: Patients with IPF were consecutively recruited and completed SGRQ, SGRQ-I, King's Brief Interstitial Lung Disease questionnaire (K-BILD), University of California, San Diego Shortness of Breath Questionnaire (SOBQ) and Short Form-36 (SF-36) along with pulmonary function tests and a 6-min walk test (6MWT) at baseline. After two weeks, SGRQ-I and Global Rating of Change Scales (GRCS) were completed.

Results: At baseline and after two weeks, 150 and 134 patients completed the questionnaires, respectively. The internal consistency of SGRQ-I was high (Cronbach's α = 0.92). Good concurrent validity was demonstrated by high intraclass correlation coefficients (ICC = 0.97), Bland-Altman plots and moderate to strong correlations to K-BILD, SOBQ and SF-36 (r = - 0.46 to 0.80). High ICC (0.92) and a Bland-Altman plot indicated good test-retest reliability. SGRQ-I was good at discriminating between patients with different stages of disease (Δscore > 18.1, effect sizes > 0.10). Validity was similar across groups of different disease duration.

Conclusions: SGRQ-I proved to be valid at distinguishing between different disease severities, valid compared to other HRQL instruments, applicable across different disease durations and reliable upon repetition. SGRQ-I is a valid option for measuring HRQL in patients with IPF.

Trial registration: The study was registered at clinicaltrials.org ( NCT02818712 ) on 15 June 2016.

Keywords: Health-related quality of life; IPF-specific version of the St. George’s respiratory questionnaire; Idiopathic pulmonary fibrosis; Interstitial lung disease; K-BILD; Quality of life; SGRQ; SGRQ-I.

Conflict of interest statement

JY developed the SGRQ-I and has nothing else to disclose. TSP, OH and EB have received an unrestricted grant from Boehringer Ingelheim for the current work. Outside the current work, TSP reports personal fees from Boehringer Ingelheim and Roche, NH reports and unrestricted grant from Roche, SBS reports personal fees from Boehringer Ingelheim, Roche and AstraZeneca, JRD reports an unrestricted grant from Boehringer Ingelheim and an unrestricted grant and personal fees from Roche, OH reports an unrestricted grant from Roche and an unrestricted grant and personal fees from Boehringer Ingelheim, EB reports unrestricted grants and personal fees from Boehringer Ingelheim, Roche, Novartis and AstraZeneca.

Figures

Fig. 1
Fig. 1
Bland-Altman plot of the agreement between SGRQ-I and SGRQ for all patients. The solid line is the mean difference, while the dashed lines are the 95% limits of agreement. SGRQ-I: IPF-specific version of the St. George’s Respiratory Questionnaire; SGRQ: St. George’s Respiratory Questionnaire
Fig. 2
Fig. 2
Bland-Altman plot of the repeatability of SGRQ-I in all stable patients. The solid line is the mean difference, while the dashed lines are the 95% limits of agreement. SGRQ-I: IPF-specific version of the St. George’s Respiratory Questionnaire
Fig. 3
Fig. 3
SGRQ-I total score in (a) the lower and upper quartile of FVC % predicted, (b) the lower and upper quartile of DLCO % predicted, (c) long-term oxygen therapy and (d) GAP index. The midlines in the boxes are the median values and the boundaries are the 25th and 75th percentiles; the whiskers are the upper adjacent values (1.5 interquartile range above the 75th percentile) and lower adjacent values (1.5 interquartile range below the 25th percentile). The dots are outlying values. SGRQ-I: IPF-specific version of the St. George’s Respiratory Questionnaire. FVC: Forced vital capacity; DLCO: Diffusing capacity of the lung for carbon monoxide; LTOT: Long-term oxygen therapy; GAP: Gender, age, physiology

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