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Psychometrics of health-related quality of life questionnaires in bronchiectasis: A systematic review and meta-analysis

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Rebecca H. McLeese, Arietta Spinou, Zina Alfahl, Michail Tsagris, J. Stuart Elborn, James D. Chalmers, Anthony de Soyza, Michael R. Loebinger, Surinder S. Birring, Konstantinos C. Fragkos, Robert Wilson, Katherine O’Neill, Judy M. Bradley

Original languageEnglish
Article number2100025
JournalEuropean Respiratory Journal
Issue number5
Published1 Nov 2021

Bibliographical note

Funding Information: Acknowledgement: We acknowledge the BronchUK consortium ( supported by a Medical Research Council grant (MR/L011263/1). Funding Information: Conflict of interest: R.H. McLeese has nothing to disclose. A. Spinou is the developer of the Bronchiectasis Health Questionnaire, one of the questionnaires included in this review. Z. Alfahl has nothing to disclose. M. Tsagris has nothing to disclose. J.S. Elborn reports grants from IMI/European Commission Inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis (iABC), Novartis, Polyphor and Alexia, outside the submitted work. J.D. Chalmers reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, Gilead Sciences, GlaxoSmithKline and Novartis, personal fees from Chiesi, Zambon and Janssen, outside the submitted work. A. De Soyza reports other (meeting support) from AstraZeneca, nonfinancial support (in-kind research support) from Novartis, nonfinancial support (meeting support) from Forest labs, personal fees for lectures and advisory board work from Bayer, personal fees for advisory board work from Novartis, other (travel bursary) from Chiesi, Almirall and Boehringer Ingelheim, grants and personal fees for lectures and advisory board work from AstraZeneca, grants from Pfizer, outside the submitted work; has received medical education grant support for a UK bronchiectasis network from GlaxoSmithKline, Gilead, Chiesi and Forest labs; A. De Soyza’s employing institution receives fees for his work as coordinating investigator in a phase III trial in bronchiectasis sponsored by Bayer. M.R. Loebinger reports personal fees from Insmed, AstraZeneca and Grifols, outside the submitted work. S.S. Birring reports grants and personal fees from Merck, personal fees from Bayer, Shionogi and Bellus, outside the submitted work; and has a patent BHQ pending, and a patent LCQ with royalties paid. K.C. Fragkos has nothing to disclose. R. Wilson has nothing to disclose. K. O’Neill has nothing to disclose. J.M. Bradley has nothing to disclose. Publisher Copyright: Copyright ©The authors 2021.

King's Authors


Introduction Understanding the psychometric properties of health-related quality of life (HRQoL) questionnaires can help inform selection in clinical trials. Our objective was to assess the psychometric properties of HRQoL questionnaires in bronchiectasis using a systematic review and meta-analysis of the literature. Methods A literature search was conducted. HRQoL questionnaires were assessed for psychometric properties (reliability, validity, minimal clinically important difference (MCID) and floor/ceiling effects). Meta-analyses assessed the associations of HRQoL with clinical measures and responsiveness of HRQoL in clinical trials. Results 166 studies and 12 HRQoL questionnaires were included. The Bronchiectasis Health Questionnaire (BHQ), Leicester Cough Questionnaire (LCQ), Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) had good internal consistency in all domains reported (Cronbach’s α≥0.7) across all studies, and the Quality of Life-Bronchiectasis (QOL-B), St George’s Respiratory Questionnaire (SGRQ), Chronic Respiratory Disease Questionnaire (CRDQ) and Seattle Obstructive Lung Disease Questionnaire (SOLQ) had good internal consistency in all domains in the majority of (but not all) studies. BHQ, SGRQ, LCQ and CAT had good test–retest reliability in all domains reported (intraclass correlation coefficient ≥0.7) across all studies, and QOL-B, CRDQ and SOLQ had good test–retest reliability in all domains in the majority of (but not all) studies. HRQoL questionnaires were able to discriminate between demographics, important markers of clinical status, disease severity, exacerbations and bacteriology. For HRQoL responsiveness, there was a difference between the treatment and placebo effect. Conclusions SGRQ was the most widely used HRQoL questionnaire in bronchiectasis studies and it had good psychometric properties; however, good psychometric data are emerging on the bronchiectasis-specific HRQoL questionnaires QOL-B and BHQ. Future studies should focus on the medium- to long-term test–retest reliability, responsiveness and MCID in these HRQoL questionnaires which show potential in bronchiectasis.

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