Validity, reliability, and responsiveness of a new shortVisual Simplified Respiratory Questionnaire (VSRQ^©) for health-related quality of life assessment in chronic obstructive pulmonary disease

Figures & data

Figure 1 Composition and definition of the populations included in the analyses.

Table 1 Factor pattern of the VSRQ resulting from the Principal Component Analysis (PCA)

Itemsa (Anchors of numerical rating scale)	Correlations resulting from PCA
Have you been hindered by your shortness of breath? (0: Extremely – 10: Not at all)	0.75779
Because of your respiratory problem, have you had difficulties in performing your usual daily activities (eg house cleaning, gardening)? (0: Extremely – 10: Not at all)	0.77796
Have your respiratory problems hindered your social life and your relations with others, your family, your friend or acquaintances? (0: All the time – 10: Never)	0.70807
The quality of your sleep was (0: Very poor – 10: Excellent)	0.61581
Have you had pleasure with the same things at other times? (0: No, much less – 10: Yes)	0.81900
Have you felt energetic? (0: Never – 10: All the time)	0.79833
Were you worried about your health? (0: All the time – 10: Almost never)	0.57470
Have your respiratory problems hindered your sexual life? (0: Extremely – 10: Not at all)	0.60476

a Notes: Items were translated into English for the purpose of publishing, but did not follow a linguistic validation process (ie there has been no process of iterative forward and backward translation; this English version is therefore not suitable for use); Recall period is one month.

Abbreviation: VSRQ, Visual Simplified Respiratory Questionnaire.

Copyright © 2008, Boehringer Ingelheim International. All rights reserved. Any use or reproduction of this questionnaire without written authorization prohibited.

Table 2 Reproducibility by test-retest of VSRQ and SGRQ between screening (V1) and baseline visits (V2), ie, two weeks, in stable patients (N = 535)

Questionnaires	N	Mean change in scores (SD)	ICC	CCC	p-value sign rank test
VSRQ global scorea	455	0.32 (11.1)	0.77	0.77	0.45
SGRQ total scorea	515	0.37 (9.30)	0.86	0.86	0.27

a Notes: 80 missing data for VSRQ; 20 missing data for SGRQ.

Abbreviations: CCC, concordance correlation coefficient; ICC, intraclass correlation coefficient; SD, standard deviation; SGRQ, St George’s Respiratory Questionnaire; VSRQ, Visual Simplified Respiratory Questionnaire.

Table 3 Score distribution for VSRQ and SGRQ according to global health patient groups as assessed by physicians at V1 (N = 636)

	Physician’s global assessment				p-valueb
	Poor	Fair	Good	Excellent
VSRQ
Na	48	248	248	33
Global score (mean ± SD)	31.9 ± 14.3	41.7 ± 14.5	48.1 ± 15.7	57.6 ± 14.0	<0.0001
SGRQ
Na	54	271	263	34
Total score (mean ± SD)	63.8 ± 15.2	49.7 ± 15.7	43.2 ± 16.9	31.8 ± 14.3	<0.0001

a Notes: 59 missing data for VSRQ; 14 missing data for SGRQ;

b Kruskal-Wallis test.

Abbreviations: SGRQ, St George’s Respiratory Questionnaire; VSRQ, Visual Simplified Respiratory Questionnaire.

Table 4 Spearman correlation coefficients between VSRQ and SGRQ at screening visit (n = 636) (p < 0.0001)

	Shortness of breath	Daily activities impact	Social life impact	Sexual life impact	Pleasure impact	Energy impact	Worry impact	Sleep impact	VSRQ total score
Symptoms sub-score	−0.43	−0.40	−0.31	−0.26	−0.40	−0.39	−0.30	−0.32	−0.50
Impacts sub-score	−0.48	−0.55	−0.51	−0.38	−0.56	−0.51	−0.39	−0.42	−0.68
Activities sub-score	−0.43	−0.56	−0.40	−0.35	−0.52	−0.47	−0.26	−0.28	−0.58
SGRQ total score	−0.52	−0.59	−0.50	−0.38	−0.59	−0.54	−0.38	−0.41	−0.70

Abbreviations: SGRQ, St George’s Respiratory Questionnaire; VSRQ, Visual Simplified Respiratory Questionnaire.

Figure 2 Responsiveness of VSRQ global score and SGRQ total score over baseline and three- month visits according to patients’ health status groups measured by A), effect size, B) standardized response mean, and C), Guyatt’s statistic (N = 373).

Table 5 Responsiveness to change of VSRQ and SGRQ over three months (N = 373)

Change in score between V2 and V3	Global rating of healtha
	Worsened n = 53	Stable n = 114	Improved n = 206
VSRQ global mean score	−0.82	2.38	6.66
nb (MDc)	39 (14)	89 (25)	177 (29)
SGRQ total mean score	3.08	−3.33	−9.30
nb (MDc)	48 (5)	108 (6)	198 (8)

a Notes: Subgroups defined from the OTE; “worsened”: all OTE scores ≤0, and at least one OTE score <−1; “stable”: all OTE scores within [−1; +1]; “improved”: all OTE scores ≥0 and at least one OTE score >1;

b patients whose global rating health and complete VSRQ at V2 and V3 were available; patients whose global rating health and SGRQ with at least 41 item completed at V2 and V3 were available;

c MD, ie, patients whose VSRQ was incomplete at V2 and/or V3; patients whose SGRQ contained at least 10 missing items at V2 and/or V3.

Abbreviations: MD, missing data; OTE, Overall Treatment Effect Questionnaire; SGRQ, St George’s Respiratory Questionnaire; VSRQ, Visual Simplified Respiratory Questionnaire.

Figure 3 Cumulative response curves according to the evolution of dyspnea for the four health groups defined from the dyspnea Overall Treatment Effect questionnaire. ‘Worsened patients’, n = 30; ‘stable patients’, n = 185; ‘minimally improved’, n = 83; ‘improved’, n = 116.

Abbreviations: MID, minimal important difference = 3.5. and VSRQ is not