Psychometric Properties of Patient-Reported Outcome Measures Assessing Self-Efficacy in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review

Figures & data

Figure 1. PRISMA flow diagram showing study selection process.

Table 1. Development and content validity results of self-efficacy PROM in COPD patients.

PROM Author & year	Country	RoB of PROM development	Content validity
			RoB	Result (rating)
CSES Wigal et al., 1991	United States	No information (Inadequate)
CSES- Modified Chinese Wong et al., 2005	China		Five experts in respiratory care and a pilot test in COPD patients (Inadequate)	CVI = 0.64 − 0.84 (?)
CSES- Norwegian Bentsen et al, 2010	Norway		Professionals in pulmonary disease and COPD patients (Inadequate)	Not reported (?)
CSES- Korean Lee et al., 2014	South Korea		Pilot test on COPD patients (Inadequate)	Not reported (?)
CSES- Hindi Khan et al., 2016	India		COPD patients (Inadequate)	Not reported (?)
PRIASE Vincent et al., 2011	United Kingdom	Expert clinicians in focused groups and COPD patients (Inadequate)
PRIASE- Korean Song & Nam, 2017	South Korea		Panel of six experts in nursing and medicine, and 18 COPD patients (Inadequate)	I-CVI = 0.8 to 1.0 S-CVI = 0.96 (?)
Ex-SRES Davis et al., 2007	United States	One to one interview with 14 COPD patients; Pilot testing in 45 COPD patients (Inadequate)
Ex-SRES- Chinese Tsai et al., 2018	Taiwan		Six respiratory care experts (Inadequate)	I-CVI = 0.83 S-CVI = 0.99 (?)
DMQ Norweg et al., 2006	United States	Qualitative data, literature review and 3 COPD patients (Inadequate)	Panel of 12 experts and four COPD patients (Inadequate)	Not reported (?)
SCES-COPD Matarese et al., 2020	Italy	Literature review (Inadequate)	20 experts and 20 COPD patients; A pilot test in five COPD patients (Inadequate)	I-CVR = 0.90 − 0.50 S-CVI = 0.75 (?)
CSMS Zhang et al., 2013	China	Panel of nine experts and 20 COPD patients; A pilot test in 30 COPD patients (Inadequate)	No information (Inadequate)	CVI = 0.90 (?)

Abbreviations: PROM: patient-reported outcome measures; COPD: chronic obstructive pulmonary disease; CSES: COPD Self-efficacy Scale; PRAISE: pulmonary rehabilitation adapted index of self-efficacy; I-CVI: item content validity index; S-CVI: scale content validity index; Ex-SRES: exercise self-regulatory efficacy scale; DMQ: dyspnea management questionnaire; SCES-COPD: self-care self-efficacy scale in COPD; CSMS: COPD self-management scale; CDSMBS: chronic disease self-management behavior scale; CDSES: chronic disease self-efficacy scale; RoB: risk of bias of the study’s psychometric properties rated as: very good, adequate, doubtful, inadequate; Results rating: (+) sufficient, (?) indeterminate, (-) insufficient.

Table 2. Results of studies on Reliability of self-efficacy PROM in COPD patients.

PROM Author & year	Country	n	Internal consistency		Test-retest reliability
			RoB	Result (rating)	RoB	Result (rating)
CSES Wigal et al., 1991	United States	102	Inadequate	Cronbach’s alpha for the total scale = 0.95 (?)	Adequate	r = 0.77 (?)
CSES Scherer et al., 1998	United States	59	Very good	Cronbach’s alpha for subscales = 0.74-0.95 (+)
CSES- Norwegian Bentsen et al, 2010	Norway	100	Very good	Cronbach’s alpha for subscales = 0.80 − 0.90; Total score = 0.98 (+)
CSES- Danish Emme et al., 2012	Denmark	151	Very good	Cronbach’s alpha for the five dimensions = 0.71 − 0.93 (+)	Inadequate	r = 0.82 (?)
CSES- Korean Lee et al., 2014	South Korea	249	Very good	Cronbach’s alpha for the subscales = 0.74 − 0.91; Total score = 0.96 (+)
CSES- Hindi Khan et al., 2016	India	50	Very good	Cronbach’s alpha for the subscales = 0.72 − 0.95 (+)
Qualitative summary result (overall rating)			Cronbach’s Alpha = 0.71- 0.98 (+)		0.77-0.82 (?)
Quality of evidence GRADE			Low quality (n = 711)
PRIASE Vincent et al., 2011	United Kingdom	29	Very good	Cronbach’s Alpha = 0.95 (+)	Adequate	ICC = 0.99 (+)
PRIASE- Korean Song & Nam, 2017	South Korea	118	Very good	Cronbach’s Alpha for first factor = 0.94; Second factor = 0.79 (+)
Qualitative summary result (overall rating)			Cronbach’s Alpha = 0.79 − 0.95 (+)
Quality of evidence GRADE			Moderate quality (n = 147)
Ex-SRES Davis et al., 2007	United States	109	Very good	Cronbach’s alpha = 0.92 (+)
Ex-SRES- Chinese Tsai et al., 2018	Taiwan	76	Very good	Cronbach’s alpha = 0.93 (+)
Ex-SRES-Turkish Unal Aslan et al., 2020	Turkey	160	Very good	Cronbach’s alpha = 0.96 (+)
Qualitative summary result (overall rating)			Cronbach’s alpha = 0.92 − 0.96 (+)
Quality of evidence GRADE			High quality (n = 345)
DMQ-30 Norweg et al., 2006	United States	69	Very good	Cronbach’s alpha = 0.87 − 0.96 For self-efficacy subscale = 0.87 (+)	Doubtful (n = 26)	ICC for the scale = 0.71 − 0.95 For self-efficacy subscale = 0.71 (+)
Expanded DMQ-56 Norweg et al., 2011	United States	107	Very good	Cronbach’s alpha = 0.85 − 0.96 For self-efficacy subscale = 0.86 (+)	Adequate	ICC for the scale = 0.69 − 0.92 For self-efficacy subscale = 0.83 (+)
DMQ-CAT-71 Norweg et al., 2011	United States	292	Very good	Cronbach’s alpha = 0.92 − 0.98 (+)
CSES- Modified Chinese Wong et al., 2005	China	60	Very good	Cronbach’s alpha for subscales = 0.80 − 0.98 (+)	Doubtful	r = 0.88 (?)
SCES-COPD Matarese et al., 2020	Italy	398	Very good	Cronbach’s alpha = 0.86 The global reliability index for multidimensional scales = 0.87 (+)	Doubtful	ICC = 0.84 Weighted K = 0.7 − 0.86 (+)
CSMS Zhang et al., 2013	China	413	Very good	Cronbach’s alpha CSMS = 0.92 (0.82 − 0.92) For self-efficacy subscale = 0.83 (+)	Doubtful	Total CSMS r = 0.87; For self-efficacy subscale r = 0.76 (?)

Abbreviations: COPD: chronic obstructive pulmonary disease; PROM: patient-reported outcome measures; CSES: COPD Self-efficacy Scale; r: Pearson correlation coefficient; PRAISE: pulmonary rehabilitation adapted index of self-efficacy; ICC: intraclass correlation coefficient; Ex-SRES: exercise self-regulatory efficacy scale; DMQ: dyspnea management questionnaire; CAT: computer adaptive test; CSMS: COPD self-management scale; RoB: risk of bias of the study’s psychometric properties rated as: very good, adequate, doubtful, inadequate; Results rating: (+) sufficient, (?) indeterminate, (-) insufficient; GRADE: Grading of Recommendations Assessment, Development, and Evaluation.

Table 3. Results of studies on responsiveness of self-efficacy PROM in COPD patients.

PROM (Author & year)	Country	n	Responsiveness
			Comparison with other outcome measures		Comparison between subgroups		Before and after intervention (PR)
			RoB	Result (rating)	RoB	Result (rating)	RoB	Result (rating)
PRIASE Vincent et al., 2011	United Kingdom	225	Adequate	Small correlation of baseline PRAISE with the change (pre-post) in ISWT(r = 0.35) (-); Small negative correlation with the change in HADS-anxiety (r = -0.30) (+) (1+) and (1-)	Adequate	Non-significant difference between male and female patients who underwent PR (+)	Doubtful	Significant change over time (7-week) in PRAISE: mean 3.59 (95% CI, 2.24-4.73; p = 0.015) ES = 0.37 (+)
					Doubtful	Non-significant difference between patients who did and did not complete PR (-)
PRIASE Liacos et al., 2019	Australia	144	MID (Anchor based measure) (Very good) (n = 141)	Compared with GRCS MID = 0.5 points with AUC = 0.69, sensitivity 0.71 and specificity 0.4 (-) Compared with CRQ Mastery MID = 1.5 points with AUC = 0.68, sensitivity 0.65 and specificity 0.34 (-) (2-)	Very good	Non-significant difference between home-based PR and hospital-based PR) (+)	Very good (n = 144)	Significant change over time (8-week) in PRAISE score : mean 1.3 points (95% CI, 0.08 – 2.46) ES = 0.21 (+)
			MID (Distribution based measure) (Very good) (n = 141)	MID = 3.61 points with SEM = 0.7 points (?)
Qualitative summary result (overall rating)			Results in line with one hypothesis and not in line with three hypotheses 1+ and 3- Overall (-)		Results in line with two hypotheses and not in line with one hypothesis 2+ and 1- Overall (+)		Results in line with two hypotheses 2+ Overall (+)
Quality of evidence GRADE			High quality (n = 366)		High quality (n = 369)		High quality (n = 369)

Abbreviations: COPD: chronic obstructive pulmonary disease; PROM: patient-reported outcome measures; PRAISE: pulmonary rehabilitation adapted index of self-efficacy; ISWT: incremental shuttle walk test; HADS: Hospital Anxiety and Depression Scale; CRQ: chronic respiratory questionnaire; PR: pulmonary rehabilitation; ES: effect size; GRCS: global rating of change scale; MID: minimal important difference; SEM: standard error of measurement; RoB: risk of bias of the study’s psychometric properties rated as: very good, adequate, doubtful, inadequate; Results rating: (+) sufficient, (?) indeterminate, (-) insufficient; (±) inconsistent; GRADE: Grading of Recommendations Assessment, Development, and Evaluation..