Although HRQoL instruments have been widely used for studying COPD impacts on patients’ HRQoL, none of them combine brevity, comprehensive coverage of all dimensions of HRQoL (ie, physical function, psychological state, social interaction, and somatic sensation, as defined by Schipper and colleagues) and COPD specificity altogether.9
VSRQ is a new disease-specific tool assessing the impact of COPD on patients’ HRQoL in routine practice and large real-life studies. It comprises only eight items covering dyspnea, state of anxiety, depressed mood, quality of sleep, energy, daily activities, social activities and sexual life HRQoL domains. Its average length of completion is 3 min, 20 sec, much lower than the time required for the two widely used instruments SGRQ or CRQ (10 to 25 minutes).13
VSRQ recall period is one month, similar to that reported for SGRQ.13
The VSRQ showed fair psychometric properties, comparable to the SGRQ regarding most validation criteria. The correlations between the questionnaires’ scores indicated good level of consistency between the concepts measured by VSRQ and SGRQ, but no redundancy (correlations of −0.70 between VSRQ global score and SGRQ total score). The VRSQ global score was found to be more strongly correlated with the SGRQ activities and impacts sub-scores than with the symptoms sub-score, which agrees with the fact that VSRQ was developed as a HRQoL tool rather than a symptom assessment tool. In the same way, VSRQ items about sexual life, emotional and sleep impacts were the most weakly correlated with the SGRQ total score, which was expected as these former VSRQ items measure concepts that are not explicitly covered by the SGRQ. VSRQ demonstrated good reliability, with good internal consistency of each individual item between one to each of the others. Reproducibility analyses concluded to the stability of the VSRQ over 2 weeks, although somewhat slightly lower than the one observed for the SGRQ; yet it remained satisfactory and comparable to that of the recently self-administered modified version of the CRQ.17
VSRQ also showed as good ability as the SGRQ in discriminating between groups of patients presenting different levels of COPD severity, thus demonstrating that in spite of its brevity, the VSRQ was clinically valid. One could question the possible interference between VSRQ administration and health status rating by the physician. However, it has been recently reported that physician’s rating of patient’s health status was only marginally influenced by patient’s own self-rated health.37
In order to consolidate these clinical findings, it should be interesting to validate each individual item of the VSRQ by comparing it with its corresponding physiological measures, eg, dyspnea item with lung hyperinflation, daily activities item with the 6-min walking distance.
The responsiveness of the VSRQ over 3 months, though slightly lower than the SGRQ especially in detecting deterioration, was satisfactory, indicating that the VSRQ enabled to report modifications in patients’ COPD medical condition that may have occurred during this time. Comparable data were recently reported for both CRQ and SGRQ in different study settings,38
and one should point out that the responsiveness property of disease-specific questionnaires widely differ between clinical studies according to patients’ clinical characteristics.40
The number of worsened patients with complete VSRQ was low (n = 39), which might have compromised the sensitivity analysis in this subgroup. The change in SGRQ score was also of borderline significance in these patients.
The low correlation between FEV1
surprising. Indeed, numerous studies have shown weak relationship between lung function parameter measurements and HRQoL outcomes in COPD; such observation has also been reported recently for SGRQ.5
It is important to note that the strongest correlation was observed with the VSRQ dyspnea item, the most prominent symptom limiting daily life activities and the most frequently reported complaint of COPD patients. In other words, spirometry and the VSRQ as a HRQoL tool complement each other well to evaluate disease severity and the impact of treatment, eventually giving a more comprehensive image of the patient’s clinical condition.
Lastly, the determined MID for VSRQ was 3.4 when using a similar approach than Juniper and colleagues.33
When performing a regression analysis between changes in VSRQ and SGRQ scores, a MID value of 3.2 for VSRQ was found to be corresponding to the MID value of 4 previously determined by Jones for the SGRQ.35
The close range of these two values is remarkable enough to be highlighted. The MID of VSRQ was set at 3.4. In other terms, scores of VSRQ needed to increase by 3.4 for a patient to consider their clinical status improved. In order to support the interpretation of VSRQ, we represented the cumulative response curves of changes. For the VSRQ, the determined median value was found to be of 3.5, again very close to the two previously MID values defined above (3.2 and 3.4). It would be interesting in the future to see if these MID do indeed predict serious clinical events such as hospitalizations or deaths.
As the VSRQ is a newly developed instrument, our first aim was to consolidate the use and validation of the VSRQ in its whole. In a next step, it would be interesting to validate each of the items of the VSRQ by assessing their ability and validity to measure HRQoL when taken individually. The VSRQ brevity, simple scoring and good psychometric properties make it a good candidate for large epidemiological studies or clinical trials, where length of completion is often an obstacle to the use of HRQoL questionnaires in the protocol. Short questionnaires such as the disease-specific Clinical COPD Questionnaire (CCQ) have not been validated in clinical trials evaluating inhaled therapy (corticosteroids and/or bronchodilators) in COPD patients yet.12
Furthermore, CCQ was designed to measure clinical control in COPD patients and does not cover all four HRQoL domains.
Patient-reported outcomes are major target of COPD treatment. Although this approach needs validation studies, the use of a simple HRQoL tool such as the VSRQ to modulate treatment in individual COPD patients might prove helpful. However the use of HRQoL for the clinical management of individual patients remains controversial, since the repeatability of scores is often lower than MID, as emphasized by Jones.40
The focusing of VSRQ questions on aims of daily life and the immediate availability of scores might also facilitate the communication between the physician and his patient about their expectations in treatment benefits. This particular issue still needs further validation in different clinical settings (eg, severity level) and in larger series. The psychometric performances of the VSRQ should also be evaluated during pulmonary rehabilitation, which has a highly significant impact on HRQoL.42
Finally, it would also be interesting to investigate how the VSRQ performs in severely affected COPD subgroup of patients, particularly those with chronic respiratory failure, for whom new instruments are welcome.43
Developing and validating multi-language versions of the present VSRQ will be necessary to allow its implementation in future international clinical studies.
In conclusion, the VSRQ is now available for researchers and clinicians as an addition to the existing sets of HRQoL questionnaires. It is a promising tool for use in large real-life studies, epidemiological and phase IV studies, as well as in clinical practice.7
However, further validation in specific studies is needed.