Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, USA.
Department of Surgery, Southern Illinois University School of Medicine, Springfield, USA.
Qual Life Res. 2019 Jul;28(7):1885-1892. doi: 10.1007/s11136-019-02123-x. Epub 2019 Feb 1.
Lung volume reduction surgery (LVRS) has been shown to improve lung function, but also improve the overall quality of life (QOL). The aim of this study is to compare two QOL questionnaires-EuroQol Questionnaire (EQ-5D-3L) and 36-item Short Form Health Survey (SF-36) in patients post-LVRS.
All patients undergoing LVRS for severe chronic obstructive pulmonary disease (COPD) at a single center of excellence were analyzed (n = 94). Baseline demographic and clinical outcomes were characterized. Both EQ-5D-3L and SF-36 questionnaires were administered to all patients at baseline (n = 94) and at the end of 1 year (n = 89) post-surgery. SF-36 was converted to Short Form six-dimensions (SF-6D) using standard algorithm. Correlation, discrimination, responsiveness and differences across the two questionnaires were examined.
The mean age of patients enrolled in the cohort was 66 years. There was significant increase in forced expiratory volume (FEV1, 43%), forced vital capacity (FVC 46%), diffusion capacity (DLCO 15%), 6 min walk distance test (6MWD 21%) and a significant decrease in residual volume (RV 23%) at the end of 1-year follow-up. The overall mean utility index significantly improved for both SF-6D and EQ-5D-3L questionnaires at the end of follow-up (p = 0.0001). However, the magnitude of percentage increase was higher with EQ-5D-3L compared to SF-6D (32% vs. 13%). Stronger correlations confirmed convergent validity at the end of 1-year follow-up between similar domains. Both questionnaires failed to discriminate between different levels of disease severity post-LVRS in patients with severe COPD.
Both questionnaires responded similarly in patients with COPD post-LVRS. Combining results from QOL questionnaire(s) along with symptoms of disease and history of exacerbation may be a possible solution for identifying disease severity in old and sick patients unwilling/unable to come to hospital for a pulmonary function test post-LVRS.
肺减容术（LVRS）已被证明能改善肺功能，但也能提高整体生活质量（QOL）。本研究旨在比较两种 QOL 问卷——欧洲五维健康量表（EQ-5D-3L）和 36 项简短健康调查问卷（SF-36）在 LVRS 术后患者中的应用。
在一个卓越中心对所有接受 LVRS 治疗严重慢性阻塞性肺疾病（COPD）的患者进行分析（n=94）。对基线人口统计学和临床结局进行特征描述。在基线（n=94）和术后 1 年（n=89）时，所有患者均接受 EQ-5D-3L 和 SF-36 问卷。SF-36 使用标准算法转换为六维度简短健康调查问卷（SF-6D）。检验了两个问卷之间的相关性、区分度、反应度和差异。
入组患者的平均年龄为 66 岁。术后 1 年随访时，用力呼气量（FEV1，43%）、用力肺活量（FVC，46%）、弥散量（DLCO，15%）和 6 分钟步行距离（6MWD，21%）显著增加，残气量（RV，23%）显著减少。随访结束时，SF-6D 和 EQ-5D-3L 问卷的总体平均效用指数均显著提高（p=0.0001）。然而，EQ-5D-3L 的百分比增加幅度高于 SF-6D（32% vs. 13%）。在 1 年随访结束时，相似领域之间的相关性较强，证实了两种问卷的收敛效度。在 LVRS 术后严重 COPD 患者中，两种问卷均不能区分疾病严重程度。
在 LVRS 术后的 COPD 患者中，两种问卷的反应相似。将 QOL 问卷（s）的结果与疾病症状和加重病史相结合，可能是识别 LVRS 术后不愿/不能到医院进行肺功能检查的老年和体弱患者疾病严重程度的一种方法。
