Is The CAT Questionnaire Sensitive To Changes In Health Status In Patients With Severe COPD Exacerbations?

Abstract

The COPD Assessment Test (CAT) was validated in English showing good psychometric properties. The objective of this study is to assess the capacity of the CAT to detect changes in health status in patients experiencing COPD exacerbations (ECOPD) and to further explore the validity of the Spanish version. An observational study was conducted in 49 Spanish centres. Patients hospitalised because of ECOPD (n = 224) completed the CAT, the St. George's Respiratory Questionnaire-adapted for COPD (SGRQ-C) and the London Chest Activities of Daily Living (LCADL) questionnaire during the first 48 hours of admission and 4 ± 1 weeks after discharge. Stable patients (n = 153) also completed these at recruitment and 4 ± 1 weeks later. Over 90% of patients were male. The CAT discriminated between stable and ECOPD patients (15.8 vs 22.4, p < 0.01), as well as between patients with different levels of airflow limitation and dyspnea (MRC scale). The CAT proved sensitive to change; change in mean score was 8.9 points (effect size (ES), 0.90) in ECOPD patients reporting their health state as "much better" after discharge, 4.8 points in those reporting "quite a lot better" (ES = 0.63), and 4.6 points in those reporting "slightly better" (ES = 0.59). Cronbach's alpha and Intraclass Correlation Coefficient were 0.86 and 0.83, respectively. It correlated with both the SGRQ (r = 0.82; p < 0.01) and the LCADL (r = 0.63; p < 0.01). Change in CAT correlated well with Δ SGRQ (r = 0.63; p < 0.01). The CAT showed to be sensitive to the change in health status associated with ECOPD. We also provide evidence of the validity of the Spanish version.

Validation of the COPD Assessment Test in Patients with COPD in Iran

“…This questionnaire was also translated to Chinese and Turkish and had acceptable report [18,19]. The CAT questionnaire has been used to follow the condition of patients with COPD, particularly for evaluating health improvement with rehabilitation and recovery from disease exacerbation [20][21][22]. Development of the CAT questionnaire to become familiar with patients problems in their own language has some advantages including its well acceptance by patients and correlation with SGRQ and patients' psychometric status [23].…”

The COPD assessment test: a systematic review

“…Nonresponse rate and floor and ceiling effect Only six studies reported the proportions of the population with complete CAT scores (no missing items) and those with missing items [9,15,17,21,26,41] (table 2). The percentage of patients with the minimum (floor effect) and maximum (ceiling effect) possible total score was measured in two populations [9,36] (table 2).…”

“…The percentage of patients with the minimum (floor effect) and maximum (ceiling effect) possible total score was measured in two populations [9,36] (table 2).…”

The concept of control in COPD: a new proposal for optimising therapy

“…The CAT or CCQ may also be potentially useful to evaluate clinical changes over time [10,11]. In the case of the CAT it has been described that a change of greater than 2 points may indicate clinically significant deterioration [12], with the same occurring with a change greater than 0.4 points for the CCQ [13].…”

“…Questionnaires of clinical control, such as the COPD Assessment Test (CAT) [8] or the Clinical COPD Questionnaire (CCQ) may be used as an alternative or complementary measure to clinical evaluation [9]. CCQ or CAT scores may significantly differ in patients within the same level of COPD severity, and these scores are sensitive to changes in health status after an exacerbation or intervention [10,11]. Together with the simplicity and ease of use of these questionnaires, they are ideal tools to assess clinical impact.…”