National Validation and Sensitivity to Change of the SAQ

University Hospital Plymouth NHS Trust410 enrolled

Overview

DESIGN A multi-centre mixed methods study of a new asthma specific quality of life questionnaire including limited clinic data. AIMS To collect further quantitative data to validate a new asthma quality of life scale, the Severe Asthma Questionnaire (SAQ). To determine the Minimum Clinically Important Difference (MCID) of the SAQ OUTCOME MEASURES Questionnaires: 1. The Severe Asthma Questionnaire (SAQ) 2. The Mini Asthma Quality of Life Questionnaire (MiniAQLQ) 3. The EQ-5D-5L 4. The Asthma Control Test (ACT)/ Asthma Control Questionnaire (ACQ) 5. Global Rating of Change Questionnaire (GRCQ) Clinical data comprises: 6. Spirometry 7. BMI 8. Asthma severity 9. Health care utilisation: ED attendance in the last 12 months, Hospital admissions in the last 12 months; 10. Number of exacerbations in the last 12 months requiring OCS Prednisolone dose mg/day (if oral steroid dependent). POPULATION All patients aged 16 years or over, who have attended one of three participating UK specialist asthma centres for the validation study and with data also collected from Derriford Hospital's Chest Clinic (DHCC) for use in determining Minimum clinically Important difference. ELIGIBILITY Over 16 years of age Diagnosis of Severe Asthma DURATION 18 months

Study Type

OBSERVATIONAL

Enrollment

410

Conditions

Asthma Severe Asthma

Eligibility

Sex: ALLMin age: 16 YearsMax age: 100 Years

Medical Language ↔ Plain English

Part 1: National Validation Inclusion Criteria: * All patients must have a diagnosis of severe asthma, be taking high dose inhaled corticosteroids (GINA step 4 \& 5), and be aged 16 years or over. Exclusion Criteria: * Patients that are unwilling to participate will be excluded from the study. * In the opinion of the physician responsible for the care of the patient, the patient has a condition, other than asthma, which is significantly contributing to their respiratory symptoms, e.g. lung cancer, heart failure or severe Chronic Obstructive Pulmonary Disease (COPD). * The SAQ is currently only translated into British English. Therefore, if the participant is unable to read in English, they will be unable to participate. Part 2: Sensitivity to change Inclusion Criteria * Patients commencing a biologic treatment for their severe asthma (GINA step 4 \& 5), as per NICE guidelines. Exclusion Criteria * Patients will be excluded from the study if they are unwilling to participate * In the opinion of the physician responsible for the care of the patient, the patient has a condition, other than asthma which is significantly contributing to their respiratory symptoms, e.g. lung cancer, heart failure or severe COPD.

Outcomes

Primary Outcomes

Severe Asthma Questionnaire (SAQ) score

The new questionnaire will provide a combined assessment of disease and its treatment on the quality of life of patients with severe asthma. The scale is based on existing Health Related Quality of Life (HRQoL) scales but modified for the severe population and provides assessments of the effect of asthma symptoms and the effect of asthma medicines. The SAQ was produced from detailed qualitative research. The questionnaire has 16 items, scored on a 1-7 scale (a higher score indicating better quality of life). The mean score of these 16 questions is calculated to produce an overall score. An additional 3 items are included to asses overall HRQoL, and HRQoL during different months of the year. These three questions are scored on a 100 point scale with a higher score indicating better HRQoL.

Time frame: Part 1: National Validation - Only cross-sectional data recorded within 2 weeks after enrollment (enrollment period of 6 months)

Change in Severe Asthma Questionnaire (SAQ) score

The Severe Asthma Questionnaire (SAQ) will be collected at 5 time points and matched with the Global Rating of Change questionnaire at these time points to determine the SAQ's Minimum Clinically Important Difference (MCID). The questionnaire has 16 items, scored on a 1-7 scale (a higher score indicating better quality of life). The mean score of these 16 questions is calculated to produce an overall score. An additional 3 items are included to asses overall HRQoL, and HRQoL during different months of the year. These three questions are scored on a 100 point scale with a higher score indicating better HRQoL.

Time frame: Part 2: Sensitivity to change: Collected at 0 (baseline) 4, 8, 12 & 16 weeks, (enrollment period of 10 months)

Secondary Outcomes

The Mini Asthma Quality of Life Questionnaire (MiniAQLQ)

This 15-item scale is commonly used as the quality of life scale in asthma studies. It consists of 15 questions which are scored on on a 1-7 scale, with a higher score indicating better health related quality of life. Whilst the MiniAQLQ can be scored as four separate domains (Symptoms, Activity Limitations, Emotional Functional and Environmental Stimuli), these will not be used. Instead the mean score of the 15 questions will be used as the MiniAQLQ score. For the purpose of validation, we wish to show that this scale correlates with the burden of symptoms but not, or with a much lower correlation, with the burden of treatment.

Time frame: Part 1: National Validation & Part 2: Sensitivity to change - Collected at 0 (baseline) weeks, within two weeks after enrollment (enrollment period of 6 or 10 months respectively)

Asthma Control Test (ACT)

Note: Recruiting sites are able to chose which Asthma Control Patient Reported Outcome (PRO) to contribute data for, (The ACT or the ACQ). The Asthma Control Test (ACT) is a 5-item scale is commonly used as a measure of asthma control in asthma studies. It is scored on a scale of 1-5 with a higher score indicating better asthma control. For the purpose of validation, we wish to show that this scale correlates with the burden of symptoms but not, or with a much lower correlation, with the burden of treatment.

Time frame: Part 1: National Validation - Only cross-sectional data recorded within 2 weeks after enrollment (enrollment period of 6 months), Part 2: Sensitivity to change - Collected at 0 (baseline) 4, 8, 12 & 16 weeks

Asthma Control Questionnaire (ACQ)

The Asthma Control Questionnaire (ACQ) contains 7 items and takes into consideration FEV1% predicted and daily use of rescue bronchodilator. Patients respond to 7 items concerning their symptom severity on a 0-6 scale (0 = no impairment, 6 = maximum impairment). The mean of the 7-items will be used as the score of the ACQ.

Time frame: Part 1: National Validation - Only cross-sectional data recorded within 2 weeks after enrollment, Part 2: Sensitivity to change - Collected at 0 (baseline) 4, 8, 12 & 16 weeks

EQ-5D-5L

This is a 5-item scale scored from 1-5 with a higher score indicating worse health. For the purposes of this study, the mean score of the five items will be used as the score for the EQ5D. In addition to the 5 items, the EQ-5D-5L also includes a category rating scale to rate their quality of life on the day of completion. This is scored from 0-100 with a higher score indicating better health. This scale is commonly used in clinical trials to determine improvement in patients' perceived quality of life. The correlations between EQ-5D-5L scores and SAQ scores will be explored.

Time frame: Part 1: National Validation - Only cross-sectional data recorded within 2 weeks after enrollment (enrollment period of 6 months) , Part 2: Sensitivity to change - Collected at 0 (baseline) & 16 weeks within 2 weeks of enrollment

Change in Global Rating of Change Questionnaire (GRCQ)

This scale will be used by participants to indicate how much better they feel since commencing a biologic treatment for asthma. The 11-point scale ranges from -5 (a great deal worse) to 5 (A great deal better).

Time frame: Part 2: Sensitivity to change - Collected at 4, 8, 12 & 16 weeks within 2 weeks of enrollment (enrollment period of 10 months)