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Sorano A, Fumagalli C, Cinelli E, Birring SS, Fontana GA, Lavorini F. Development of an Italian version of the Leicester cough questionnaire and its relationship with other symptom-specific measures for patients with chronic cough. Respir Med 2024; 227:107642. [PMID: 38670318 DOI: 10.1016/j.rmed.2024.107642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To implement subjective methods for measuring the impact of chronic cough on patients' daily life, including an Italian version of the symptom-specific, health status measure for patients with chronic cough, i.e. the Leicester Cough Questionnaire (LCQ). METHODS Sixty-five chronic cough patients attended a tertiary cough clinic on two separate occasions 8 weeks apart. The visual analogue scale for cough severity (VAS), the LCQ and the cough disturbance score (CDS) were administered on both occasions. The LCQ was adapted for Italian conditions following a forward-backward translation procedure. Concurrent validation, internal consistency, repeatability and responsiveness were determined. RESULTS The CDS, VAS and LCQ were correlated (r coefficients ranging from 0.69 to 0.94, p < 0.01). The internal consistency for each LCQ domain was high (alpha coefficient range 0.87-0.93), as was the 8-week repeatability of the LCQ in the patients (n = 36, 60 %) who displayed no change in CDS and VAS (intra-class correlation coefficient = 0.86, p < 001) over the same period. Patients who reported an improvement in CDS and VAS after 8 weeks (n = 29) also demonstrated significant improvements in each LCQ domain. The mean difference in LCQ total score before and after improvements was 2.26 (95 % CI: 1.58-4.47). CONCLUSIONS The Italian version of the LCQ appears to be just as valid as the other language versions of the questionnaire. In addition, the CDS appears to be a clinically useful, symptom-specific measure of the overall disturbance provoked by cough.
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Affiliation(s)
- Alessandra Sorano
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Carlo Fumagalli
- Department of Advanced Medical and Surgical Sciences, 'Luigi Vanvitelli' University of Campania', Naples, Italy
| | - Elenia Cinelli
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Surinder S Birring
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Giovanni A Fontana
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Italy.
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Ternesten-Hasséus E, Johansson EL. Validity and reliability of the Swedish version of the Leicester Cough Questionnaire in unexplained chronic cough. Respir Med 2024; 224:107582. [PMID: 38428509 DOI: 10.1016/j.rmed.2024.107582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/14/2024] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Cough is considered chronic when it lasts for >8 weeks. When no medical explanation can be found it is often called unexplained chronic cough (UCC), which may affect health-related quality of life (HRQOL). This study aimed to assesses the validity and reliability of the Swedish version of the Leicester Cough Questionnaire (LCQ-S) in patients with UCC. METHODS Seventy-six consecutively selected patients with UCC replied to: a local questionnaire; the LCQ-S; a Visual Analog Scale (VAS) for cough; the Swedish version of the Hull Airway Reflux Questionnaire (HARQ-S); and the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR). To evaluate the reproducibility of the LCQ-S, the VAS and LCQ-S were answered again after two to four weeks. RESULTS Seventy-four patients (17 men) answered the questionnaires at baseline. Concurrent validity for LCQ-S was regarded as moderate with the VAS for cough and HARQ-S. Internal consistency using Cronbach's alpha was high for the LCQ-S total score (0.92) and satisfactory for the LCQ-S domains (0.78-0.83). Reliability and reproducibility were analysed in 57 patients (14 men). Intra-class correlation for the LCQ-S total score and domains showed strong reliability (≥0.92), without any significant differences over time. The standard error of measurement and the smallest real difference were 1.26 and 3.49, respectively. The Bland-Altman plot showed no systematic change in the mean values. CONCLUSIONS The LCQ-S has good validity and reliability and can be used in clinical settings to evaluate HRQOL in Swedish-speaking adult patients with UCC.
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Affiliation(s)
- Ewa Ternesten-Hasséus
- Department of Respiratory Medicine and Allergology, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, SE 405 30, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Respiratory Medicine, Allergology and Palliative Medicine, Gothenburg, Sweden.
| | - Ewa-Lena Johansson
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, SE 405 30, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Physiotherapy and Occupational Therapy, Gothenburg, Sweden
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Nguyen AM, Schelfhout J, Muccino D, Bacci ED, La Rosa C, Vernon M, Birring SS. Leicester Cough Questionnaire validation and clinically important thresholds for change in refractory or unexplained chronic cough. Ther Adv Respir Dis 2022; 16:17534666221099737. [PMID: 35614875 PMCID: PMC9149626 DOI: 10.1177/17534666221099737] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The Leicester Cough Questionnaire (LCQ), a cough-specific quality-of-life measure, evaluates the impact of cough across physical, psychological, and social domains in patients with chronic cough (CC). This study assessed the psychometric properties of the LCQ. METHODS Data from a phase IIb, randomized controlled trial of the P2X3-receptor antagonist gefapixant were analyzed (NCT02612610). Subjective [Cough Severity Diary, cough severity visual analogue scale, and patient global impression of change (PGIC)] and objective (awake and 24-h cough frequency) data were used to validate the LCQ for use in patients with refractory or unexplained CC (RCC and UCC, respectively). Psychometric analyses included confirmatory factor analyses, internal consistency and test-retest reliability, validity, responsiveness, and estimated within-patient thresholds for clinically meaningful change. RESULTS Model-fit values for the proposed three-factor LCQ domains and most individual items were acceptable. Analyses suggest that a mean improvement ranging from 1.3 to 2.3 points for the LCQ total and ⩾0.8, ⩾0.9, and ⩾0.8 points for physical, psychological, and social domain scores, respectively, had the best sensitivity and/or specificity for predicting patient ratings of improvement on the PGIC. CONCLUSIONS The LCQ is a valid and reliable measure to evaluate cough-specific quality of life and is a fit-for-purpose measure for use in patients with RCC or UCC. Although a single threshold for defining clinically meaningful change depends on the context of use, the results can help guide both treatment decisions and drug development. Therefore, clinicians may consider a ⩾1.3-point increase in the LCQ total score as clinically meaningful.
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Affiliation(s)
| | | | | | | | | | | | - Surinder S. Birring
- Centre for Human & Applied Physiological
Sciences, School of Basic & Medical Biosciences, Faculty of Life
Sciences & Medicine, King’s College London, Denmark Hill, London SE5
9RS, UK
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Haukeland-Parker S, Hasvik E, Jelsness-Jørgensen LP, Birring S, Johannessen HH. Cross-cultural adaptation and validation of the Norwegian version of the Leicester Cough Questionnaire in chronic obstructive pulmonary disease. Physiother Theory Pract 2021; 38:2175-2184. [PMID: 33840375 DOI: 10.1080/09593985.2021.1911012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Cough is a common symptom among patients with chronic obstructive pulmonary disease (COPD), but there are currently no patient-reported outcome measures (PROM) for subjective cough symptoms in Norwegian.Objective: The objective was to translate and validated the most widely used PROM for chronic cough, the Leicester Cough Questionnaire (LCQ) from English to Norwegian (NLCQ) using established guidelines.Methods: Forward and backward translations were performed using external translators. All phases were discussed in an expert workgroup until consensus was achieved. Ten patients were interviewed about the pre-final version to assess understandability and ease to complete. The final NLCQ was externally proofread and tested for content and construct validity, internal consistency, test-retest reliability and measurement error.Results: Mean (SD) age was 67 (7.9) years, and 62% of the sample were female (n = 56/89). According to GOLD stages, 10% had mild, 27% moderate, 35% severe and 22% very severe COPD, respectively. GOLD stages were missing for five patients (6%). The NLCQ showed acceptable accordance with the original, acceptable understandability and ease to complete, satisfactory content reliability, total score construct validity, internal consistency and test-retest reliability. Test-retest bias was low, but measurement error was larger than previously reported. The standard error of measurement and smallest detectable change were 1.56 and 4.32, respectively. Construct validity and factor analysis raised concerns regarding the three subdomains.Conclusion: The present cross-cultural adaptation of the NLCQ showed satisfactory reliability and overall validity. Due to concerns for the validity of the three domains, we suggest use should be restricted to the NLCQ total score until these are reassessed.
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Affiliation(s)
| | - Eivind Hasvik
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Internal Medicine, Østfold Hospital Trust, Grålum, Norway.,Department of Health and Welfare, Østfold University College, Halden, Norway
| | - Surinder Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, Department of Respiratory Medicine, Denmark Hill, King's College London, London, UK
| | - Hege Hølmo Johannessen
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway.,Department of Health and Welfare, Østfold University College, Halden, Norway
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Gvozdenovic BS, Mihailovic-Vucinic VV, Vukovic MH, Stjepanovic MI, Buha I, Mihailovic SV, Maric NB. Predictors of cough-specific and generic quality of life in sarcoidosis patients. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 37:158-168. [PMID: 33093779 PMCID: PMC7569550 DOI: 10.36141/svdld.v37i2.9234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Abstract
Background Cough is frequent symptom in sarcoidosis and its impact on patient's quality of life (QoL) has not been adequately addressed so far. Objectives The goal of this study was to determine the significant predictors of cough-specific and generic QoL in sarcoidosis patients. Methods In the prospective study 275 sarcoidosis patients administered Patient Reported Outcomes instruments for measurement of dyspnea (Borg and MRC scales) and fatigue (Fatigue Assessment Scale (FAS) and Daily Activity List (DAL)), as well as patients' QoL (cough-specific Leicester Cough Questionnaire (LCQ) and generic tool - 15D). The LCQ contains 3 domains covering physical, psychological and social aspects of chronic cough. Pulmonary function tests (spirometry and diffusing capacity for carbon monoxide) and serum angiotensin converting enzyme (sACE) were also measured. Results Dyspnea measured by Borg scale and impairment of daily activities determined by DAL instrument as well as sACE were the strongest predictors of all cough-specific QoL domains. Mental aspect of patients' fatigue was significantly correlated with all domains except with psychological LCQ domain. Regarding the generic QoL, the following significant predictors were: dyspnea measured by MRC scale, overall fatigue determined by FAS and physical domain of the LCQ. Conclusion It is important to measure both cough-specific and generic QoL in sarcoidosis patients since they measure different health aspects and their predictors can be different. We demonstrated that physical domain of cough-specific QoL is significant predictor of generic QoL. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 158-168).
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Affiliation(s)
| | - Violeta V Mihailovic-Vucinic
- Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Serbia
| | | | - Mihailo I Stjepanovic
- Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Serbia
| | - Ivana Buha
- Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Nikola B Maric
- Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade, Serbia
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Wang Z, Wang M, Wen S, Yu L, Xu X. Types and applications of cough-related questionnaires. J Thorac Dis 2019; 11:4379-4388. [PMID: 31737324 DOI: 10.21037/jtd.2019.09.62] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cough is a normal protective reflex that can effectively remove foreign bodies and secretions from the airway. However, excessive cough adversely affects a patient's physiological, psychological and social functions. Thus, it is important to effectively evaluate the severity of cough to determine its diagnosis and treatment. Cough severity can be assessed with subjective or objective tools. Herein, we summarize the subjective evaluation of cough severity with questionnaires.
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Affiliation(s)
- Zhijing Wang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Miao Wang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Siwan Wen
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Li Yu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Xianghuai Xu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
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Schupp JC, Fichtner UA, Frye BC, Heyduck-Weides K, Birring SS, Windisch W, Criée CP, Müller-Quernheim J, Farin E. Psychometric properties of the German version of the Leicester Cough Questionnaire in sarcoidosis. PLoS One 2018; 13:e0205308. [PMID: 30286204 PMCID: PMC6171952 DOI: 10.1371/journal.pone.0205308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/21/2018] [Indexed: 12/19/2022] Open
Abstract
Background Cough is one of the most common symptoms in general and pulmonary medicine with profound negative impact on health-related quality of life (HRQL). The Leicester Cough Questionnaire (LCQ) is a validated HRQL questionnaire, yet a validated German version of the LCQ is not available and it has never been tested in a cohort with sarcoidosis. Objectives To translate the LCQ into German and determine its psychometric properties. Methods The LCQ was translated in a forward-backward approach. Structured interviews in sarcoidosis patients were performed. Subsequently, sarcoidosis patients were asked to answer the German LCQ and comparative questionnaires. Distribution properties, item difficulty, concurrent validity, Rasch model fit and internal consistency of the German LCQ were determined. Results 200 patients with sarcoidosis were included. We provide evidence for reliability, unidimensionality and internal consistency. However, only a moderate correlation with general and respiratory-specific HRQL questionnaires, no Rasch model fit could be shown. Skewed responses caused by floor effects were detected. Conclusion We demonstrate that the German LCQ is valid and reliable and its psychometric properties fulfil the standards required for its use in clinical settings as well as in interventional trials.
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Affiliation(s)
- Jonas Christian Schupp
- Department of Pneumology, Faculty of Medicine, University Medical Centre, Freiburg, Germany
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Urs Alexander Fichtner
- Institute for Quality Management and Social Medicine, Faculty of Medicine, University Medical Centre, Freiburg, Germany
| | - Björn Christian Frye
- Department of Pneumology, Faculty of Medicine, University Medical Centre, Freiburg, Germany
| | - Katja Heyduck-Weides
- Institute for Quality Management and Social Medicine, Faculty of Medicine, University Medical Centre, Freiburg, Germany
| | - Surinder S. Birring
- Division of Asthma, Allergy and Lung Biology, King’s College London, London, United Kingdom
| | - Wolfram Windisch
- Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Carl-Peter Criée
- Department of Sleep and Respiratory Medicine, Evangelical Hospital Göttingen-Weende, Bovenden, Germany
| | | | - Erik Farin
- Institute for Quality Management and Social Medicine, Faculty of Medicine, University Medical Centre, Freiburg, Germany
- * E-mail:
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Sönnerfors P, Faager G, Einarsson U. Translation of the Leicester Cough Questionnaire into Swedish, and validity and reliability in chronic obstructive pulmonary disease. Disabil Rehabil 2017; 40:2662-2670. [PMID: 28728439 DOI: 10.1080/09638288.2017.1353648] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to translate and culturally adapt the Leicester Cough Questionnaire into Swedish and to test the validity and reliability of the Swedish version, in patients with chronic obstructive pulmonary disease. METHODS The original Leicester Cough Questionnaire was translated into Swedish by a method, which followed an established forward-backward procedure, including cross-cultural adaptation and pretest. To test the validity of the final version of Leicester Cough Questionnaire in Swedish, the St George's Respiratory Questionnaire and the COPD Assessment Test were used (n =112) and to test reliability, the questionnaire was repeated (n = 86). RESULTS The Leicester Cough Questionnaire in Swedish showed proof of construct validity and proof of internal consistency (Cronbach's alpha coefficient 0.97). All domains and total scores had good-excellent test-retest reliability (intra-class correlation coefficient 2,1 > 0.94). The standard error of measurement, (standard error of measurement percent), for the Leicester Cough Questionnaire in Swedish was 0.84 (5.15%). The smallest real difference, (smallest real difference percent), derived from cross sectional standard error of measurement was 2.33 (14.25%). The Bland-Altman plot indicated no systemic change in the mean. CONCLUSION The Leicester Cough Questionnaire in Swedish is a valid and reliable instrument to measure health-related quality of life in patients with chronic obstructive pulmonary disease and can be used in clinical settings. Implications for Rehabilitation The Leicester Cough Questionnaire, has been translated into Swedish, following an established forward-backward procedure, including cross-cultural adaptation The Swedish version of the Leicester Cough Questionnaire, is a valid, reliable instrument for measuring health-related quality of life regarding cough in patients with chronic obstructive pulmonary disease The Swedish version of the Leicester Cough Questionnaire is easy to administer and can be used in clinical and rehabilitation settings and for research purposes The absolute reliability presented at group and individual levels to indicate a real improvement is an advantage to assist when interpreting a clinically relevant difference.
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Affiliation(s)
- Pernilla Sönnerfors
- a Functional Area Occupational Therapy & Physiotherapy , Karolinska University Hospital , Stockholm , Sweden.,b Division of Physiotherapy, Department of Neurobiology, Caring Sciences and Society , Karolinska Institutet , Stockholm , Sweden
| | - Gun Faager
- a Functional Area Occupational Therapy & Physiotherapy , Karolinska University Hospital , Stockholm , Sweden.,b Division of Physiotherapy, Department of Neurobiology, Caring Sciences and Society , Karolinska Institutet , Stockholm , Sweden
| | - Ulrika Einarsson
- a Functional Area Occupational Therapy & Physiotherapy , Karolinska University Hospital , Stockholm , Sweden
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