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Racette SD, Schneider AL, Ganesh M, Huang JH, Lehmann DS, Price CP, Rodegherio SG, Reddy AT, Eide JG, Conley DB, Welch KC, Kern RC, Shintani‐Smith S, Kato A, Schleimer RP, Tan BK. CRS-PRO and SNOT-22 correlations with type 2 inflammatory mediators in chronic rhinosinusitis. Int Forum Allergy Rhinol 2022; 12:1377-1386. [PMID: 35363947 PMCID: PMC9525449 DOI: 10.1002/alr.23002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 12/30/2022]
Abstract
The 22-item Sino-Nasal Outcome Test (SNOT-22) and 12-item Patient Reported Outcomes in Chronic Rhinosinusitis (CRS-PRO) instrument are validated patient-reported outcomes measures in CRS. In this study we assess the correlation of these with type 2 (T2) biomarkers before and after endoscopic sinus surgery (ESS). METHODS Middle meatal mucus data were collected and the SNOT-22 and CRS-PRO were administered to 123 patients (71 CRS without nasal polyps [CRSsNP], 52 CRS with nasal polyps [CRSwNP]) with CRS before and 6 to 12 months after undergoing ESS. Interleukin (IL)-4, IL-5, IL-13, and eosinophilic cationic protein (ECP) were measured using a multiplexed bead assay and enzyme-linked immunoassay. Pre- and post-ESS SNOT-22 and CRS-PRO were compared with T2 biomarkers. RESULTS Before ESS neither PROM correlated with any biomarker. After ESS, CRS-PRO showed a correlation with 2 mediators (IL-5 and IL-13: p = 0.012 and 0.003, respectively) compared with none for the SNOT-22. For CRSwNP patients, pre-ESS CRS-PRO and SNOT-22 correlated with IL-4 (p = 0.04 for both). However, after ESS, CRS-PRO correlated with 3 biomarkers (IL-5, IL-13, and ECP: p = 0.02, 0.024, and 0.04, respectively) and SNOT-22 with 2 biomarkers (IL-5 and IL-13: p = 0.038 and 0.02, respectively). There were no significant relationships between any of the T2 biomarkers pre- or post-ESS among patients with CRSsNP. Exploratory analyses of the subdomains showed the SNOT-22 rhinologic and CRS-PRO rhinopsychologic subdomains correlated better with the T2 biomarkers. On individual item analysis, IL-13 correlated significantly post-ESS with 8 of 12 items on the CRS-PRO vs 6 of 22 items on the SNOT-22. CONCLUSION The CRS-PRO total score showed a significant correlation with T2 biomarkers especially when assessed post-ESS and among CRSwNP patients.
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Affiliation(s)
- Samuel D. Racette
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Alexander L. Schneider
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Meera Ganesh
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Julia H. Huang
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - David S. Lehmann
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Caroline P.E. Price
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Samuel G. Rodegherio
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Abhita T. Reddy
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Jacob G. Eide
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - David B. Conley
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Kevin C. Welch
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Robert C. Kern
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Stephanie Shintani‐Smith
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
| | - Atsushi Kato
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
- Division of Allergy and ImmunologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Robert P. Schleimer
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
- Division of Allergy and ImmunologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Bruce K. Tan
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIL
- Division of Allergy and ImmunologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
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Lin KA, Price CPE, Huang JH, Ghadersohi S, Cella D, Kern RC, Conley DB, Shintani-Smith S, Welch KC, Tan BK. Responsiveness and convergent validity of the chronic rhinosinusitis patient-reported outcome ( CRS-PRO) measure in CRS patients undergoing endoscopic sinus surgery. Int Forum Allergy Rhinol 2021; 11:1308-1320. [PMID: 33728827 DOI: 10.1002/alr.22782] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/04/2021] [Accepted: 01/26/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The chronic rhinosinusitis patient-reported outcome (CRS-PRO) measure is a 12-item measure with previously demonstrated validity in chronic rhinosinusitis (CRS) patients receiving medical therapy. This study establishes the factor structure, responsiveness, and convergent validity of the CRS-PRO following endoscopic sinus surgery (ESS). METHODS Northwestern CRS Subject Registry patients had pre-ESS, 3-month (n = 111; CRS without nasal polyps [CRSsNP] = 60, CRS with nasal polyps [CRSwNP] = 51), and 6-month (n = 86; CRSsNP = 47, CRSwNP = 39) post-ESS assessments where patients completed the CRS-PRO, 22-item Sino-Nasal Outcome Test (SNOT-22), and four Patient-Reported Outcomes Measurement (PROM) Information System (PROMIS) short forms (general health measures). Patients had pre-ESS objective testing (endoscopic and radiographic assessment). Factor analysis was conducted using principal axis factoring with varimax rotation on the baseline CRS-PRO. The clinically important difference (CID) was estimated using both distribution-based and anchor-based methods. RESULTS Factor analysis found the CRS-PRO comprised the "rhino-psychologic," "facial discomfort," and "cough" factors, which were responsive to ESS and correlated with the other PROMs. The changes observed in the CRS-PRO at 3 months had strong correlation with the corresponding changes in SNOT-22 (r = 0.792, p < 0.0001) and moderate correlations with changes in PROMIS fatigue and sleep domains. These changes had a very large effect size (Cohen's d 1.44) comparable to the longer SNOT-22 (Cohen's d 1.41) with slightly larger effect sizes observed in CRSwNP compared to CRSsNP patients. Similar convergent validity and responsiveness were observed in the 6-month data. The CRS-PRO CID was estimated to be between 5.0 and 7.5 (midpoint 6.0) using distribution-based and anchor-based methods. CONCLUSION This study demonstrates the validity and responsiveness of the CRS-PRO in subjects receiving ESS.
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Affiliation(s)
- Katherine A Lin
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Caroline P E Price
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Julia H Huang
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Saied Ghadersohi
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.,Institute for Public Health and Medicine (IPHAM)-Center for Patient-Centered Outcomes, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David B Conley
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Stephanie Shintani-Smith
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.,Institute for Public Health and Medicine (IPHAM)-Center for Patient-Centered Outcomes, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Kevin C Welch
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Bruce K Tan
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Ghadersohi S, Price CPE, Beaumont JL, Kern RC, Conley DB, Welch KC, Calice AM, Stanton E, VanderMeeden MK, Jensen SE, Peters AT, Grammer LC, Stevens WW, Schleimer RP, Tan BK. Responsiveness and Convergent Validity of a New Patient-Reported Outcome Measure for Chronic Rhinosinusitis ( CRS-PRO). J Allergy Clin Immunol Pract 2020; 8:2351-2359.e2. [PMID: 32361009 PMCID: PMC7448959 DOI: 10.1016/j.jaip.2020.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The CRS-PRO is a new patient-reported outcome measure (PROM) for chronic rhinosinusitis (CRS) that was developed using extensive patient input per Food and Drug Administration guidance on PROMs acceptable for use as end points in clinical trials. OBJECTIVE To assess the responsiveness and convergent validity of the CRS-PRO following standard-of-care medical therapy. METHODS This was a prospective study of 51 patients (21 with nasal polyps and 30 without) with newly diagnosed CRS or having an acute CRS exacerbation who were initiated on appropriate medical therapy. At the baseline visit each patient completed the CRS-PRO questionnaire, the 22-item Sino-Nasal Outcome Test, the EuroQol 5-dimensional questionnaire, and 4 Patient-Reported Outcome Measure Information System short forms along with objective testing including endoscopic and radiographic scores, smell discrimination, and nasal inspiratory flow testing. This same battery of questionnaires and testing was administered at a follow-up visit 4 to 8 weeks later. RESULTS We verified that shortening the 21-item CRS-PRO to 12 items as previously described maintains its psychometric properties. The 12-item CRS-PRO was responsive with a large effect size (Cohen's d, 0.94) comparable to the longer 22-item Sino-Nasal Outcome Test (Cohen's d, 0.93). The instrument was slightly more responsive to medically treated patients with CRS without nasal polyps compared with patients with CRS with nasal polyps (Cohen's d, 1.1 vs 0.89, respectively). The change in 12-item CRS-PRO total score has moderate correlation with change in Lund-Mackay computed tomography scores. CONCLUSIONS The CRS-PRO is a 12-item rigorously developed, responsive, and valid PROM that was developed using extensive input from patients with current definitions of CRS, including its 2 major phenotypes.
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Affiliation(s)
- Saied Ghadersohi
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Caroline P E Price
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | | | - Robert C Kern
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Allergy-Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - David B Conley
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Kevin C Welch
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Alexis M Calice
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Elizabeth Stanton
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Marisa K VanderMeeden
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Sally E Jensen
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Anju T Peters
- Division of Allergy-Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Leslie C Grammer
- Division of Allergy-Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Whitney W Stevens
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Allergy-Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Robert P Schleimer
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Allergy-Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Bruce K Tan
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Allergy-Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill.
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Ghadersohi S, Price CPE, Jensen SE, Beaumont JL, Kern RC, Conley DB, Welch KC, Peters AT, Grammer LC, Stevens WW, Calice AM, Stanton E, VanderMeeden MK, Schleimer RP, Tan BK. Development and Preliminary Validation of a New Patient-Reported Outcome Measure for Chronic Rhinosinusitis ( CRS-PRO). J Allergy Clin Immunol Pract 2020; 8:2341-2350.e1. [PMID: 32376490 PMCID: PMC7448958 DOI: 10.1016/j.jaip.2020.04.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patient-reported outcome (PRO) measures developed and validated on patients with the currently defined phenotypes of chronic rhinosinusitis (CRS) are needed to support clinical trials in CRS. OBJECTIVE This study developed and examined the initial reliability and validity of the CRS-PRO, a new PRO measure of CRS. METHODS Instrument development was performed through structured interviews and focus groups with clinical experts and 45 patients with CRS meeting current definitions of disease, 21 patients with CRS without nasal polyps (CRSsNP), and 24 patients with CRS with nasal polyps (CRSwNP) to identify items important to patients. Then another 50 patients (32 with CRSsNP and 18 with CRSwNP) with stable CRS symptoms were enrolled to evaluate the reliability of the instrument. Each patient completed the CRS-PRO, Sinonasal Outcome Test-22 (SNOT-22), and 4 Patient-Reported Outcome Measurement Information System short forms at the baseline visit and then at least 7 days later. RESULTS After the development process, 21 items were identified from the conceptual domains of physical symptoms, sensory impairment, psychosocial effects, and life impact. Using the responses of the 50 patients with CRS, 21 draft items were further refined to 12 items by eliminating conceptually similar or highly correlated items or those with low mean symptom severity. The 12-item questionnaire was shown to have excellent internal consistency (Cronbach α, 0.86) and test-retest reliability with a high intraclass correlation coefficient (0.89) and Pearson's correlation (r = 0.82, P < .0001). The 12-item CRS-PRO correlated highly with the longer SNOT-22 (r = 0.83, P < .0001) demonstrating its concurrent validity. We also demonstrated validity and reliability in a separate analysis for patients with CRSsNP and CRSwNP. CONCLUSION The CRS-PRO is a concise, valid, and reliable measure that was developed with extensive input from patients with CRS with current disease definitions.
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Affiliation(s)
- Saied Ghadersohi
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Caroline P E Price
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Sally E Jensen
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | | | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - David B Conley
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Kevin C Welch
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Anju T Peters
- Division of Allergy and Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Leslie C Grammer
- Division of Allergy and Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Whitney W Stevens
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Alexis M Calice
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Elizabeth Stanton
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Marisa K VanderMeeden
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Robert P Schleimer
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Bruce K Tan
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Northwestern University, Feinberg School of Medicine, Chicago, Ill.
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