Skip to main content
PMC home page
Thorax logoLink to Thorax
. 2004 Jul;59(7):591–595. doi: 10.1136/thx.2003.015107

Development and validation of a short questionnaire in community acquired pneumonia

R El Moussaoui 1, B Opmeer 1, P Bossuyt 1, P Speelman 1, C A J M de Borgie 1, J Prins 1
PMCID: PMC1747065  PMID: 15223867

Abstract

Background: A short but sensitive questionnaire evaluating changes in respiratory symptoms and well being during the treatment of community acquired pneumonia (CAP) is needed. We have developed a measurement and evaluated its psychometric properties in 67 patients admitted with CAP.

Methods: The patients were asked to indicate the presence and severity of dyspnoea, coughing, coughing up sputum, coughing up sputum with ease, the colour of the sputum, fatigue, fitness, and their state of health. The item fatigue showed substantial overlap with fitness and was therefore excluded. The response of the patients to the remaining eight items was used to calculate a CAP score.

Results: The percentage of missing data (0.2–1.7%), floor and ceiling effects (0.2/5.5%), internal consistency (Cronbach α = 0.87), and the intraclass correlation coefficient for test-retest reproducibility (0.83) met predefined criteria, indicating good acceptability and reliability. Face and clinical validity were satisfactory. Effect sizes under treatment were large, indicating high responsiveness.

Conclusion: The newly developed CAP score is a simple, reliable, valid, and highly responsive instrument. This makes it scientifically sound and clinically relevant for measuring outcome when evaluating treatment strategies in CAP.

Full Text

The Full Text of this article is available as a PDF (97.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bartlett J. G., Dowell S. F., Mandell L. A., File Jr T. M., Musher D. M., Fine M. J. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin Infect Dis. 2000 Sep 7;31(2):347–382. doi: 10.1086/313954. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Brandenburg J. A., Marrie T. J., Coley C. M., Singer D. E., Obrosky D. S., Kapoor W. N., Fine M. J. Clinical presentation, processes and outcomes of care for patients with pneumococcal pneumonia. J Gen Intern Med. 2000 Sep;15(9):638–646. doi: 10.1046/j.1525-1497.2000.04429.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Eisen M., Ware J. E., Jr, Donald C. A., Brook R. H. Measuring components of children's health status. Med Care. 1979 Sep;17(9):902–921. doi: 10.1097/00005650-197909000-00003. [DOI] [PubMed] [Google Scholar]
  4. Feagan B. G. A controlled trial of a critical pathway for treating community-acquired pneumonia: the CAPITAL study. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. Pharmacotherapy. 2001 Jul;21(7 Pt 2):89S–94S. doi: 10.1592/phco.21.10.89s.34535. [DOI] [PubMed] [Google Scholar]
  5. Fine M. J., Auble T. E., Yealy D. M., Hanusa B. H., Weissfeld L. A., Singer D. E., Coley C. M., Marrie T. J., Kapoor W. N. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997 Jan 23;336(4):243–250. doi: 10.1056/NEJM199701233360402. [DOI] [PubMed] [Google Scholar]
  6. Fine M. J., Stone R. A., Singer D. E., Coley C. M., Marrie T. J., Lave J. R., Hough L. J., Obrosky D. S., Schulz R., Ricci E. M. Processes and outcomes of care for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team (PORT) cohort study. Arch Intern Med. 1999 May 10;159(9):970–980. doi: 10.1001/archinte.159.9.970. [DOI] [PubMed] [Google Scholar]
  7. Gleason P. P., Kapoor W. N., Stone R. A., Lave J. R., Obrosky D. S., Schulz R., Singer D. E., Coley C. M., Marrie T. J., Fine M. J. Medical outcomes and antimicrobial costs with the use of the American Thoracic Society guidelines for outpatients with community-acquired pneumonia. JAMA. 1997 Jul 2;278(1):32–39. [PubMed] [Google Scholar]
  8. Hobart J. C., Lamping D. L., Freeman J. A., Langdon D. W., McLellan D. L., Greenwood R. J., Thompson A. J. Evidence-based measurement: which disability scale for neurologic rehabilitation? Neurology. 2001 Aug 28;57(4):639–644. doi: 10.1212/wnl.57.4.639. [DOI] [PubMed] [Google Scholar]
  9. Holmes W. C., Shea J. A. Performance of a new, HIV/AIDS-targeted quality of life (HAT-QoL) instrument in asymptomatic seropositive individuals. Qual Life Res. 1997 Aug;6(6):561–571. doi: 10.1023/a:1018464200708. [DOI] [PubMed] [Google Scholar]
  10. Kazis L. E., Anderson J. J., Meenan R. F. Effect sizes for interpreting changes in health status. Med Care. 1989 Mar;27(3 Suppl):S178–S189. doi: 10.1097/00005650-198903001-00015. [DOI] [PubMed] [Google Scholar]
  11. Kuru T., Lynch J. P., 3rd Nonresolving or slowly resolving pneumonia. Clin Chest Med. 1999 Sep;20(3):623–651. doi: 10.1016/s0272-5231(05)70241-0. [DOI] [PubMed] [Google Scholar]
  12. Lamping Donna L., Schroter Sara, Marquis Patrick, Marrel Alexia, Duprat-Lomon Isabelle, Sagnier Pierre-Philippe. The community-acquired pneumonia symptom questionnaire: a new, patient-based outcome measure to evaluate symptoms in patients with community-acquired pneumonia. Chest. 2002 Sep;122(3):920–929. doi: 10.1378/chest.122.3.920. [DOI] [PubMed] [Google Scholar]
  13. Liang M. H., Fossel A. H., Larson M. G. Comparisons of five health status instruments for orthopedic evaluation. Med Care. 1990 Jul;28(7):632–642. doi: 10.1097/00005650-199007000-00008. [DOI] [PubMed] [Google Scholar]
  14. Lohr K. N., Aaronson N. K., Alonso J., Burnam M. A., Patrick D. L., Perrin E. B., Roberts J. S. Evaluating quality-of-life and health status instruments: development of scientific review criteria. Clin Ther. 1996 Sep-Oct;18(5):979–992. doi: 10.1016/s0149-2918(96)80054-3. [DOI] [PubMed] [Google Scholar]
  15. Marrie T. J., Lau C. Y., Wheeler S. L., Wong C. J., Feagan B. G. Predictors of symptom resolution in patients with community-acquired pneumonia. Clin Infect Dis. 2000 Nov 29;31(6):1362–1367. doi: 10.1086/317495. [DOI] [PubMed] [Google Scholar]
  16. Marrie T. J., Lau C. Y., Wheeler S. L., Wong C. J., Vandervoort M. K., Feagan B. G. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA. 2000 Feb 9;283(6):749–755. doi: 10.1001/jama.283.6.749. [DOI] [PubMed] [Google Scholar]
  17. McHorney C. A., Ware J. E., Jr, Lu J. F., Sherbourne C. D. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994 Jan;32(1):40–66. doi: 10.1097/00005650-199401000-00004. [DOI] [PubMed] [Google Scholar]
  18. Metlay J. P., Atlas S. J., Borowsky L. H., Singer D. E. Time course of symptom resolution in patients with community-acquired pneumonia. Respir Med. 1998 Sep;92(9):1137–1142. doi: 10.1016/s0954-6111(98)90408-5. [DOI] [PubMed] [Google Scholar]
  19. Metlay J. P., Fine M. J., Schulz R., Marrie T. J., Coley C. M., Kapoor W. N., Singer D. E. Measuring symptomatic and functional recovery in patients with community-acquired pneumonia. J Gen Intern Med. 1997 Jul;12(7):423–430. doi: 10.1046/j.1525-1497.1997.00074.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Metlay J. P., Schulz R., Li Y. H., Singer D. E., Marrie T. J., Coley C. M., Hough L. J., Obrosky D. S., Kapoor W. N., Fine M. J. Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med. 1997 Jul 14;157(13):1453–1459. [PubMed] [Google Scholar]
  21. Niederman M. S., McCombs J. S., Unger A. N., Kumar A., Popovian R. The cost of treating community-acquired pneumonia. Clin Ther. 1998 Jul-Aug;20(4):820–837. doi: 10.1016/s0149-2918(98)80144-6. [DOI] [PubMed] [Google Scholar]
  22. Palmer C. S., Zhan C., Elixhauser A., Halpern M. T., Rance L., Feagan B. G., Marrie T. J. Economic assessment of the community-acquired pneumonia intervention trial employing levofloxacin. Clin Ther. 2000 Feb;22(2):250–264. doi: 10.1016/s0149-2918(00)88483-0. [DOI] [PubMed] [Google Scholar]
  23. Torres A., Muir J. F., Corris P., Kubin R., Duprat-Lomon I., Sagnier P. P., Höffken G. Effectiveness of oral moxifloxacin in standard first-line therapy in community-acquired pneumonia. Eur Respir J. 2003 Jan;21(1):135–143. doi: 10.1183/09031936.03.00045202. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

[Web-only Appendices]
thorax_59_7_591__index.html (1.2KB, html)
thorax_59_7_591__1.pdf (92KB, pdf)
thorax_59_7_591__2.pdf (67.2KB, pdf)

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES