Abstracts
OBJECTIVE:
To validate a Portuguese-language version of the COPD assessment test (CAT) for use in Brazil and to assess the reproducibility of this version.
METHODS:
This was multicenter study involving patients with stable COPD at two teaching hospitals in the city of Fortaleza, Brazil. Two independent observers (twice in one day) administered the Portuguese-language version of the CAT to 50 patients with COPD. One of those observers again administered the scale to the same patients one week later. At baseline, the patients were submitted to pulmonary function testing and the six-minute walk test (6MWT), as well as completing the previously validated Portuguese-language versions of the Saint George's Respiratory Questionnaire (SGRQ), modified Medical Research Council (MMRC) dyspnea scale, and hospital anxiety and depression scale (HADS).
RESULTS:
Inter-rater and intra-rater reliability was excellent (intraclass correlation coefficient [ICC] = 0.96; 95% CI: 0.93-0.97; p < 0.001; and ICC = 0.98; 95% CI: 0.96-0.98; p < 0.001, respectively). Bland Altman plots showed good test-retest reliability. The CAT total score correlated significantly with spirometry results, 6MWT distance, SGRQ scores, MMRC dyspnea scale scores, and HADS-depression scores.
CONCLUSIONS:
The Portuguese-language version of the CAT is a valid, reproducible, and reliable instrument for evaluating patients with COPD in Brazil.
Pulmonary disease, chronic obstructive; Questionnaires; Validation studies; Quality of life; Reproducibility of results
OBJETIVO:
Realizar a validação e verificar a reprodutibilidade da versão em português do Brasil do COPD Assessment Test (CAT).
MÉTODOS:
Estudo multicêntrico, no qual foram selecionados pacientes com DPOC estável em dois hospitais de ensino na cidade de Fortaleza, CE. A versão do CAT foi aplicada duas vezes a 50 pacientes com DPOC por dois observadores independentes no mesmo dia. Após uma semana, esse mesmo questionário foi aplicado novamente aos mesmos pacientes por um dos observadores. No primeiro dia, os pacientes foram submetidos à prova de função pulmonar e ao teste de caminhada de seis minutos (TC6) e responderam as versões validadas de qualidade de vida relacionada à saúde (QVRS). (SGRQ), escala de dispneia Modified Medical Research Council (MMRC) e hospital anxiety and depression scale (HADS).
RESULTADOS:
As reprodutibilidades interobservador e intraobservador foram excelentes (coeficiente de correlação intraclasse [CCI] = 0,96; IC95%: 0,93-0,97; p < 0,001; e CCI = 0,98; IC95%: 0,96-0,98; p < 0,001, respectivamente). As disposições gráficas de Bland Altman demonstraram boa confiabilidade teste-reteste. Houve correlações significativas do escore total do CAT com os resultados de espirometria, TC6, SGRQ, escala de dispneia MMRC e HADS-depressão.
CONCLUSÕES:
A versão brasileira do CAT é um instrumento válido, reprodutível e confiável para a avaliação dos pacientes com DPOC na população brasileira.
Doença pulmonar obstrutiva crônica; Questionários; Estudos de validação; Qualidade de vida; Reprodutibilidade dos testes
Introduction
Classically, COPD is defined as chronic progressive airflow limitation that is partially
reversible and causes significant extrapulmonary effects, culminating in a reduction in
the functional capacity, social interaction, and well-being of the patients, negatively
affecting their health-related quality of life (HRQoL).(
11. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al.
Global strategy for the diagnosis, management, and prevention of chronic obstructive
pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med.
2007;176(6):532-55. http://dx.doi.org/10.1164/rccm.200703-456SO PMid:17507545
http://dx.doi.org/10.1164/rccm.200703-45...
,
22. Agusti A, Calverley PM, Celli B, Coxson HO, Edwards LD, Lomas DA, et
al. Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res.
2010;11:122. PMid:20831787 PMCid:2944278
)
The literature indicates that the chronic symptoms of COPD associated with the systemic
manifestations of the disease are the major factors responsible for the worsening of
HRQoL. Although the airflow obstruction is partially reversible, the disease control
interventions are primarily aimed at improving the HRQoL of patients, which thereby
becomes an important measure to be assessed.(
33. Barnes PJ, Celli BR. Systemic manifestations and comorbidities of
COPD. Eur Respir J. 2009;33(5):1165-85. http://dx.doi.org/10.1183/09031936.00128008
PMid:19407051
http://dx.doi.org/10.1183/09031936.00128...
,
44. Ng TP, Niti M, Tan WC, Cao Z, Ong KC, Eng P. Depressive symptoms and
chronic obstructive pulmonary disease: effect on mortality, hospital readmission,
symptom burden, functional status, and quality of life. Arch Intern Med.
2007;167(1):60-7. http://dx.doi.org/10.1001/archinte.167.1.60 PMid:17210879
http://dx.doi.org/10.1001/archinte.167.1...
)
The administration of questionnaires to assess the HRQoL of patients with COPD has been widely discussed in the literature. The results inferred by the use of these instruments generate reliable, valid, and reproducible evidence.( 55. Ferreira CA, Cukier A. Evaluating COPD from the perspective of the patient. J Bras Pneumol. 2006;32(2):vii-viii. PMid:17273576 )
Disease-specific questionnaires designed to assess COPD impact are widely used in
clinical studies. However, these questionnaires are still considered complex and
extensive, requiring a substantial amount of time to completion. Chief among them are
the Saint George's Respiratory Questionnaire (SGRQ),(
66. Sousa TC, Jardim JR, Jones P. Validação do Questionário do Hospital
Saint George na Doença Respiratória (SGRQ) em pacientes portadores de doença pulmonar
obstrutiva crônica no Brasil. J Pneumol. 2000; 26(3):119-28.
http://dx.doi.org/10.1590/S0102-35862000000300004
http://dx.doi.org/10.1590/S0102-35862000...
) the Chronic Respiratory Questionnaire (CRQ),(
77. Moreira GL, Pitta F, Ramos D, Nascimento CS, Barzon D, Kovelis D, et
al. Portuguese-language version of the Chronic Respiratory Questionnaire: a validity
and reproducibility study. J Bras Pneumol. 2009;35(8):737-44.
http://dx.doi.org/10.1590/S1806-37132009000800004 PMid:19750325
http://dx.doi.org/10.1590/S1806-37132009...
) the Breathing Problems Questionnaire,(
88. Silva PN, Jardim JR, Costa e Souza GM, Hyland ME, Nascimento OA.
Cultural adaptation and reproducibility of the Breathing Problems Questionnaire for
use in patients with COPD in Brazil. J Bras Pneumol. 2012;38(3):339-45. Erratum in: J
Bras Pneumol. 2012;38(4):538. http://dx.doi.org/10.1590/S1806-37132012000300009
PMid:22782604
http://dx.doi.org/10.1590/S1806-37132012...
) and the Airways Questionnaire 20 (AQ20),(
99. Camelier A, Rosa F, Jones P, Jardim JR. Validação do questionário de
vias aéreas 20 (“Airways questionnaire 20†– AQ20) em pacientes portadores
de doença pulmonar obstrutiva crônica (DPOC) no Brasil. J Pneumol.
2003;29(1):28-35.
) all of which have been validated for use in Brazil.
Recently, a group of researchers in the United Kingdom developed and validated the COPD
Assessment Test (CAT), which is a short, simple instrument for quantifying COPD impact
during routine clinical practice, in addition to aiding health status assessment and
facilitating communication between patients and health professionals.(
1010. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N.
Development and first validation of the COPD Assessment Test. Eur Respir J.
2009;34(3):648-54. http://dx.doi.org/10.1183/09031936.00102509 PMid:19720809
http://dx.doi.org/10.1183/09031936.00102...
) However, this questionnaire has not been validated for use in Brazil.
Therefore, the objective of the present study was to validate a Portuguese-language
version of the CAT for use in Brazil and to assess the reproducibility of this
version.
Methods
This was a cross-sectional study, conducted between January and November of 2012, involving patients treated at the Pulmonology Outpatient Clinic of the Federal University of Ceará Walter Cantídio University Hospital and patients eligible for pulmonary rehabilitation at the Dr. Carlos Alberto Studart Gomes Messejana Hospital, both of which are located in the city of Fortaleza, Brazil.
The present study was conducted in accordance with Brazilian National Health Council Resolution 196/96, which sets out the ethical principles for human research, and was approved by the ethics committees of the two hospitals (Ruling no. 108.10/11 and Ruling no. 880/12, respectively). All patients gave written informed consent prior to their inclusion in the study.
The inclusion criteria were as follows: having been clinically diagnosed with COPD with
moderate to severe airflow obstruction and having an FEV1/FVC ratio < 0.7
(as measured by spirometry), in accordance with the recommendations of the Global
Initiative for Chronic Obstructive Lung Disease(
11. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al.
Global strategy for the diagnosis, management, and prevention of chronic obstructive
pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med.
2007;176(6):532-55. http://dx.doi.org/10.1164/rccm.200703-456SO PMid:17507545
http://dx.doi.org/10.1164/rccm.200703-45...
); being between 40 and 80 years of age; being clinically stable (no
hospitalizations or infections in the three months prior to the study); and being a
smoker or former smoker with a smoking history greater than 10 pack-years.
The exclusion criteria were as follows: experiencing an exacerbation of COPD requiring therapeutic intervention; and having other nonpulmonary diseases that are considered disabling, severe, or difficult-to-control.
The CAT consists of eight items, designated cough, phlegm, chest tightness,
breathlessness, activity limitations at home, confidence leaving home, sleep, and
energy. For each item, the patient chooses only one response option, which is scored
from zero to five (Appendix 1). At the end of the test, all response scores are summed,
and then the clinical impact of COPD is determined on the basis of the stratification
scoring of the study that developed and validated the CAT.(
1010. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N.
Development and first validation of the COPD Assessment Test. Eur Respir J.
2009;34(3):648-54. http://dx.doi.org/10.1183/09031936.00102509 PMid:19720809
http://dx.doi.org/10.1183/09031936.00102...
) The results vary according to the range within which the scores obtained
lie, being classified by clinical impact as follows: 6-10 points, mild; 11-20, moderate;
21-30, severe; and 31-40, extremely severe.
In order to test the inter-rater reliability of the CAT, the patients were administered the questionnaire twice by two observers, 30 minutes apart, during the first visit (V1). The second visit (V2) occurred 7 days after the first one, and the CAT was again administered to the same patients by only one of the observers in order to test the intra-rater reliability.
Also at baseline, the patients underwent the six-minute walk test (6MWT) and spirometry,
as well as being administered the previously validated Portuguese-language versions of
the SGRQ,(
66. Sousa TC, Jardim JR, Jones P. Validação do Questionário do Hospital
Saint George na Doença Respiratória (SGRQ) em pacientes portadores de doença pulmonar
obstrutiva crônica no Brasil. J Pneumol. 2000; 26(3):119-28.
http://dx.doi.org/10.1590/S0102-35862000000300004
http://dx.doi.org/10.1590/S0102-35862000...
) hospital anxiety and depression scale (HADS), and modified Medical Research
Council (MMRC) dyspnea scale.
Spirometry was performed with a Respiradyne II Plus spirometer (Sherwood Medical, St. Louis, MO, USA), in accordance with Brazilian guidelines,( 1111. Sociedade Brasileira de Pneumologia e Tisiologia. II Consenso Brasileiro de Doença Pulmonar Obstrutiva Crônica (DPOC) - 2004. J Bras Pneumol. 2004;30(5):1-42. ) using the reference values for the Brazilian population established by Pereira et al.( 1212. Pereira CA, Barreto SP, Simoes JG, Pereira FW, Gerstler JG, Nakatami J. Valores de referência para a espirometria em uma amostra da população brasileira adulta. J Pneumol. 1992;18(1):10-22. )
The 6MWT was performed in accordance with guidelines established by the American
Thoracic Society,(
1313. Brooks D, Solway S, Gibbons WJ. ATS statement on six-minute walk
test. Am J Respir Crit Care Med. 2003;167(9):1287.
http://dx.doi.org/10.1164/ajrccm.167.9.950 PMid:12714344
http://dx.doi.org/10.1164/ajrccm.167.9.9...
) with the patient being encouraged to walk as far as possible, in six
minutes, on a 30-m level corridor. At the end of the test, the examiner recorded the
distance covered.
The HADS consists of 14 items, of which 7 focus on the assessment of anxiety (HADS-A)
and 7 focus on the assessment of depression (HADS-D). Each item can be scored from zero
to three, the maximum score on each subscale being 21 points. We adopted the cut-off
points recommended for both subscales: 0-8 points, absence of anxiety and/or depression;
and ≥ 9 points, presence of anxiety and/or depression.(
1414. Zigmond AS, Snaith RP. The hospital anxiety and depression scale.
Acta Psychiatr Scand. 1983;67(6):361-70.
http://dx.doi.org/10.1111/j.1600-0447.1983.tb09716.x
http://dx.doi.org/10.1111/j.1600-0447.19...
)
Dyspnea was assessed with the MMRC dyspnea scale.( 1111. Sociedade Brasileira de Pneumologia e Tisiologia. II Consenso Brasileiro de Doença Pulmonar Obstrutiva Crônica (DPOC) - 2004. J Bras Pneumol. 2004;30(5):1-42. )
Data were statistically analyzed with the Statistical Package for the Social Sciences, version 17.0 (SPSS Inc., Chicago, IL, USA) and GraphPad Prism, version 6.0 (GraphPad Software Inc., San Diego, CA, USA). For the analysis of the reliability of the administration of the CAT (V1 vs. V2), we used the intraclass correlation coefficient (ICC). The Wilcoxon test was used to compare the scores obtained from the administration of the CAT by the observer in V1 and V2. In order to assess the agreement between V1 and V2, we used Bland & Altman plots. The instruments were tested for internal consistency by Cronbach's alpha coefficient. In order to validate the CAT, we assessed the correlations (Spearman's correlation test) of its scores with those obtained on the SGRQ (gold standard questionnaire), HADS, and MMRC dyspnea scale, as well as with 6MWD and spirometry values. The level of significance was set at 5%.
Results
The study sample comprised 50 patients with COPD, 26 of whom were female (52%). The mean age of the patients was 62.2 ± 8.4 years, whereas the mean height and weight were 1.58 ± 0.08 cm and 65.8 ± 15.9 kg, respectively (Table 1).
There were no significant differences between the total scores obtained from the administration of the CAT by the same observer in V1 and V2 (20.7 ± 9.8 vs. 20.1 ± 9.4; p = 0.8). The ICC for intra-rater reliability (V1 vs. V2) was 0.96 (95% CI: 0.93-0.97).
There were also no significant differences in the scores between the two observers of the study (20.7 ± 8.5 vs. 21.2 ± 9.0; p = 0.4). The ICC for inter-rater reliability was 0.98 (95% CI: 0.96-0.98). The Cronbach's alpha coefficient for the CAT was 0.98 (p < 0.001).
Bland Altman plots showed good test-retest reliability and good inter-rater reliability (Figure 1).
Bland & Altman plots. In A, intra-rater analysis: mean = 0.64; upper limit (UL) = 5.69 and lower limit (LL) = –4.41. In B, inter-rater analysis: mean = –0.26; UL = 4.80 and LL = –5.32.
There were significant correlations between the CAT score and the SGRQ total and domain scores (0.51 < r < 0.64). The CAT score correlated better with the MMRC dyspnea scale score than with the HADS-D score (r = 0.48 vs. r = 0.39; p < 0.05 for both). The CAT scores correlated negatively with 6MWD (r = –0.37) and with some pulmonary function measurements, such as FEV1 in L (r = –0.38); FVC in L (r = –0.39); and FVC as % of the predicted value (r = –0.30; Table 2).
The mean administration time was 104.00 ± 0.69 seconds.
Discussion
The present study showed that the Portuguese-language version of the CAT had excellent reliability when administered by different observers and when administered by the same observer at two distinct time points. Bland Altman plots showed that the CAT has good test-retest reliability, as well as a high Cronbach's alpha coefficient and a good correlation with the SGRQ (total and domain scores).
The process of development and preparation of the CAT arose from the need for new
instruments for evaluating COPD impact on HRQoL and clinical practice in a simple, fast,
and effective way.(
1010. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N.
Development and first validation of the COPD Assessment Test. Eur Respir J.
2009;34(3):648-54. http://dx.doi.org/10.1183/09031936.00102509 PMid:19720809
http://dx.doi.org/10.1183/09031936.00102...
)
Various studies conducted in countries such as Spain,(
1515. Agustí A, Soler JJ, Molina J, Mu-oz MJ, García-Losa M, Roset M, et
al. Is the CAT questionnaire sensitive to changes in health status in patients with
severe COPD exacerbations? COPD. 2012;9(5):492-8.
http://dx.doi.org/10.3109/15412555.2012.692409 PMid:22958111
http://dx.doi.org/10.3109/15412555.2012....
) China,(
1616. Wiklund I, Berry P, Lu KX, Fang J, Fu C. The Chinese translation of
COPD Assessment Testâ"¢ (CAT) provides a valid and reliable measurement of COPD
health status in Chinese COPD patients. Am J Respir Crit Care Med
181;2010:A3575.
) South Korea,(17) and Saudi Arabia(
1818. Al-Moamary MS, Al-Hajjaj MS, Tamim HM, Al-Ghobain MO, Al-Qahtani HA,
Al-Kassimi FA. The reliability of an Arabic translation of the chronic obstructive
pulmonary disease assessment test. Saudi Med J. 2011;32(10):1028-33. PMid:22008922
,
1919. Al Moamary MS, Tamim HM, Al-Mutairi SS, Al-Khouzaie TH, Mahboub BH,
Al-Jawder SE, et al. Quality of life of patients with chronic obstructive pulmonary
disease in the Gulf Cooperation Council countries. Saudi Med J. 2012;33(10):1111-7.
PMid:23047217
) have validated versions of the CAT in their language and reported the
instrument to have good reproducibility. We found no studies validating a
Portuguese-language version of the CAT for use in Brazil or assessing the
reproducibility of the CAT.
During test-retest, the ICC was found to be 0.98. Jones et al.(
1010. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N.
Development and first validation of the COPD Assessment Test. Eur Respir J.
2009;34(3):648-54. http://dx.doi.org/10.1183/09031936.00102509 PMid:19720809
http://dx.doi.org/10.1183/09031936.00102...
) found high ICC values and high Cronbach's alpha coefficients when they
performed the first validation of the CAT in a multicenter study. The Cronbach's alpha
coefficient of 0.98 found in the present study shows that the questionnaire has
excellent internal consistency.
The questionnaires used for the validation of the CAT were the SGRQ, MMRC dyspnea scale, and HADS. These instruments were used because they are related to some specific items of the CAT, such as those concerning respiratory symptoms and limitations in activities of daily living (which are also addressed in the SGRQ and MMRC dyspnea scale) and those concerning self-confidence and energy (which are also addressed in the HADS and SGRQ).
In general, there were high and significant correlations between the CAT scores and the SGRQ total and domain scores.
Previous studies have demonstrated that the CAT can measure the impact of COPD on the
lives of patients, showing correlations with standard questionnaires other than the
SGRQ, such as the CRQ and the Clinical COPD Questionnaire.(
2020. Jones PW, Price D, van der Molen T. Role of clinical questionnaires
in optimizing everyday care of chronic obstructive pulmonary disease. Int J Chron
Obstruct Pulmon Dis. 2011;6:289-96. http://dx.doi.org/10.2147/COPD.S18181
PMid:21697993 PMCid:3119104
http://dx.doi.org/10.2147/COPD.S18181...
21. Tsiligianni IG, van der Molen T, Moraitaki D, Lopez I, Kocks JW,
Karagiannis K, et al. Assessing health status in COPD. A head-to-head comparison
between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ) .
BMC Pulm Med. 2012;12:20. http://dx.doi.org/10.1186/1471-2466-12-20 PMid:22607459
PMCid:3431277
http://dx.doi.org/10.1186/1471-2466-12-2...
22. Weldam SW, Schuurmans MJ, Liu R, Lammers JW. Evaluation of Quality
of Life instruments for use in COPD care and research: a systematic review. Int J
Nurs Stud. 2013;50(5):688-707. http://dx.doi.org/10.1016/j.ijnurstu.2012.07.017
PMid:22921317
http://dx.doi.org/10.1016/j.ijnurstu.201...
23. Dodd JW, Marns PL, Clark AL, Ingram KA, Fowler RP, Canavan JL, et
al. The COPD Assessment Test (CAT): short- and medium-term response to pulmonary
rehabilitation. COPD. 2012;9(4):390-4. PMid:22497561
-
2424. Mackay AJ, Donaldson GC, Patel AR, Jones PW, Hurst JR, Wedzicha JA.
Usefulness of the Chronic Obstructive Pulmonary Disease Assessment Test to evaluate
severity of COPD exacerbations. Am J Respir Crit Care Med. 2012;185(11):1218-24.
http://dx.doi.org/10.1164/rccm.201110-1843OC PMid:22281834
http://dx.doi.org/10.1164/rccm.201110-18...
)
Regarding the pulmonary function variables, the present study showed that there was a
weak but significant correlation of the CAT scores with some spirometry values and 6MWD.
This might represent a discrepancy between patient experiences and perspectives and the
degree of respiratory dysfunction. Other studies have also shown weak correlations
between the CAT scores and pulmonary function values, especially
FEV1.(
1717. Lee S, Lee JS, Song JW, Choi CM, Shim TS, Kim TB, et al. Validation
of the Korean version of Chronic Obstructive Pulmonary Disease Assessment Test (CAT)
and Dyspnea-12 Questionnaire. Tuberc Respir Dis. 2010;69(3):171-6.
http://dx.doi.org/10.4046/trd.2010.69.3.171
http://dx.doi.org/10.4046/trd.2010.69.3....
,
2020. Jones PW, Price D, van der Molen T. Role of clinical questionnaires
in optimizing everyday care of chronic obstructive pulmonary disease. Int J Chron
Obstruct Pulmon Dis. 2011;6:289-96. http://dx.doi.org/10.2147/COPD.S18181
PMid:21697993 PMCid:3119104
http://dx.doi.org/10.2147/COPD.S18181...
,
2121. Tsiligianni IG, van der Molen T, Moraitaki D, Lopez I, Kocks JW,
Karagiannis K, et al. Assessing health status in COPD. A head-to-head comparison
between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ) .
BMC Pulm Med. 2012;12:20. http://dx.doi.org/10.1186/1471-2466-12-20 PMid:22607459
PMCid:3431277
http://dx.doi.org/10.1186/1471-2466-12-2...
,
2525. Ghobadi H, Ahari SS, Kameli A, Lari SM. The relationship between
COPD Assessment Test (CAT) scores and severity of airflow obstruction in stable COPD
patients. Tanaffos. 2012;11(2):22-6
)
Regarding the sensation of dyspnea, the CAT scores correlated significantly with MMRC dyspnea scale scores and SGRQ symptom scores, showing that the CAT can detect the patient's respiratory complaints.
There was no significant correlation between the CAT scores and the anxiety scores. However, for the depression scores, the correlation was found to be weak. This might have occurred because, among the CAT questions, only the items concerning energy and confidence leaving home address issues that are more directly related to the psychological component of the patient.
The administration time of the CAT in the present study was, on average, 104 s; this
occurred because of the simplicity of the questions and response options. While
administering the CAT to patients with COPD, Ringbaek et al.(
2626. Ringbaek T, Martinez G, Lange P. A comparison of the assessment of
quality of life with CAT, CCQ, and SGRQ in COPD patients participating in pulmonary
rehabilitation. COPD. 2012;9(1):12-5. http://dx.doi.org/10.3109/15412555.2011.630248
PMid: 22292593
http://dx.doi.org/10.3109/15412555.2011....
) found that it required a shorter administration time than did the SGRQ and
CRQ (107 s, 134 s, and 578 s, respectively).
There was no back-translation analysis of the CAT, since there is already a Portuguese-language version, written in congruent, easy-to-understand language, ready for use. None of the items in the present version sounded odd in Brazilian Portuguese or seemed to be alien to the Brazilian culture and society, and therefore there was no need for any significant adaptations.
Since the present study was cross-sectional in design, it was not possible to evaluate
the responsiveness of the Portuguese-language version of the CAT to interventions, such
as pulmonary rehabilitation. This can be considered a limitation of the study; however,
other studies have used the same approach.(
1515. Agustí A, Soler JJ, Molina J, Mu-oz MJ, García-Losa M, Roset M, et
al. Is the CAT questionnaire sensitive to changes in health status in patients with
severe COPD exacerbations? COPD. 2012;9(5):492-8.
http://dx.doi.org/10.3109/15412555.2012.692409 PMid:22958111
http://dx.doi.org/10.3109/15412555.2012....
,
2121. Tsiligianni IG, van der Molen T, Moraitaki D, Lopez I, Kocks JW,
Karagiannis K, et al. Assessing health status in COPD. A head-to-head comparison
between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ) .
BMC Pulm Med. 2012;12:20. http://dx.doi.org/10.1186/1471-2466-12-20 PMid:22607459
PMCid:3431277
http://dx.doi.org/10.1186/1471-2466-12-2...
,
2323. Dodd JW, Marns PL, Clark AL, Ingram KA, Fowler RP, Canavan JL, et
al. The COPD Assessment Test (CAT): short- and medium-term response to pulmonary
rehabilitation. COPD. 2012;9(4):390-4. PMid:22497561
,
2626. Ringbaek T, Martinez G, Lange P. A comparison of the assessment of
quality of life with CAT, CCQ, and SGRQ in COPD patients participating in pulmonary
rehabilitation. COPD. 2012;9(1):12-5. http://dx.doi.org/10.3109/15412555.2011.630248
PMid: 22292593
http://dx.doi.org/10.3109/15412555.2011....
) Following this line of thought and knowing that the Portuguese-language
version of the CAT proved to be valid and reproducible, we believe that, in future
studies, it will prove to be responsive.
In conclusion, the Portuguese-language version of the CAT is a valid, reproducible, and reliable instrument for assessing the impact of COPD on the lives of patients in Brazil.
References
-
1Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532-55. http://dx.doi.org/10.1164/rccm.200703-456SO PMid:17507545
» http://dx.doi.org/10.1164/rccm.200703-456SO -
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Appendix 1 Portuguese-language version of the COPD Assessment Test.
Publication Dates
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Publication in this collection
June-August 2013
History
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Received
22 Jan 2013 -
Accepted
07 May 2013