Introduction Outcomes in pulmonary rehabilitation (PR) can be evaluated using exercise performance tests and health status measures such as the St George′s Respiratory Questionnaire (SGRQ) and Hospital Anxiety and Depression Score (HADS). The SGRQ and HADS are timing consuming and difficult to analyse and may dissuade patients from attending. The COPD Assessment Test (CAT) is a shorter, simpler questionnaire for assessment and monitoring of health status in COPD. Scores range from 0 to 40. A high score indicates poor health status. CAT score correlates with SGRQ (r>0.8)1.
Objective To determine if the CAT score could replace existing measures of health status in the evaluation of pulmonary rehabilitation.
Method 70 patients underwent standard PR in community and hospital based programs. 45 were men and 25 were women. The mean age was 69. The vast majority of patients attending had COPD, confirmed by spirometry and clinical assessment. They had MRC score of 3 or more. All patients completed CAT, SGRQ questionnaires and did a modified shuttle walk test (MSWT) at the beginning and end of the program.
Results After PR mean SGRQ score reduced by 5.54 (CI: 2.6 to 8.4, p <0.001). CAT score reduced by 2.08 (CI: 0.8 to 3.3, p=0.001). MSWT distance increased by 75.7 metres (CI: 55.7 to 95.8, p<0.001). Anxiety and depression scores reduced by 1.64 (CI: 0.6 to 2.6, p= 0.002) and 1.02 (CI: 0.17 to 1.88, p= 0.02) respectively. At baseline, the CAT score correlated moderately with SGRQ (r=0.48), shuttle walk (r=0.47), and HADS (r=0.43). The change in CAT before and after PR correlated weakly (r=0.38 p=0.001) with the change in SGRQ, and MSWT (r=0.45 p<0.001), and not significantly with change in HADS (r=0.28 p=0.059).
Conclusion Jones et al. have evaluated the CAT in pulmonary rehabilitation.2 Their study reported an improvement in CAT of 2.2. At baseline, CAT correlated well with CRQ (Chronic Respiratory Questionnaire) domain scores. Change in CAT correlated with change in CRQ domain scores. Our study confirms CAT score can detect improvement in health status after PR. However, the lack of stong correlation with SGRQ & HADS suggests CAT should not be assumed to be equivalent in the evaluation of PR.
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