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Manual: ST George'S Respiratory Questionnaire For Copd Patients (SGRQ-C)
Manual: ST George'S Respiratory Questionnaire For Copd Patients (SGRQ-C)
MANUAL
Paul W. Jones
Yvonne Forde
1. The SGRQ
3. Structure of SGRQ
4. Administration
5. Item Weights
6. Scoring Algorithm
The SGRQ-C was developed from the SGRQ which was designed to measure health
impairment in patients with asthma and COPD. The SGRQ is also valid for use in
bronchiectasis and post tuberculosis and has been used successfully in patients with
kyphoscoliosis, sarcoidosis. It is not suitable for cystic fibrosis. It is in two parts. Part I
produces the Symptoms score, and Part 2 the Activity and Impacts scores. A Total
score is also produced.
The SGRQ-C is a shorter version derived from the original version following detailed
analysis of data from large studies in COPD. The intention was to remove the items
with the weakest measurement properties in the original instrument, but at the same
time ensure that its scores were directly comparable with the original SGRQ. A full
description of this process and validation studies has been published in Chest (Meguro
et al. Chest 2006;132: 456-463). The accompanying on-line supplement gives
additional details concerning its development and the differences from the original).
http://chestjournal.chestpubs.org/content/132/2/456.full.html
The SGRQ-C has been developed using COPD data only, so is valid for this disease.
The validity for its use in other conditions has yet to be established, but it is unlikely to
perform very differently from the SGRQ.
3. STRUCTURE OF SGRQ
Part 2 (Questions 8-14) addresses the patient’s current state (i.e. how they are these
days). The Activity score measures disturbances to daily physical activity. The Impacts
score covers a range of disturbances of psycho-social function. Validation studies for
the original SGRQ showed that this component relates in part to respiratory symptoms,
but it also correlates quite strongly with exercise performance (6-minute walking test),
breathlessness in daily life (MRC breathlessness score) and disturbances of mood
(anxiety and depression). The Impacts score is, therefore, the broadest component of
the questionnaires, covering the whole range of disturbances that respiratory patients
experience in their lives.
Note: the general scale on the front page is not part of the SGRQ or SGRQ-C, but
some investigators find it useful as an additional global measure.
The questionnaire should be completed in a quiet area, free from distraction and the
patient should ideally be sitting at a desk or table. Explain to the patient why they are
completing it, and how important it is for clinicians and researchers to understand how
their illness affects them and their daily life. Ask him or her to complete the
questionnaire as honestly as they can and stress that there are no right or wrong
answers, simply the answer that they feel best applies to them. Explain that they must
answer every question and that someone will be close at hand to answer any queries
about how to complete the questionnaire.
It is designed for supervised self-administration. This means that the patients should
complete the questionnaire themselves, but someone should be available to give
advice if required. It is designed to elicit the patient’s opinion of his/her health, not
someone else’s opinion of it, so family, friends or members of staff should not influence
the patient’s responses. If the spouse or partner has accompanied the patient they
should be asked to wait in a separate area. Similarly, do not allow patients to take the
SGRQ-C home to be completed since you cannot be sure that it will be completed
without the help of family or friends. A recent study of the use of surrogates to complete
the questionnaire has shown small but significant differences in scores obtained from
the patients themselves (Santiveri et al Respiratory Medicine (2007) 101, 439–445)
Once the patient has finished, it is very important that you check the questionnaire to
make sure a response has been given to every question. If they have missed an item
return it to the patient for completion, before they leave.
Telephone administration of the SGRQ has been validated (Anie et al J Clin Epidemiol
1996;49:653-6.), as has computer based presentation (Meguro and Jones,
unpublished), but postal administration has not. It is recommended that patients have a
copy of the SGRQ-C to hand by the telephone so that they can read it at the same time
as they are interviewed.
If a patient asks for help with a question, do not provide an answer for them. The
questionnaire is designed to get an understanding of how the patient views his or her
illness. It is appropriate to clarify a question but not to provide an answer. Questions
may be read aloud if patients have difficulty with reading, but the responses must be
theirs alone. If a patient gives an answer you disagree with it is not appropriate to
challenge their response or to query it. It is their view of their condition we are
interested in – no matter how strange the response!
The following are notes that may help you explain to patients what is required
1. In Part 1 of the questionnaire, emphasise to patients that you are interested in how
much chest trouble they have recently. The exact period is not important. We are
looking for an impression or perception of health.
3. COPD can vary day-to-day. Part 2 is concerned with the patient’s current state (i.e.
on average over ‘these days’), not necessarily just today.
Each questionnaire response has a unique empirically derived 'weight' (Quirk et al Clin
Sci 1990;79:17-21; Quirk et al Eur Respir J 1991;4:167-71).The lowest possible weight
is zero and the highest is 100. Note that, in cases where the two response options to an
item in the original SGRQ were combined in the SGRQ-C, the weight for the new
response option was calculated from the mean of the two that were combined.
(Note: the wording is abbreviated from that used in the questionnaire.)
PART 1
Question 1: I cough:
Most days 80.6
Several days 46.3
With chest infections 28.1
Not at all 0.0
Question 2: I bring up phlegm (sputum):
Most days 76.8
Several days 47.0
With chest infections 30.2
Not at all 0.0
Question 3: I have shortness of breath:
Most days 87.2
Several days 50.3
Not at all 0.0
Question 4: I have attacks of wheezing:
Most days 86.2
Several days 71.0
A few days 45.6
With chest infection 36.4
Not at all 0.0
Question 5:How many attacks of chest trouble have you had
3 or more 80.1
1 or 2 attacks 52.3
None 0.0
Question 6: How often do you have good days (with little chest trouble)?
None 93.3
A few 76.6
Most are good 38.5
Every day 0.0
Question 7: If you have a wheeze, is it worse in the morning?
No 0.0
Yes 62.0
Question 9: Questions about what activities usually make you feel breathless.
Getting washed or dressed 82.8
Walking around the home 80.2
Walking outside on the level 81.4
Walking up a flight of stairs 76.1
Walking up hills 75.1
Question 11: Questions about other effects your chest trouble may have on you.
My cough or breathing is embarrassing in public 74.1
My chest trouble is a nuisance to my family, friends or neighbours 79.1
I get afraid or panic when I cannot get my breath 87.7
I feel that I am not in control of my chest problem 90.1
I have become frail or an invalid because of my chest 89.9
Exercise is not safe for me 75.7
Everything seems too much of an effort 84.5
Question 12: Questions about how activities may be affected by your breathing.
I take a long time to get washed or dressed 74.2
I cannot take a bath or shower, or I take a long time 81.0
I walk more slowly than other people, or I stop for rests 71.7
Jobs such as housework take a long time, or I have to stop for rests 70.6
If I walk up one flight of stairs, I have to go slowly or stop 71.6
If I hurry or walk fast, I have to stop or slow down 72.3
My breathing makes it difficult to do things such as walk up hills, carry things up
stairs, light gardening such as weeding, dance, play bowls or play golf 74.5
My breathing makes it difficult to do things such as carry heavy loads, dig the garden
or shovel snow, jog or walk at 5 miles per hour, play tennis or swim 71.4
Question 14: Tick the statement which you think best describes how your chest affects
you.
It does not stop me doing anything I would like to do 0.0
It stops me doing one or two things I would like to do 42.0
It stops me doing most of the things I would like to do 84.2
It stops me doing everything I would like to do 96.7
A Total and three component scores are calculated: Symptoms; Activity; Impacts.
Each component of the questionnaire is scored separately:
6.1 Sum the weights for all items with a positive response
SYMPTOMS COMPONENT
This consists of all the questions in Part 1. The weights for Questions 1-7 are summed.
A single response is required to each item. If multiple responses are given to an item,
the weights for the multiple positive responses should be averaged then added to the
sum. This is a better approach than losing the data set and this technique was for
calculating scores used in the original validation studies for patients who gave multiple
responses. (Clearly a better approach is to prevent such multiple responses occurring).
ACTIVITY COMPONENT
This is calculated from the summed weights for the positive responses to items
Questions 9 and 12 in Part 2 of the questionnaire.
IMPACTS COMPONENT
This is calculated from Questions 8, 10, 11, 13, 14 in Part 2 of the questionnaire. The
weights for all positive responses to items in Questions 10, 11, 13 are summed together
with the responses to the single item that should have been checked (ticked) in
Questions 8 and 14. In the case of multiple responses to either of these items, the
average weight for the item should be calculated.
TOTAL SCORE
The Total score is calculated by summing the weights to all the positive responses in
each component.
Score = 100 x Summed weights from all positive items in that component
Sum of weights for all items in that component
Score = 100 x Summed weights from all positive items in the questionnaire
Sum of weights for all items in the questionnaire
Symptoms 566.2
Activity 982.9
(Note: these are the maximum possible weights that could be obtained for the worst
possible state of the patient).
It is better not to miss items and any missing items are the fault of the investigator, not
the patient. We have examined the effect of missing items and recommend the
following methods:
General rules
You can calculate a Total score in the presence of missing data, but only if the domains
meet their ‘missing items’ rules (see below). If one domain exceeds its permitted
number of missed items, then a total score cannot be calculated.
Add the weights of the two checked responses and divide by two. If more than three
responses are checked, treat the item as missing.
Scores for SGRQ-C, calculated as described above, need a small arithmetic adjustment
to make them directly comparable to those obtained with the SGRQ.
Means (95% confidence intervals) for SGRQ scores in normal subjects with no history of
respiratory disease
74 46 95 12 9 2 6
range 17-80 (91-99) (9-15) (7-12) (1-3) (5-7)
A full range of normative values for a general population studied in Spain can be found
in Ferrer et al Eur Respir J 2002;19:405-413.
The threshold for a clinically significant difference between groups of patients and for
changes within groups of patients is four units. Note this is an indicative value (the
threshold is not 4.0). As with all measurements there is biological variation, sampling
error and measurement error. Four units is an average value obtained in different
groups of patients. Estimation of clinical thresholds, their use and implications are
discussed in much greater detail in Jones P.W. Eur Respir J 2002;19:398-404 and
Jones P.W. Journal of COPD 2005;2:75-79.
Note: A responder analysis using the 4 unit threshold may be suitable in some
analyses. Such estimates, including the Number Needed to Treat (NNT), appear to be
relatively insensitive to small differences in the value used for the threshold for clinical
significance. (Jones P.W. Eur Respir J 2002;19:398-404 and Norman et al Med Care
2001;39:1039-47).
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Finnish *
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English for Australia * Latvian *
France * Russian for Latvia *
Austria
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Lithuanian *
Belgium Greece * Russian for Lithuania *
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German for Belgium Spanish for
Guatemala Malaysia
Brazil Malay for Malaysia ◊
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Bulgaria ◊ Cantonese* Malaysia ◊
English English for Malaysia ◊
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Bengali ◊ Netherlands ◊
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St. George’s Respiratory Questionnaire Filipino Translation revised edition copyright 2009 by
Francisco N.A., Balanag Jr V.M., Naval S.S., & Zaldivar Jr C.A. under Philippine Copyright Law &
International Treaty/Republic Act 8293. All rights reserved. This document is protected by
copyright. No part of it may be reproduced, printed, published, distributed, translated, made into any
version, exhibited, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, or any other use or disposition, without written
permission from the copyright owners c/o Department of Research & Development, Lung Center of
the Philippines, Quezon Avenue, Quezon City 1100, Philippines. Tel +63 (2) 924 6101 extension #s
235 & 221 / Fax +63 (2) 925 2021. Email: [email protected]; [email protected];
[email protected].
12. SELECTED BIBLIOGRAPHY
Other references
4. Quirk FH, Jones PW. Patients' perception of distress due to symptoms and effects of
asthma on daily living and an investigation of possible influential factors. Clin Sci
1990;79:17-21.
5. Quirk FH, Baveystock CM, Wilson RC, Jones PW. Influence of demographic and
disease related factors on the degree of distress associated with symptoms and restrictions
on daily living due to asthma in six countries. Eur Respir J 1991;4:167-71.
6. Jones PW, the Nedocromil Sodium Quality of Life Study Group. Quality of Life,
symptoms and pulmonary function in asthma: long-term treatment with nedocromil sodium
examined in a controlled multicentre trial. Eur Respir J 1994;7:55-62.
7. Anie KA, Jones PW, Hilton SR, Anderson HR. A computer-assisted telephone
interview technique for assessment of asthma morbidity and drug use in adult asthma. J
Clin Epidemiol 1996;49:653-6.
8. Ketelaars CAJ, Sclösser MAG, Mostert R, Huyer Abu-Saad H, Halfens RJG, Wouters
EFM. Determinants of health-related quality of life in patients with chronic obstructive
pulmonary disease. Thorax 1996;51:39-43.
9. Okubadejo AA, Jones PW, Wedzicha JA. Quality of life in patients with chronic
obstructive pulmonary disease and severe hypoxaemia. Thorax 1996;51(1):44-7.
10. Renwick DS, Connolly MJ. Impact of obstructive airways disease on quality of life in
older adults. Thorax 1996;51:520-5.
11. Jones PW, Bosh TK. Changes in quality of life in COPD patients treated with
salmeterol. Am J Resp Crit Care Med 1997;155:1283-9.
12. Wilson CB, Jones PW, O'Leary CJ, Cole PJ, Wilson R. Validation of the St George's
Respiratory Questionnaire in Bronchiectasis. AJRCCM 1997;156:536-41.
13. Osman LM, Godden DJ, Friend JAR, Legge JS, Douglas JG. Quality of life and
hospital re-admission in patients with chronic obstructive pulmonary disease. Thorax
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15. Seemungal TAR, Donaldson GC, Paul EA, Bestall JC, Jefferies DJ, Wedzicha JA.
Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary
disease. Am J Respir Crit Care Med 1998;157:1418-22.
16. Wijkstra PJ, Jones PW. Quality of life in patients with chronic obstructive pulmonary
disease. Eur Respir Monogr 1998;3(7):235-46.
17. Barley EA, Jones PW. A comparison of global questions versus health status
questionnaires as measures of the severity and impact of asthma. European Respiratory
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19. Jones PW. Health status in chronic obstructive pulmonary disease. Eur Respir Rev
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asthma and COPD. Eur Respir J 2002;19:398-404.
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Respir J 2002;19:405-413.
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