title: Measurement of agreement on health-related quality of life changes in response to respiratory rehabilitation by patients and physicians--a prospective study.
abstract: BACKGROUND
  To provide optimal care for patients with chronic obstructive pulmonary disease physicians need to understand if their patients benefit from an intervention. The objective of this study was to assess agreement between patients and physicians on health-related quality of life (HRQL) changes in response to respiratory rehabilitation and to explore sources for disagreement.
  
  
  METHODS
  Sixty-one patients rated their health states on a validated preference-based instrument, the feeling thermometer (FT). In an analogous manner, the eight treating physicians rated the patients' health states on the FT. Patients and physicians were blinded to each other's ratings. We calculated intraclass correlation coefficients (ICC) to assess agreement between patients and physicians and used HRQL instruments and the 6-min walking test to assess the evaluative properties of the FT.
  
  
  RESULTS
  We found moderate agreement at baseline (ICC 0.40, P = 0.018) and follow-up (ICC 0.49, P = 0.008) but large disagreement about change scores (ICC 0.02, P = 0.46). Patients' FTchange scores correlated well with change scores of the Chronic Respiratory Questionnaire, SF-36 and the Borg scale for dyspnoea whereas physicians' FT change scores correlated significantly with the change score of the 6- min walking test (r = 0.33). Physicians' ratings showed an inconsistent pattern for correlations with HRQL measures.
  
  
  CONCLUSIONS
  There is large disagreement between patients and physicians on HRQL changes in response to respiratory rehabilitation. Investigators should assess whether the introduction of HRQL instruments into clinical practice raises the awareness of physicians towards HRQL and improves agreement with their patients.
authors.affiliation: Horten Centre, University Hospital of Zurich, Bolleystrasse 40, CH-8091 Zurich, Switzerland. milo.puhan@evimed.ch
authors.forename: Milo A
authors.initials: MA
authors.lastname: Puhan
authors.forename: Michaela
authors.initials: M
authors.lastname: Behnke
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.forename: Otto
authors.initials: O
authors.lastname: Braendli
authors.forename: Martin
authors.initials: M
authors.lastname: Frey
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D016896:Treatment Outcome