title: The validity of health-related quality of life questionnaires in bronchiectasis: a systematic review and meta-analysis.
abstract: A range of questionnaires have been used to assess health-related quality of life (HRQOL) in bronchiectasis. A systematic review was conducted to evaluate their psychometric properties and assess associations between HRQOL and clinical measures.
  
  
  
  Five electronic databases were searched. Studies eligible for inclusion were those that investigated the validity of HRQOL questionnaires and/or their association with other outcomes in adults with bronchiectasis. Patients with cystic fibrosis were excluded. The identified questionnaires were assessed for convergent, discriminant and cross-cultural translation validity; missing data, floor and ceiling effects, internal consistency, responsiveness and test-retest reliability. A meta-analysis was conducted to estimate the strength of associations between HRQOL and clinical measures.
  
  
  
  From 1918 studies identified, 43 studies were included in the systematic review, of which 38 were suitable for the meta-analysis. Nine HRQOL questionnaires were identified, with the most widely used being: St George's Respiratory Questionnaire, Leicester Cough Questionnaire, Quality of Life-Bronchiectasis and Short Form-36. HRQOL questionnaires had moderate to good internal consistency and good test-retest reliability. Only 8 of 18 studies that used translated HRQOL questionnaires reported or referred to the validity of the translated questionnaire. There was a stronger correlation (mean r (95% CI)) between HRQOL and subjective outcome measures, such as dyspnoea (0.55 (0.41 to 0.68)) and fatigue (0.42 (0.23 to 0.58)) compared with objective measures; exercise capacity (-0.41 (-0.54 to -0.24)), FEV1% predicted (-0.31 (-0.40 to -0.23)) and extent of bronchiectasis on CT scan (0.35 (0.03 to 0.61)); all p<0.001.
  
  
  
  This review supports most HRQOL questionnaires used in bronchiectasis have good psychometric properties. There was a weak to moderate association between HRQOL and objective outcome measures. This suggests that HRQOL questionnaires assess a unique aspect of health not captured by objective measures.
authors: Division of Asthma, Allergy and Lung Biology, King's College London, Respiratory Medicine, London, UK.
authors: Arietta
authors: A
authors: Spinou
authors: Division of Medicine, University College London (UCL), London, UK.
authors: Konstantinos C
authors: KC
authors: Fragkos
authors: Adult Cystic Fibrosis Unit, King's College Hospital, London, UK.
authors: Kai K
authors: KK
authors: Lee
authors: Adult Cystic Fibrosis Unit, King's College Hospital, London, UK.
authors: Caroline
authors: C
authors: Elston
authors: Auckland University of Technology (AUT), School of Public Health and Psychosocial Studies and School of Rehabilitation and Occupation Studies, Auckland, New Zealand.
authors: Richard J
authors: RJ
authors: Siegert
authors: Host Defence Unit, Royal Brompton Hospital, London, UK.
authors: Michael R
authors: MR
authors: Loebinger
authors: Host Defence Unit, Royal Brompton Hospital, London, UK.
authors: Robert
authors: R
authors: Wilson
authors: Denmark Hill Campus, King's College London, Therapies, London, UK.
authors: Rachel
authors: R
authors: Garrod
authors: Division of Asthma, Allergy and Lung Biology, King's College London, Respiratory Medicine, London, UK.
authors: Surinder S
authors: SS
authors: Birring
mesh_terms: D001987:Bronchiectasis / Q000150:complications / Q000523:psychology*; D003371:Cough / Q000209:etiology / Q000523:psychology; D004417:Dyspnea / Q000523:psychology; D006304:Health Status; D006801:Humans; D011594:Psychometrics; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: Bronchiectasis