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      Disability related to COPD tool (DIRECT): towards an assessment of COPD-related disability in routine practice

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          Chronic Obstructive Pulmonary Disease (COPD) is a worldwide public health concern. It is also a major source of disability that is often overlooked, depriving patients of effective treatments. This study describes the development and validation of a questionnaire specifically assessing COPD-related disability.


          The DIsability RElated to COPD Tool (DIRECT) was developed according to reference methods, including literature review, patient and clinician interviews and test in a pilot study. A 12-item questionnaire was included for finalization and validation in an observational cross-sectional study conducted by 60 French pulmonologists, who recruited 275 COPD patients of stage II, III and IV according to the GOLD classification. Rasch modeling was conducted and psychometric properties were assessed (internal consistency reliability; concurrent and clinical validity).


          The DIRECT score was built from the 10 items retained in the Rasch model. Their internal consistency reliability was excellent (Cronbach’s alpha = 0.95). The score was highly correlated with the Saint George’s Respiratory Questionnaire Activity score (r = 0.83) and the London Handicap Scale (r = −0.70), a generic disability measure. It was highly statistically significantly associated to four clinical parameters ( P < 0.001): GOLD classification, BODE index, FEV 1 and 6-minute walk distance.


          DIRECT is a promising tool that could help enhance the management of COPD patients by integrating an evaluation of the COPD-related disability into daily practice.

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          Most cited references 15

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          A conceptual framework for patient-provider communication: a tool in the PRO research tool box.

          To demonstrate how a previously described conceptual framework of physician-patient communication can inform the application of existing theory and the extension of new theory regarding the impact of patient-reported outcomes (PROs) in clinical practice.
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            Sexuality in patients with asthma and COPD.

            Sexual quality of life was examined in 55 outpatients with chronic obstructive pulmonary disease (COPD) and asthma, using disease-specific questionnaires. Compared to an age- and sex-matched norm group, male patients with COPD reported a significantly lower sexual quality of life on all dimensions of the questionnaire. Female patients with COPD reported a lower frequency of sexual intimacy and lower sexual quality of life overall. Patients with asthma reported sexual quality-of-life scores that were somewhat better than COPD patients but worse than the healthy control group. Patients reported that they did not discuss sexual quality-of-life issues with their physician. Sexuality needs to be discussed by the health care provider in the consultation in order to improve quality of life of patients with chronic respiratory disorders.
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              Psychometric theory


                Author and article information

                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                05 July 2011
                : 6
                : 387-398
                [1 ] HYLAB, Physiologie Clinique, Grenoble, France
                [2 ] Assistance Publique – Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Pneumologie et Réanimation, Paris, France
                [3 ] Mapi Values, Lyon, France
                [4 ] Formerly Boehringer Ingelheim, Paris, France
                [5 ] General Practitioner, Sainte- Foy-lès-Lyon, Paris, France
                [6 ] Centre Hospitalier Lyon Sud, Lyon, France
                [7 ] Université Paris 6 Pierre et Marie Curie, ER10, Paris, France
                Author notes
                Correspondence: Antoine Regnault, Mapi Values, 27 rue de la Villette, 69003 Lyon, France, Tel +33 4 7213 6662, Email antoine.regnault@
                © 2011 Aguilaniu et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Original Research


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