Saint George’s Respiratory Questionnaire

Last Updated

July 25, 2012

Purpose

The Saint George’s Respiratory Questionnaire (SGRQ) is a self-reported disease-specific, health-related quality of life (QOL) questionnaire. It was originally developed to measure the impact of Chronic Obstructive Pulmonary Disease (COPD) on a person’s life, but has also been studied and applied to non-COPD pulmonary populations.

Link to Instrument

Instrument Details

Acronym SGRQ

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

Pulmonary Disorders

Pulmonary Diseases

The American version of the SGRQ (SGRQ-A, adapted from the original British English version) consists of 76 items in three domains:
1) Symptoms
2) Activity
3) Impact of disease on daily life
Part 1 (first 8 questions) asks for symptom recall of the previous 4 weeks; this is a change from the previous version of the SGRQ.
There are versions with 3-month and 1-year symptom recall domains.
A total score is calculated from 0 (no health impairment) to 100 (maximum health impairment).
In addition to the total score, there is also a score for each domain: symptoms, activity, and impact which are scored 0 – 100 as well.
Dyspnea is not measured specifically, but it is included in the symptom scale, along with information about cough, sputum production, and wheezing.
Test items are weighted and scored using an Excel calculator.

Number of Items

Copy of questionnaire: https://www.fda.gov/ohrms/dockets/ac/03/briefing/3976B1_01_L-Glaxo-Appendices.pdf
Excel calculator

10 minutes

Required Training

Reading an Article/Manual

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Jason Barbas, PT, DPT, NCS in 1/2010

ICF Domain

Body Function

Professional Association Recommendation

Recommendations have not been made

Considerations

May not be appropriate for setting short term goals due to 4-week symptom recall section
Patient will report improved overall health-related quality of life (SGRQ total score change > 4.0) upon completion of 8-week pulmonary rehabilitation program.

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Minimal Detectable Change (MDC)

COPD: (Jones, 2005; literature review)

MDC = 4

Minimally Clinically Important Difference (MCID)

Pulmonary Rehabilitation: (Schunemann et al, 2003; n= 84 patients who completed the CRQ, SGRQ, and FT before beginning pulmonary rehabilitation and 3 months later; mean age = 65.8 (7.6) years)

MCID = 4

Normative Data

COPD: (Ferrer et al, 2002; n = 862 probable cases of COPD, 460 of which were eligible to complete the SGRQ; sex = 533 males and 329 females; age range 40-69 years)

Education
- Attended High School or University: 42.5%
- Attended Primary/No School: 56.7%
Smoking Status
- Never Smoke: 52.7%
- Former Smoker: 24.1%
- Smoker >20 pack-yrs: 13.2%
- Smoker <20 pack-years: 10.0%
Respiratory Disease
- COPD: 10.2%
- Asthma: 3.6%

Test/Retest Reliability

COPD/Pulmonary Disease: (Barr et al, 2000; n = 102 patients with COPD (92 patients with COPD who completed the retest and 75 patients who completed the entire pulmonary rehabilitation program); mean age = 68 (9.34) years)

Excellent test-retest reliability for patients who completed the entire pulmonary rehabilitation program (ICC = 0.795 to 0.900)

Test-retest reliability (ICC) of the American translation of the St. George’s Respiratory Questionnaire (SGRQ-A) for all patients (n = 92) who took the test at baseline and the next pulmonary rehabilitation session

Score	*All patients (n =* 92)**	*Completers (n =* 75)**
Symptoms- 1 year	0.678 Adequate	0.795 Excellent
Symptoms- 1 month	0.770 Excellent	0.834 Excellent
Activity	0.848 Excellent	0.824 Excellent
Impact	0.895 Excellent	0.890 Excellent
Total- 1 year	0.906 Excellent	0.900 Excellent
Total- 1 month	0.908 Excellent	0.899 Excellent

Interrater/Intrarater Reliability

COPD: (Ketelarrs et al, 1996; n = 126 patients with COPD who were recruited on admission to a pulmonary rehabilitation center; mean age = 65 (9) years)

Poor interrater reliability for symptoms (Chronbach alpha = 0.60)
Excellent interrater reliability for activities (Chronbach alpha = 0.82)
Adequate interrater reliability for impact (Chronbach alpha = 0.71)

Internal Consistency

COPD / Pulmonary Disease: (Barr et al, 2000)

Internal Consistency of the American translation of the St. George’s Respiratory Questionnaire (SGRQ-A):

Score	Cronbach Alpha
Symptoms-1 year	Poor (0.42)
Symptoms-1 month	Adequate (0.72)
Activity	Excellent (0.83)
Impact	Excellent (0.82)
Total-1 year	Excellent (0.88)
Total-1 month	Excellent (0.90)

Construct Validity

COPD / Pulmonary Disease: (Rutten-Van Molken, 1999; n = 144 patients with moderate or severe COPD) and (Hajiro, 1998; patients with chronic obstructive pulmonary disease)

Poor to adequate construct validity for all components (r = 0.30-0.72)
Discriminate validity was demonstrated when all components of the SGRQ-A with the modified 1-month symptom-reporting period were shown to discriminate better between disease-severity groups

Floor/Ceiling Effects

COPD / Pulmonary Disease: (Barr et al, 2000)

Adequate floor and ceiling effects (<3%)

Responsiveness

COPD/Pulmonary Disease: (Harper et al, 1997; n = 156 patients with COPD attending routine outpatient clinic; 76 males; mean age = 67 (10.4) years; 80 females; mean age = 62 (10.3) years)

Good responsiveness (intervention: pulmonary rehab)
Responsiveness of the SGRQ-A to change in health status was demonstrated when scores on the symptoms 1-month and total 1-month components detected significant improvements in patients’ health status (p = 0.02 and p = 0.04)

Bibliography

Barr, J. T., Schumacher, G. E., et al. (2000). "American translation, modification, and validation of the St. George's Respiratory Questionnaire." Clin Ther 22(9): 1121-1145. Find it on PubMed

Ferrer, M., Villasante, C., et al. (2002). "Interpretation of quality of life scores from the St George's Respiratory Questionnaire." Eur Respir J 19(3): 405-413. Find it on PubMed

Harper, R., Brazier, J. E., et al. (1997). "Comparison of outcome measures for patients with chronic obstructive pulmonary disease (COPD) in an outpatient setting." Thorax 52(10): 879-887. Find it on PubMed

Jones, P. W. (2005). "St. George's Respiratory Questionnaire: MCID." Copd 2(1): 75-79. Find it on PubMed

Ketelaars, C. A., Schlosser, M. A., et al. (1996). "Determinants of health-related quality of life in patients with chronic obstructive pulmonary disease." Thorax 51(1): 39-43. Find it on PubMed

Rutten-van Molken, M., Roos, B., et al. (1999). "An empirical comparison of the St George's Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Disease Questionnaire (CRQ) in a clinical trial setting." Thorax 54(11): 995-1003. Find it on PubMed

Schunemann, H. J., Griffith, L., et al. (2003). "Evaluation of the minimal important difference for the feeling thermometer and the St. George's Respiratory Questionnaire in patients with chronic airflow obstruction." J Clin Epidemiol 56(12): 1170-1176. Find it on PubMed